4 Ways to Ease the Transition to Hospital Ownership of a Surgery Center

Marge Schillaci, administrator of the Surgery Center of Joliet (Ill.), has spent the last two years working with surgeon-investors, hospital administration and legal representation to transition her center to hospital ownership with Provena St. Joseph Medical Center. Here she discusses four strategies to make the process easier.

1. Take advantage of your hospital transition team. The hospital will likely assign your ASC a project manager to oversee the transition of the facility into becoming a department of the hospital. Don't shy away from a relationship with this person — they can be your biggest advocate in terms of operational issues. "I try to work through [our project manager] when we need to have action," Ms. Schillaci says. Meet with the transition team at least weekly and discuss upcoming changes to the center and where you are in the project plan. For example, Ms. Schillaci is currently working through procedures that have been performed as outpatient procedures in the hospital and determining which cases can now be sent to the ASC. The center is also trying to combine the ASC schedule with the hospital schedule so the schedulers can see both at once. "The hospital can't send cases to us because they don't know what our schedule looks like and vice versa," she says. "[Combining schedules] will enable us to make the schedule flow better and better utilize the scheduling time and surgeon time."

In addition, the ASC is in the process of establishing benchmarks that will be used to evaluate the success of co-management. "It's having that plan that's reviewed weekly and updated on where we are with all these points in the process," Ms. Schillaci. Communication is important to make sure the ASC is up-to-speed on changes that are occurring within the hospital. "Things change faster in the hospital and [if we don't meet], we don't always get the information," Ms. Schillaci says.

2. Communicate regularly with your staff about changes. Transitioning from a free-standing ASC to a hospital-owned facility can be hard on staff members as they deal with unexpected cultural changes and new policies. Moving from the culture of a small ASC with a family atmosphere to the culture of a large medical center can be stressful, and you may have to implement new forms, policies and procedures. "We have gone from a much more simple form of documentation that met our needs to a much more complex format," Ms. Schillaci says. She says her center has also met challenges in transitioning from one accrediting body to another; the ASC received a three-year accreditation from AAAHC one year ago and must now adapt to meeting the Joint Commission standards.

You may feel inclined to hide decisions in order to keep morale high, but honesty is much more effective, Ms. Schillaci says. Let your staff know about changes as they happen, and stress the fact that you will deal with each change as a team. Keep your door open and allow staff members to stop by and chat when they need to. "It's hard, but it means just having meetings and trying to give [employees] as much accurate information as possible," she says.

3. Stress the positives.
Change is difficult, and it's easy to focus on the negative aspects of transitioning away from a free-standing ASC. You no longer have total control over policies and culture, and staff members may feel confused about the decision-making process and new hierarchy. But despite these difficulties, looking on the bright side is essential to making the relationship work. In the case of Ms. Schillaci's center, a relationship with the hospital means the ASC can perform more procedures; in the past, certain cases had to be sent to the hospital because ASC reimbursement rates were too low to cover expenses. Staff members have better benefits under hospital employment, and the hospital and the ASC are both better-positioned to meet the demands of health reform and the economy.

In addition, the ASC now has hospital support on issues such as credentialing, finances, quality assurance, risk management and infection control. "There are now a lot more resources, and it's about taking advantage of those resources," Ms. Schillaci says. Meet with your employees to talk about the positives and negatives of joining the hospital. "It would help to go through some of those positive things and do the balance board – what are the pros, what are the cons and how are we as individuals working to overcome those barriers," Ms. Schillaci says.

4. Emphasize training and education. Ms. Schillaci's ASC is planning to adopt hospital policies, meaning staff members need to be trained and educated on the changes to their daily job descriptions. For example, the surgery center must work with the hospital to adapt the hospital's safety plan to the physical layout and separate location of the center. "It requires a great deal of education," Ms. Schillaci says. Fitting in education can be very difficult when you must work around patient care, so make sure you have a workable plan. "With the training and education, it's not something that happens overnight," Ms. Schillaci says. "Very often, the staff expects that everything will work like a turnkey operation, and looking back, I probably would have suggested that we start some of these things earlier." If staff will be affected by a certain policy change, listen to challenges the staff is experiencing and then follow up regularly to make sure the new policy is being followed.

Read more on hospital ownership:

-6 Observations on Investment, Mergers and Acquisitions in Healthcare

-Reductions in ASC Private Reimbursements and Flat Revenue Drives New Surgeon and Hospital Alignments

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