Karen C. Howey, CASC, administrator of Matrix Surgery Center in Saginaw, Mich., discusses 10 steps that helped her facility expand from a single-specialty pain center to a multi-specialty ASC.
1. Research the local area. Before you decide which specialties to add, you have to know the availability of physicians and specialties in the surrounding area, Ms. Howey says. It helps to know which physicians are already attached to hospitals or other ASCs, as they may be more difficult to recruit. You should also know which specialties are offered at other local ASCs — if two centers within a mile of yours are already offering ophthalmology, for example, you may struggle with case volume.
To research the available physicians in her community, Ms. Howey held an open house at her pain center and invited physicians to stop by. "One of the things that made us very attractive was that we're a CON state. We had three ORs and my pain physicians were never going to use three ORs," she says. The surgery center presented its case in casual terms: They were at no risk of going under, so physicians could feel free to make decisions that fit their needs. "There wasn't a lot of pressure initially," she says. "We wanted people to come and see the facility and then decide if they were interested."
2. Research reimbursement and cost. Once you know which physicians might be interested in bringing cases to your center, you should determine the potential profitability of each specialty. For each specialty, you should know how much volume the ASC will require to break even or make money. "With a specialty such as pain or ophthalmology, these cases do not pay huge on their own, but if you can be an efficient, higher-volume [center], they are good specialties to add," she says. The opposite is also true: Ms. Howey decided to add podiatry to her center because the specialty provides relatively high reimbursement despite low case volume. If you have a particular physician in mind, talk to his or her office manager and scheduler to find out which procedures you will see most often. Factor those procedures into your cost calculation.
3. Assess your physical location. Determine which specialties can be added to your existing facility without improvements or expansion, Ms. Howey says. Physical limitations of your facility — such as your pre-op holding area and PACU — may determine if you should consider a large group or a single physician. Since Ms. Howey's facility performed around 6,000 pain cases a year, she needed to figure out how the ASC would preserve the pain specialty.
"I turned my eye to pre-op and PACU," she says. "I know I'm turning cases every half hour, so how many beds can I have available for outside surgeons? How often will they be here?" She met with the center's clinical director and OR crew to brainstorm how to accommodate a new physician. Since the center scheduled cases for four physicians on three weekdays, she decided to schedule the new physician on one of the other days.
4. Review staff competencies. You need to know if you already have personnel capable of handling new specialties or if you will need to hire new staff. "Having good surgical staff cannot be stressed enough," Ms. Howey says. "Physicians want to walk into an OR with no stress and expect the same environment they routinely work [in]." This process will be more difficult if you add a challenging specialty with new equipment. Ms. Howey says through talking to her staff, she was surprised to find that several nurses had worked with podiatry before and could easily handle the specialty change. You should also talk to non-clinical staff at your center; Ms. Howey talked to her certified processer to determine whether the additional case volume would pose a problem for her workload.
5. Never add more than one specialty at a time. If you're going to add a specialty, you want to do it well, Ms. Howey says. Adapting to new procedures takes time, so you should focus on training your staff and getting to know your new physician. This will be much easier if you don't have to juggle multiple specialties in addition to your original specialty. Ms. Howey recommends talking to your new physician's office staff about his or her preferences. "The two key people in any physician's office are the scheduler and usually one other person. That may be an office manager or a nurse [or surgical tech] that follows them to cases," she says. "That person will know everything about the surgeon." The staff member can tell you the physician's favorite music and scrubs, as well as his or her usual arrival time. Invite the key staff members out to lunch and introduce them to your team. This is a good opportunity to truly get to know your new specialty and show your appreciate for the physician's business.
6. Lay out a plan with your staff. Hold a meeting a discuss the game plan with your staff. This includes everyone from the business office to your anesthesia providers to your clinical staff, Ms. Howey says. Discuss how new patients will be admitted, how POHA and PACU processes will change for these patients and differences in OR set-up and sterilization. Distribute the physician's preference cards to your surgical crew after checking with the physician's office manager that the cards are up-to-date.
7. Bring the new physician in for orientation. If possible, invite the new physician for an orientation before the first case. If the physician has time after hours or over lunch, you can schedule the orientation then; otherwise, you can always ask the physician to arrive a few hours early on his or her first day. During orientation, you can introduce the physician to your staff, discuss parking, point out the physician's lounge and go over the dictation process.
"[Dictation] is interesting because so many physicians coming out of the hospital assume transcription is on-site or in the basement," she says. "Every facility handles transcription differently, and it's important for making sure your billing goes out on time. Your physician should understand the dictation process and that you want them to dictate before they leave." Ms. Howey says providing food never hurts — go the extra mile and set out pastries, fruit or sandwiches when your physician stops by.
8. Consider other specialties after a few months. Give your physician and staff a few months to settle in, and then start considering other specialties. If your physician is talking to other providers in the community, you may receive calls from other interested physicians. Ms. Howey added plastics and oral surgery soon after podiatry because several surgeons approached her. The same process will apply for each new specialty you add. Keep in mind that some will be harder to install than others; Ms. Howey says her center ran into more challenges with spine because the procedures are more invasive and the equipment is more expensive. "[Spine surgeons] have the most expensive, latest, greatest toys, and when they come to you, everyone wants all the new toys and none are cheap," she says. "Initially I brought a lot of things in on 30-60 day trials and let them play with a few things without having to throw cash out there."
9. Block time accordingly. When you run a single-specialty center, it is easy to ignore issues with block time, Ms. Howey says. She says once your center expands to multiple specialties, your schedulers should meet with physician schedulers on a monthly basis to discuss scheduling. She cautions administrators to understand that a surgeon's preferred block time can change: Just because the physician told you at your first meeting that Tuesday mornings are most convenient doesn't mean it will stay that way. She adds that you should also call physicians to make sure they are planning to use their block time.
"That's something that people forget, even though everyone thinks they've heard it a hundred times," she says. "Tell your scheduler [to follow up] and then make sure they're actually doing it." You can also work with your original physician-investors — in Ms. Howey's case, a group of pain physicians — to open up extra block time. Ms. Howey's physicians allowed her to move their schedules around to accommodate the new physicians.
10. Keep communicating. The most important part of adding a new specialty is communication, Ms. Howey says. She always brings a team of staff to a potential surgeon's office to answer any questions they have. "We always take a packet with us that contains all necessary scheduling forms, standard POHA and PACU forms, a sample of our chart packet and a list of all the important phone numbers they may need, such as our materials department, our lead surgical tech and our PACU charge nurse," she says. "This gives them contact people right away."
Learn more about Matrix Surgery Center.
Read more advice for multi-specialty ASCs:
-Typical Spine Procedures Performed in a Surgery Center: Q&A With Jeff Leland of Blue Chip Surgical Partners
-Successful ASC Case Study: Q&A With Neal Maerki of Bend Surgery Center
-3 Ways Ravine Way Surgery Center Increased Spine Case Volume
1. Research the local area. Before you decide which specialties to add, you have to know the availability of physicians and specialties in the surrounding area, Ms. Howey says. It helps to know which physicians are already attached to hospitals or other ASCs, as they may be more difficult to recruit. You should also know which specialties are offered at other local ASCs — if two centers within a mile of yours are already offering ophthalmology, for example, you may struggle with case volume.
To research the available physicians in her community, Ms. Howey held an open house at her pain center and invited physicians to stop by. "One of the things that made us very attractive was that we're a CON state. We had three ORs and my pain physicians were never going to use three ORs," she says. The surgery center presented its case in casual terms: They were at no risk of going under, so physicians could feel free to make decisions that fit their needs. "There wasn't a lot of pressure initially," she says. "We wanted people to come and see the facility and then decide if they were interested."
2. Research reimbursement and cost. Once you know which physicians might be interested in bringing cases to your center, you should determine the potential profitability of each specialty. For each specialty, you should know how much volume the ASC will require to break even or make money. "With a specialty such as pain or ophthalmology, these cases do not pay huge on their own, but if you can be an efficient, higher-volume [center], they are good specialties to add," she says. The opposite is also true: Ms. Howey decided to add podiatry to her center because the specialty provides relatively high reimbursement despite low case volume. If you have a particular physician in mind, talk to his or her office manager and scheduler to find out which procedures you will see most often. Factor those procedures into your cost calculation.
3. Assess your physical location. Determine which specialties can be added to your existing facility without improvements or expansion, Ms. Howey says. Physical limitations of your facility — such as your pre-op holding area and PACU — may determine if you should consider a large group or a single physician. Since Ms. Howey's facility performed around 6,000 pain cases a year, she needed to figure out how the ASC would preserve the pain specialty.
"I turned my eye to pre-op and PACU," she says. "I know I'm turning cases every half hour, so how many beds can I have available for outside surgeons? How often will they be here?" She met with the center's clinical director and OR crew to brainstorm how to accommodate a new physician. Since the center scheduled cases for four physicians on three weekdays, she decided to schedule the new physician on one of the other days.
4. Review staff competencies. You need to know if you already have personnel capable of handling new specialties or if you will need to hire new staff. "Having good surgical staff cannot be stressed enough," Ms. Howey says. "Physicians want to walk into an OR with no stress and expect the same environment they routinely work [in]." This process will be more difficult if you add a challenging specialty with new equipment. Ms. Howey says through talking to her staff, she was surprised to find that several nurses had worked with podiatry before and could easily handle the specialty change. You should also talk to non-clinical staff at your center; Ms. Howey talked to her certified processer to determine whether the additional case volume would pose a problem for her workload.
5. Never add more than one specialty at a time. If you're going to add a specialty, you want to do it well, Ms. Howey says. Adapting to new procedures takes time, so you should focus on training your staff and getting to know your new physician. This will be much easier if you don't have to juggle multiple specialties in addition to your original specialty. Ms. Howey recommends talking to your new physician's office staff about his or her preferences. "The two key people in any physician's office are the scheduler and usually one other person. That may be an office manager or a nurse [or surgical tech] that follows them to cases," she says. "That person will know everything about the surgeon." The staff member can tell you the physician's favorite music and scrubs, as well as his or her usual arrival time. Invite the key staff members out to lunch and introduce them to your team. This is a good opportunity to truly get to know your new specialty and show your appreciate for the physician's business.
6. Lay out a plan with your staff. Hold a meeting a discuss the game plan with your staff. This includes everyone from the business office to your anesthesia providers to your clinical staff, Ms. Howey says. Discuss how new patients will be admitted, how POHA and PACU processes will change for these patients and differences in OR set-up and sterilization. Distribute the physician's preference cards to your surgical crew after checking with the physician's office manager that the cards are up-to-date.
7. Bring the new physician in for orientation. If possible, invite the new physician for an orientation before the first case. If the physician has time after hours or over lunch, you can schedule the orientation then; otherwise, you can always ask the physician to arrive a few hours early on his or her first day. During orientation, you can introduce the physician to your staff, discuss parking, point out the physician's lounge and go over the dictation process.
"[Dictation] is interesting because so many physicians coming out of the hospital assume transcription is on-site or in the basement," she says. "Every facility handles transcription differently, and it's important for making sure your billing goes out on time. Your physician should understand the dictation process and that you want them to dictate before they leave." Ms. Howey says providing food never hurts — go the extra mile and set out pastries, fruit or sandwiches when your physician stops by.
8. Consider other specialties after a few months. Give your physician and staff a few months to settle in, and then start considering other specialties. If your physician is talking to other providers in the community, you may receive calls from other interested physicians. Ms. Howey added plastics and oral surgery soon after podiatry because several surgeons approached her. The same process will apply for each new specialty you add. Keep in mind that some will be harder to install than others; Ms. Howey says her center ran into more challenges with spine because the procedures are more invasive and the equipment is more expensive. "[Spine surgeons] have the most expensive, latest, greatest toys, and when they come to you, everyone wants all the new toys and none are cheap," she says. "Initially I brought a lot of things in on 30-60 day trials and let them play with a few things without having to throw cash out there."
9. Block time accordingly. When you run a single-specialty center, it is easy to ignore issues with block time, Ms. Howey says. She says once your center expands to multiple specialties, your schedulers should meet with physician schedulers on a monthly basis to discuss scheduling. She cautions administrators to understand that a surgeon's preferred block time can change: Just because the physician told you at your first meeting that Tuesday mornings are most convenient doesn't mean it will stay that way. She adds that you should also call physicians to make sure they are planning to use their block time.
"That's something that people forget, even though everyone thinks they've heard it a hundred times," she says. "Tell your scheduler [to follow up] and then make sure they're actually doing it." You can also work with your original physician-investors — in Ms. Howey's case, a group of pain physicians — to open up extra block time. Ms. Howey's physicians allowed her to move their schedules around to accommodate the new physicians.
10. Keep communicating. The most important part of adding a new specialty is communication, Ms. Howey says. She always brings a team of staff to a potential surgeon's office to answer any questions they have. "We always take a packet with us that contains all necessary scheduling forms, standard POHA and PACU forms, a sample of our chart packet and a list of all the important phone numbers they may need, such as our materials department, our lead surgical tech and our PACU charge nurse," she says. "This gives them contact people right away."
Learn more about Matrix Surgery Center.
Read more advice for multi-specialty ASCs:
-Typical Spine Procedures Performed in a Surgery Center: Q&A With Jeff Leland of Blue Chip Surgical Partners
-Successful ASC Case Study: Q&A With Neal Maerki of Bend Surgery Center
-3 Ways Ravine Way Surgery Center Increased Spine Case Volume