Bill Heath, chief development officer at Practice Partners in Healthcare in Birmingham, Ala., cites seven questions to ask before adding another specialty to a single-specialty ambulatory surgery center.
1. How will regulations be affected? Some states with certificate of need requirements, such as Georgia and Mississippi, set aside those requirements for single-specialty centers but rigorously apply them to multispecialty centers. In these states, centers that didn’t have to worry about CON when they opened may hit a brick wall when adding another specialty, with hospitals and others opposing the CON designation.
2. Will it be as efficient? In many cases, single-specialty ASCs are more efficient than multi-specialty ones. For example, a GI-only center is often considered to be more profitable than a multi-specialty center hosting GI cases. A single-specialty ASC is optimally efficient because the nurses, scrub techs and physicians have similar cases all day long and know what they are doing. Also, changing an OR from procedures in one specialty to another can take more time than staying within the same specialty. "The orthopedic surgeon is done, and then you have to make a hard stop and change to ENT or urology," Mr. Heath says.
3. Is there room on the schedule? Is there an empty OR waiting to accommodate these new cases, or are all ORs being used and will block time have to be carved out from the current schedule? If all the preferred morning slots are booked up, then the ASC will have to be kept open in the afternoon. Will the new physicians be comfortable with afternoon slots? Some cases don't work well in the afternoon, such as colonoscopies, because patients have to fast the night before. Also, certain spine procedures may require the afternoon for recovery. However, many other cases can be done all day long.
4. Is there enough volume available? Determining if there will be enough volume in the new specialty involves answering a variety of key questions. How many physicians are lined up for the new specialty? Will the volume they bring justify the equipment and other costs of adding a new specialty? One very busy surgeon could be enough, but more likely, more than one will be needed. What types of cases will the surgeon still want to perform in the hospital? The surgeon may prefer an inpatient venue even for cases that have been deemed safe for outpatient surgery.
5. Are the new physicians committed? To make sure physicians in the new specialty will work out, establish a test period for them. "You need to know the arrangement will work out before committing to a new specialty," Mr. Heath says. This requires asking the surgeon to use the ASC in a test period. Suppliers may agree to furnish the needed equipment for the trial period. The length of the test period can vary, depending on the number of cases the surgeon is willing to perform at the ASC.
6. What will be the cost of equipment? Some surgeons have very distinct preferences that can be more costly. Surgical implants are a big expense that often need significant carve-outs in payor contracts to be affordable. "If you are paying for implants, you could end up losing your tail on some cases if you don't think it through," Mr. Health warns.
7. Is it a compatible specialty? So-called "dirty" cases, such as GI, may not be a good fit for cases that need an absolutely sterile field, such as spine. "I look at those two as almost not compatible unless you had a large center with distinct areas," Mr. Heath says. Providing two distinct areas will often require more space. On the other hand, some specialties go together well. "Orthopedics and pain are a natural fit for a lot of reasons," Mr. Heath says, "but the most obvious one is that there is a lot of referral between the two and these physicians probably have a lot of the same patients."
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