Surgery Center of Fairfield County, a four-OR facility with one procedure room in Bridgeport, Conn., hosts nine different specialties: GI, general surgery, gynecology, ophthalmology, orthopedic, pain, plastic, podiatry and urology. Faith Kycia, administrator of the center, identifies eight challenges and opportunities for a large multispecialty ambulatory surgery center.
1. Need to buy lots of equipment. A large multispecialty ASC has a lot of equipment for each specialty and the administrator has to make sure all of it is up-to-date, which can mean a lot of shopping. Ms. Kycia can often obtain discounts through the ASC's management company. When the ASC needs to buy equipment, she sends a price quote to the management company. "They can usually do better," she says. Some vendors, however, are not on the company's discount list.
2. Specialty focus changes over time. The ASC had its best year ever in 2009, due to an ophthalmologist generating huge volumes, but he left for an eye-only ASC. Now the highest-volume specialty is GI, and its volume is rising. The ASC is about to recruit three more GI physicians, bringing the total to about 10. "We are hopeful that all three will become physician partners," Ms. Kycia says.
3. Best-earning specialty can be a surprise. Medicare reimbursements are not always the best drivers of high earnings. For example, while Medicare payments for GI have fallen, many of the ASC's private-payor contracts still provide relatively high reimbursements for GI. Meanwhile, even though Medicare reimbursements for orthopedics have risen, supply costs for orthopedics have grown even faster.
4. Scheduling can get complicated. Multispecialty centers with many ORs need to keep on top of scheduling because it can get very complicated. "We remind surgical schedulers that block times are not for possible cases but for the ones that are actually scheduled," Ms. Kycia says. Unused block time is released seven days before surgery.
5. Need full partners before entering a new specialty. Generally, the ASC will not invest in a new specialty unless surgeons in that specialty agree to become physician-partners. For example, the ASC is very interested in adding spine surgery, but two spine surgeons interested in using the center were told they would need to first become partners. The spine surgeons require very specific spine equipment and instrumentation. "If they are not partners, they could come in, do a few cases and decide they are not interested," Ms. Kycia says.
6. Cross-training works, to a point. Surgical staff members are encouraged to cross-train in all specialties, but some specialties do not lend themselves well to cross-training. In orthopedics, for example, shoulder and ACL surgery is very specialized.
7. Multiple rooms increase flexibility. When two ORs are available to the same surgeon, staff can "flip" rooms. While the surgeon starts a procedure in one OR, the second room is readied so he can immediately start the next case there. This eliminates turnover time, which can amount to 15 minutes for large orthopedic cases.
8. Less flexing of staff needed. In a big surgery center, staff can be shifted around without having to put a lot of them on flex time. The center's relatively high number of cases and staff work in its favor here. "High water hides all stumps," Ms. Kycia says.
Learn more about Surgery Center of Fairfield County.
Read more about multispecialty ASCs:
- 6 Ambulatory Surgery Center Reimbursement Trends for 2011
- 3 Tips on Running a Successful Surgery Center in a Small Space
- 10 Steps to Take a Single-Specialty ASC to a Multi-Specialty ASC