Everything was going along just fine, or so the physician-owners thought, until it was accidently discovered the administrator had embezzled enough money to buy himself a nice little island in the middle of the river on which he built a home. The money for the island came from mis-directed ASC funds. So much for him. He was gone.
The next administrator was great! She came from one of the other centers in the area and was a favorite nurse among the doctors. She did a great job, or so they thought. She saved them a lot of money by not letting the compliance consultants come on site with all their hotel and travel expenses, and assured the physician owners that she was doing everything right and all was in order. All the monthly reports looked good, too! However, she got her masters degree and took a position at another center.
The new administrator immediately suspected an issue and called the compliance consultants to come for a top-to-bottom assessment. Upon re-entry into the center, the consultants advised the owners that the former administrator had been involved in the theft of drugs from another center. Closer inspection on the part of the physician-owners disclosed that the former administrator had, among other things, totally financed her master's degree on their dollar.
The next administrator was awesome! Volume soared. The center was making money hand over fist and flew through its accreditation. The owners were so happy they gave the chief tech a substantial raise even though her involvement in preparations for the accreditation process was low. Still, she WAS a favorite of one of the physician owners, so it was justified. But, wait! What about the administrator? She worked 60 to 70 hours/week, and had her entire family in the center, cleaning, painting and fixing things free of charge for the four months preceding the survey. Everything was squeaky clean, and she had made sure all the policies were up-to-date and all staff training was done. Exhausted, she sat back awaiting her bonus having written the bonus check for the tech. Imagine her surprise, when her bonus check was less than half that of the tech who had put in about 1/8th of the amount of work she had! Imagine her upset! Imagine her disappointment….her anger and discouragement!
So, what happened, you might ask? She decided to get even with the physician owners. Her brand of embezzlement took the guise of using the company credit card for personal use…for groceries and for buying gift cards for various stores. Ultimately, she resigned after which her diversion of funds was discovered.
In the realm of “Can you believe it”? another nurse was promoted from within over the protests of the consultants. This nurse had no OR experience or management experience. She began her tenure by refusing to let the consultants access to the center in spite of the existing contract. This process continued for a year, until such time as a new proposed-owner came in to do due diligence. Suspecting something amiss the business manager of the soon-to-be owner proposed bringing the consultants back in to perform their own brand of due diligence. Within one day, the consultants discovered no required documentation was present for any of the CMS, state or accreditation regulations or standards. When confronted, the administrator threw a temper tantrum and stormed out, but not before having sequestered much of the required documentation to her own possession away from the center. Not only was the documentation missing, but a financial audit disclosed this administrator had paid off all her student loans and bought furniture for her house from the ASC's accounts. The physician-owners were stunned — shocked, really.
How could this possibly happen, you might ask? The monthly reports looked to be in order. The center census was good, though they had lost some physicians. Cash flow was good and dividends were being distributed….and yet, thousands and thousands of dollars had been diverted. Again, how could this possibly happen? The simplest explanation is that the physicians had their heads in the sand, didn’t pay adequate attention and refused to hire a qualified professional to be their administrator. The first administrator was promoted from his former position as RN Scrub. Of the examples above, only the RN who took them through accreditation had any experience in management. So, the physician-owners promoted from within, and promoted staff they "liked" as in their favorite nurses in spite of the fact that these persons had no experience. The physicians did not want to pay the required salary for a professional administrator.
The physician-owners did no vetting. No references were checked in any of the above cases. No background checks were done. The doctors promoted their favorites.
The physician-owners paid no attention to all the different particles it takes to run a center. They virtually only understood and only were interested in the financials. This became very clear when during a recent survey, the CEO advised the surveyor that he would conduct the survey. The recently appointed ORS was staffing the ORs, the administrator had resigned that week, and the consultant was on vacation when Medicare walked in. The surveyor asked to see the infection control program and was told there was none, because the CEO had no idea where it was. The same was true of the QA/PI program, medication, etc., etc., etc….all because the CEO didn't know what the organization had or where it was kept.
When the surveyor asked for QA/PI minutes and board minutes, the CEO also had no idea where those were kept, nor the location of physician or staff files. He had no knowledge of what the employee health program included. And yet, this center had been open for 20-plus years.
It became clearly evident that the board paid little attention to the QAPI report given to the board quarterly and merely affixed their signatures to whatever was placed before them.
It would be a relief to be able to say that this type of informational neglect and dereliction of duties is an exception; however, CMS might be the first to point out it is probably more prevalent than anyone else could imagine. The emphasis seems to be tilted most severely to the financial side with little attention paid to what it takes to make the center run safely. It is past time for physician-owners to take up the standard and to carry it forward. This type of behavior needs to be the rare exception. There ARE some great and really interested physician owners. They NEED to be the rule. Let us in the industry make certain that this is so, and let us make certain that the surveyors from all agencies are surveying to identify these great leaders while holding those who do not fall in that category accountable.
