Brooke Day, administrator of Hastings (Neb.) Surgical Center and Keith Smith, MD, administrator of Surgery Center of Oklahoma discuss six issues surgery center leaders need to take into consideration when making the decision to add a specialty.
1. Is there enough patient need? If a surgery center leader begins to consider the addition of a new specialty, it is vital to know whether or not there will be enough cases to justify the process. Have patients asked about the specialty? Will there be a considerable amount of competition for patient volume in this specialty? If there is a patient need for a specialty, the addition makes sense. "We have added specialties, such as gynecology and urology, because of patient demand," says Dr. Smith. "If it looks like there will be enough cases, we just do it."
2. Will the reimbursement make the addition worth it? Once it has been established that there will a sufficient amount of cases to support the new specialty, surgery center leaders must take a close look at whether or not these cases will drive revenue to the center. "The first step in evaluating the potential financial gain is to obtain the reimbursement for the specific procedures, understanding that you will not always be able to predict your case mix," says Ms. Day. Reimbursement is one of the most significant challenges ASCs face right now, therefore it is necessary to understand the rate at which potential new cases will be reimbursed.
"The reimbursement for a specific procedure may be cut from one year to the next, which can be unexpected and could occasionally make the difference between procedures being profitable or not," says Ms. Day. "This may only happen with two out of 10 procedures, but it needs to be taken into consideration when evaluating the overall specialty." Only when reimbursement appears favorable, does it make sense to continue through the process of bringing a new specialty to the center.
3. Will we be able to recruit the necessary physicians? If a surgery center leader can predict that there will be a worthwhile amount of cases and a reasonable reimbursement rate for a new specialty, the first step in making it happen is finding the physicians to perform cases. One of the most important considerations when adding a new specialty to your center is the ability to recruit a physician or physicians that will be engaged in your center and willing to assist throughout the process, says Ms. Day.
A large part of whether or not a new specialty will find success at a surgery center hinges on the physicians performing the cases. "We typically will add a specialty when there is a really good doctor or group of doctors we want to bring to the facility," says Dr. Smith. "I don't want to add a specialty if there aren't the doctors for it."
4. Does purchasing the needed equipment and supplies make sense? Each specialty has its own specific set of equipment and supplies. A surgery center may already have most of what is needed for a new specialty or it may find that a considerable financial obligation will be needed to acquire what is required. "Make sure your investment is worth it. If we had a surgeon that needed a million dollars worth of lasers, but it wouldn't pay off, we wouldn't add that specialty," says Dr. Smith.
"There may be options other than purchasing the capital, such as renting or leasing, but the payment for any method of obtaining the equipment also needs to be included in the decision making process," says Ms. Day.
Equipment and supplies are not only dependent upon the type of specialty you will be adding, but also on the physicians that will be performing the cases. Physician preference is an important issue to consider. "Hysterectomies may be performed in an ASC, but the surgeons may prefer to have a specific pad to be used for positioning. Although it may not seem like a costly item, the price for each pad may be up to $65.00. This may be an item you would want to discuss with the physician prior to adding the case," says Ms. Day.
5. Is my staff prepared to take on a new specialty? An ASC's staff is what keeps the facility running smoothly. If the staff doesn't have any experience with the new specialty, it is critical that they prepare for its arrival. "Communication is key in the progression, meetings should be held with updates and various opportunities along the way. Collaboration is key in successful organizations," says Ms. Day.
If possible, a surgery centers staff should learn from centers that already have the specialty. "The opportunity to bring your team to another center that has the specialty is invaluable. It helps significantly if your biller is able to connect with a biller from another center to discuss not only the methods, but also the challenges and how to overcome them," says Ms. Day.
"It is usually a smooth transition. I have a great staff. Our circulators and scrub techs have done lots of different cases, even in specialties that we don't have here. Variety is great for the staff to avoid boredom," says Dr. Smith.
6. Will the new specialty fit with your center's long term plan? It is important to understand where the new specialty fits in with a center's long term plans. Is the specialty simply a way to drive revenue or is it a stepping stone for further growth and development?
"The benefit of adding specialties to your surgical center are typically financial, but the addition of one specialty may lead to the addition of others," says Ms. Day. "If your center performs orthopedic procedures you are more than likely to have a C-Arm. So, the addition of pain management would be simple and easy to add. The addition of pain management may lead to spine. The opportunities for growth increase with the addition of cases, investors and physicians actively engaged in your facility."