Dawn Q. McLane, RN, MSA, CASC, CNOR, regional vice president of operations at Health Inventures in Broomfield, Colo., says deciding whether to bring new cases into the ambulatory surgery center involves working through six key concerns.
1. Manage the process. "The administrator of the center should be managing the process," Ms. McLane says. This means exercising control over selection of cases, rather than letting circumstances control your decisions. "Think things through before moving ahead with a plan to bring a new procedure or specialty into the center," she says.
2. Cases should meet the mission. The administrator should frequently consult the mission statement to find direction on decisions. "We should be living our mission," Ms. McLane says. The mission statement is important because "it describes who we decided we wanted to be when we formed the organization," she says. For example, if the mission statement points to serving the community, it might be important to allow a surgeon to occasionally perform a charity-care case at the center. Some decisions require some weighing different missions. For example, treating local prisoners might meet the community mission, but it would conflict with the mission to serve all patients, who would feel uncomfortable around shackled prisoners with guards.
3. Comply with requirements. Is the new case on the center's approved procedure list? For example, a surgeon might have taken a course on a new procedure or technology and now wants to start scheduling these cases. Does the governing body first need to approve the cases before they can be added to the delineation of privileges for that specialty? And has the surgeon received sufficient training on this new procedure or do the bylaws require that he has to be proctored? "A lot of consideration must go into deciding to add a new procedure or specialty," Ms. McLane says. "The administrator must get in and manage all the required processes."
4. Determine the capital investment. A new specialty or procedure may require a great deal of new equipment, so it's important to know if the cost will be paid off with greater volume. For example, initial equipment investment for cataracts can be quite high. "If only one ophthalmologist is involved, it might make more sense, as an alternative, to lease the equipment rather than buying it," Ms. McLane says.
5. Examine the payor mix. Some payors offer enough to cover costs like implants and some simply don't. "Reimbursement can be quite variable," Ms. McLane says. If you get a better rate with one payor, it might make sense to go back to a lower-paying payor and say, "I'd love to do these cases, but it's going to take a higher rate of reimbursement." Share your costs and try to negotiate a carve-out.
6. Perform a cost analysis. It is essential to know whether the procedure will pay for itself. "You have to determine what your costs are, so that you can know whether it will work for your center," Ms. McLane says. This involves undertaking a cost analysis. "Does it at least meet the marginal cost and contribute to overhead costs?" she asks. "You may decide to aim higher than that."
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