Algorithm for reprocessing of flexible laryngoscopes in AJIC. An article in the most recent issue of the American Journal of Infection Control provides a logic, or algorithm, that healthcare staff can use to evaluate the adequacy of any type of EPA-registered or FDA-cleared biocidal agent for reprocessing critical, semi-critical and non-critical instruments. For example, the algorithm can be used to clarify and demonstrate that quaternary ammonium compounds are inadequate for reprocessing GI endoscopes, among other types of instruments.

The paper also provides minimum reprocessing standards and step-by-step reprocessing guidelines for flexible laryngoscopes; these can be adapted for other types of flexible endoscopes, including cystoscopes. The use of single-use sheaths to cover and protect reusable semi-critical instruments from contamination during clinical use is also covered in the article.

Tips for smart development and construction in an uncertain market. After years of growth in outpatient surgery, there has been a bit of an about-face: Inpatient hospital construction is booming, but the ambulatory surgical facility market is currently in something of a holding pattern.

"There's some caution out there in terms of what the new ASC payment system is going to do with regard to construction of new surgery centers," says Sandy Jacobs, the vice president of development and sales for HBE Medical Buildings. "A couple years ago, physicians would invest the money up front, do some initial design and keep the momentum going on the development side. Now, they're taking more of a wait-and-see approach, not committing to spending dollars before they're sure they have a viable opportunity."

While there are some exceptions, such as in orthopedic-centered ASCs, most multi- and single-specialty projects are proceeding with caution, if at all. The slowdown in expansion and new development is especially marked in specialties hurt by the new ASC payment system, such as GI. But adjusting to a new ASC payment system doesn't mean physicians have to fear development, just that proper planning is all the more crucial.

"If a physician group were to call me and say they're thinking about developing an ASC, I'd first recommend that it hire a consultant to put the business side together," says Mr. Jacobs. "Even if the group is bringing in an equity partner, they need to have financial and operation planning set before it commits to spending major dollars on the facility development side of the new ASC.

The consultant should then lead the way on an exploration of the logistics of the ASC project.

"As a design-build firm, we like to get involved very early and one of the advantage of 47 years' experience is that we can provide concrete cost estimates based on the programming of the project - 2 ORs and a procedure room, 4 ORs, etcetera," says Mr. Jacobs. "We can do that without a large investment on the part of the group, and they can plug that data into their financial model. This lets physicians put together an investment group according to their needs."

Mr. Jacobs says another advantage of the master builder approach is that the company works with the physicians throughout development - it doesn't deal solely with architecture or engineering and turn the project over to another specialist.

"Some hesitate to work with national firms because they're more expensive, but it's not more expensive in the end because we're able to anticipate code and safety issues that arise during projects," he says. "Further, as a big company, we have the ability to be very patient; physician groups can feel free to take their time."

Mr. Jacobs stresses that it is important to work with a firm that understands the current ASC market and builds accordingly.

"Efficiency of space is becoming more important with reimbursement changing; it's a risky proposition to build and hope patients will come," he says. "As both Medicare and managed care reimbursement get more complex, the importance of all the legal and planning issues of development increase in importance. I can design and build a building for you, but you need to do your homework before you commit to this undertaking."

"Green" Slocum Surgery Center opens for business. Slocum Orthopedics, a 20-physician practice, recently opened its surgery center for business. The 14,215-square-foot, four-OR facility opened on time, under budget and with zero Medicare deficiencies with the help of national turnkey operational development and management provider Pinnacle III.

The building was designed to be environmentally friendly and energy efficient, optimizing natural light for higher quality indoor lighting and reducing electricity consumption; for example, the building uses mercury-free HVAC and lighting and wind power from EWEB. Slocum Surgery Center was designed to minimize the use of natural resources and draw on rapidly renewable resources while meeting or exceeding all conventional building performance criteria; the facility is constructed from recycled building materials, certified wood products and alternatives to brominated fire retardants. The group anticipates that the building will be granted silver certification from Leadership in Energy and Environmental Design, or LEED.

Slocum Surgery Center expects to add additional physicians and employees to its 150-person staff over the next few years, as demand for orthopedic services continues to grow. "Slocum's orthopedic surgeons, along with a dedicated cadre of anesthesiologists, will provide an exceptional surgical experience for their patients in this state of the art facility," says Gregg Melton, MD, the center's medical director.

City of Joliet challenges hospital relocation. For a copy of a white paper regarding the opposition by the city of Joliet, Ill., to the proposed relocation of Silver Cross Hospital to outside Joliet, please go to www.BeckersASC.com and look under "Hot Topics," or e-mail Scott Becker.

Sign FASAPAC's solicitation authorization form. To help FASAPAC, FASA's political action committee, better serve ASCs, please download the solicitation authorization form, fill it out and return to FASAPAC.

Ask Scott Becker. If you have an ASC-related legal or business question, e-mail Scott, and we'll publish the answer in a future E-Weekly. Please indicate when asking whether you prefer to remain anonymous.

Call for proposals. We are seeking speaking proposals for the Orthopedic, Spine, and Pain Management Driven ASC Conference, to be held in Chicago June 19 to 21. Should you have suggestions, please e-mail Scott Becker.

Save the dates for next year's conferences! Please save the following two dates for next year's conferences:

• Orthopedic-Driven ASC Conference -- June 19 to 21, 2008


• FASA and ASC Communications: Improving Profitability and Business and Legal Issues for ASCs -- Oct. 23 to 25, 2008.