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Administrator Roundtable: Trials & Tribulations of Adding New Specialties and Procedures to ASCs

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Adding new specialties and procedures to a center's offerings can be a challenging but ultimately rewarding process. Here, three administrators share their experiences with expanding their service lines as well as their best advice for administrators facing the same decisions.

Question: Which specialty did your center add in 2013? How the process, and what was was the most difficult part?James Kamps

James Kamps, Administrator, Surgery Center at Tanasbourne (Hillsboro, Ore.):
We added ophthalmology to our center in 2013. The main reason we did this is because we felt we could offer a better surgical experience at a lower price to these patients. The process of adding a new service that no one in the center was an expert in was trying, but also I learned a lot from the experience.

You only get one chance to make a good impression, and we wanted to ensure that the patients and surgeons coming here would be well served and enjoy their experience. I would have to say the most difficult part was getting a consensus from all the new surgeons and ensuring we had everything to meet their needs.
Stephanie Martin
Stephanie Martin, Administrator, St. Augustine (Fla.) Surgery Center: During the 2011 year we added GYN, and in 2013 we added general surgery services. We had been working to identify a surgeon that could bring that service. As a multispecialty facility that already had video equipment and had expanded to perform GYN, we had many of the items that were necessary to perform general surgery.

The costs to add the service were minimal, due to previous equipment acquisitions. The facility already had video towers, scopes, cameras, insufflators, etc. Our staff was excited to expand our service offering and had the clinical experience from other places they had worked. Our clinical coordinator, Peggy McGriskin, handled the details of specific equipment the surgeon required and reviewed trays, consumables, and other details related to performing laparoscopic colonoscopies and laparoscopic hernia repairs.
Shelley Yuva
Shelley Yuva, Administrator, Slocum Orthopedics (Eugene, Ore.): We introduced uni-compartment knees, our first step into total joints. We created our outpatient model based on care currently received in an inpatient setting. We provide the patient with a comprehensive preoperative consult that includes training and education materials with our physical therapy department. Due to advances in anesthesia, these patients are discharged several hours after their procedure and can comfortably recover in their homes. We are able to provide all of this within our facility in a very efficient and organized model. 

Q: How can ASCs decide which new specialty or specialties to add?
Mr. Kamps: The best way to decide what specialties to add is to look at the surrounding area and find which procedures can be done at an outpatient center but are [currently] being done at a hospital. The next part of this is to determine why these procedures are being done in a hospital. Do the surgeons know what a center can offer them? Do the insurance companies know what a center can offer them? Do patients know that the center is an option? It may be an issue of education to the involved parties.

Ms. Yuva: Our first question in our assessment is does this provide an opportunity for patients to receive excellent clinical care and surgical experience. For orthopedics, we first assess clinical patient risk; we do not elevate risk in an ambulatory setting. We then assess if we are able to provide comprehensive episode of care, from pre-op consult through post-op recovery care and therapy. We evaluate if these patients can safely return to their homes (with support present). We consider and review procedures currently being completed in a hospital setting with patient discharge within 24 to 36 hours. We further assess if patient discharge was based on the healthcare delivery system or clinical patient indicators.

Our final step is working with insurance companies to negotiate procedures and reimbursement. At this point we have defined: if we have the patient population; if we have the surgical specialist(s) on staff; if we can deliver appropriate discharge and home pain management care; if we have the resources to provide full service of care consult through post-op recovery and if all of this is fiscally possible.

Q: Which specialties are hardest to add? Easiest to add? Why?
Mr. Kamps: In my experience the most difficult specialties are those with lots of instruments and implants. The issue tends to be centered around the need to get different sets for the same procedure. This happens due to the different approaches and training each surgeon takes. Of course, these specialties are often very rewarding to add to a center and should not be shied away from by any administrator. In fact, having a meeting with all the surgeons prior to buying anything and putting the instruments into their hands can save a lot of questions later.

Q: Is there anything of which ASCs adding new specialties should be aware?
Mr. Kamps: Find out what your reimbursements are before moving forward.  A simple return on investment goes a long way in providing information to your board on whether the new specialty is worth the money and time needed to get the specialty running.

Ms. Martin: Fully investigate current reimbursement contracts that are in place and whether the specific specialty or procedures were addressed under current reimbursement contracts.

Ms. Yuva: Is this a best practice for the patient? Will this be an affordable service line? This needs to be clearly vetted prior to moving forward. A poor specialty mix can be financially harmful to ASCs, depending on their specialty mix and contracts. In addition, OR time, surgeon case time, total cost of capital equipment and instrumentation, possible implant cost, reimbursement, staff support in education and surgeon needs also need to be considered.

Q: As an administrator, what is your best piece of advice for an ASC adding a new specialty?
Mr. Kamps: Communicate. Over-communicate. Be sure to talk to each of the staff involved in making the new specialty a success, every day if possible. Make a list of tasks and set up a timetable to achieve the tasks. Update your surgeons and board on the progress you are making and the hurdles you are encountering. 

Ms. Martin: I would recommend introducing the idea early to everyone (staff, physicians, board members, etc.) Resistance is common with any change, and in addressing the concerns that come up, this will allow time to research, implement methods to address concerns, help people with concerns, get involved in the process of working through the challenges and get comfortable with the change that is being considered and implemented. Never underestimate the amount of time that is needed to generate the support needed to make a change like this to your facility.

Ms. Yuva: Overprepare. We represent a fairly conservative medical practice, and we are allowed the time and resources to be well prepared to deliver excellent care to our patients, as well as our medical and clinical staff. Make sure your medical staff is invested and involved in the program development as well.

More Articles on Turnarounds:
3 Tips for Emotionally Intelligent Management
Could ASCs Lose Their Competitive Pricing Advantage?
6 Articles on Physician Compensation

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