The following is written by Joseph Sziabowski and Richard T. Hardaway of Hardaway Associates Architects.
Were you to purchase a used automobile, you would look under the hood, test drive it and probably have a trusted mechanic thoroughly evaluate the car. If you are purchasing a used surgery center, it is critical to give it the same kind of scrutiny. Doing so will protect you from pitfalls like failed inspections, disruptive shutdowns, loss of revenue, and expensive retrofits.
An architect experienced in surgery center design should review the construction drawings and inspect the facility as built. The architect will usually bring in engineers as well to verify the adequacy of the mechanical, plumbing and electrical systems.
Following is a short list highlighting seven important types of facility issues to be considered when purchasing an existing center.
1. Determine whether design regulations have changed since the facility was constructed, and if so, whether the facility will be grandfathered under the original approvals. Depending on the state, you may have to update the facility to meet current regulatory standards, more likely if the purchase is an asset purchase than if a stock purchase. Inquiries of regulators should be handled discreetly to avoid a possible shutdown if there are serious deficiencies. There is a greater likelihood of being required to update if the center ceased operation before changing hands. If you will be seeking accreditation, the requirements of the accrediting agency must also be taken into account.
2. Even if updating is not mandated, patient safety should be taken into account when deciding whether or not to upgrade a facility. Whether or not it has been accepted by authorities, if the emergency power system is overloaded and does not function properly during a power failure, patient safety could be seriously compromised.
3. The facility obviously needs the capacity for your anticipated case volume. Will the numbers of pre-op stations, ORs, procedure rooms and post-op beds be adequate? There are rules of thumb for all of these, varying by specialty.
4. The ASC must accommodate the specialties you intend to offer. An eye surgery facility may not meet the needs of a multi-specialty center. A recovery area for orthopedics would need more stations than for cataract surgery; likewise the ORs need to be larger. A backup power system designed for local anesthesia would probably not be adequate for general anesthesia.
5. If the center is to be split away from an adjacent practice office, all of the functions required for a surgery center must be present or able to be created. Patient pickup space, waiting room and front office are functions that are sometimes shared, and it may not be possible to accommodate these after the fact. Shared utilities may need to be sub-metered or divided when the ASC becomes a separate business entity.
6. A common trouble spot is the continuity of fire and smoke partitions, particularly in concealed locations like above ceilings. These are common targets of officials in life safety inspections and often are the source of deficiencies, especially in older facilities.
7. The design and condition of the mechanical, plumbing and electrical systems should be evaluated by knowledgeable engineers. HVAC systems can be particularly problematic with respect to regulatory compliance, infection control, patient safety, and physician comfort. We have also too often found that backup power systems in older facilities do not even meet code requirements in force at the time of construction, let alone current codes.
In addition to design issues, the condition of major building components should be evaluated. HVAC equipment, emergency generators, and roofing have finite lives and can be expensive to replace. Your architectural and engineering consultants will be able to comment on this matter, and may recommend inspections by local maintenance contractors.
Learn more about Hardaway Associates.
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