How ASCs Manage Flex Hours Post-Healthcare Reform

Many ambulatory surgery centers currently "flex" nurses and other employees depending on the daily or weekly workload. Employees may work full time hours one week and not the next; this practice could raise issues for ASCs with the employer requirement to offer health insurance coverage to full time employees.

"For example," says Tom Jacobs, CEO and co-founder of MedHQ, "if an ASC hires someone as a full time nurse but then experiences a slow period — perhaps a senior surgeon retires and it will take 18 months to bring volume back up to previous rates — so the nurse's schedule might dip below 30 hours per week for a six- or 12-month period. The employee could become ineligible for insurance benefits during that time."

"In the past, this wasn't as rigorously regulated," says Mr. Jacobs. "The employer and employee have always been subject to audit by the health insurance carrier, but with this new regime, you can imagine there is a lot more scrutiny over whether employees are working full time and direct actions could be taken under these circumstances."

If the surgery center wants to keep a nurse at full-time level and the operating schedule is slow, the nurse will likely take on additional non-clinical responsibilities instead of being sent home. "If the centers don't want to be penalized for flexing the nurses, which is normal for surgery centers, they may ask the nurses to stock materials or work on other projects that aren't typical of being a nurse in the traditional sense," says John Merski Jr., executive director of HR for MedHQ.

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