The reason over-estimation occurs is because physicians are pulling information off of practice management software. If physicians are not already involved in a surgery center, they are probably taking their ASC-type procedures to a hospital. They’re normally pulling [those procedures] by CPT code but the systems typically do not identify how many of those procedures had co-morbidities preventing them from being performed in an ASC, or instances when the ASC wouldn’t be the patient preference, or cases that may fall under the coverage of an insurance company that isn’t contracted with a particular ASC.
So we take the volume estimate provided by the physician, reduce it by 30 percent, and use the result as a conservative number to build our book of business. We look at all of our initial investors and determine how many rooms we need to put us at around 90 percent capacity. We then make a recommendation regarding square footage based on that [figure]. A [buffer] may also be built in to create enough space to accommodate a 5-10 percent increase in volume over the next five years. It is rare, however, to see many ASCs actually realizing a 10 percent volume increase in same-store growth.
Something to consider: If the [physicians] have a case mix that requires them to have a procedure room, we will often have the architect design the space in such a way that it could be used either as a procedure room or an OR. That way, as the volume grows, they’ll be able to accommodate the additional OR cases. Just make sure to check state-specific regulations to ensure that type of space planning is acceptable.
Something to consider: If the [physicians] have a case mix that requires them to have a procedure room, we will often have the architect design it in such a way that it could be used either as a procedure room or an OR. That way, as the volume grows, they’ll be able to do more OR cases in there and we’ve seen that be very effective. Just make sure to check with state regulations to make sure that’s acceptable.
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