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Publications
Build on Your Strengths
by Joining the Competition
By: Stephen Earnhart
Is it just me – or are you
starting to see the same thing: hospitals and freestanding ambulatory surgery
centers (ASCs) combining forces and working together? If this trend continues,
I think it is very positive. For years, it has been Beta vs. VHS, DPS vs. Mac,
and hospitals vs. the freestanding centers. Think of the possibilities if
hospitals and ASCs combined strengths!
I’ve enjoyed a refreshing relationship with many hospitals in the areas of my
own ASCs for years, and I find that what the hospital-based ASC and the
freestanding ASC do is similar. While philosophical differences clearly exist
between the two entities, nothing needs to change on either part to have a close
working relationship.
Having spent
years in both environments, I feel I have a right to point out some of the
differences and the similarities:
Hospitals
tend to market more to the patient, while the freestanding ASCs market more to
the physicians. Hospitals, in and of themselves, can attract patients and then
dispense their patients to their surgical staffs. They do this via the
emergency department and with outreach programs sponsored by the hospital.
Freestanding ASCs on the other hand, have no real conduit from the patient to
the surgeon and must rely on the surgeons bringing their patients to the ASC.
While each entity is effective in its marketing skills, they could combine their
efforts and corner the market in their geographical area.
Freestanding
ASCs, for the most part, are more efficient in operating the surgical caseload.
They may have unfair advantage over the hospitals, i.e., no trauma cases to bog
down the schedule or no involved procedures, such as open heart and organ
transplants, that can be unpredictable in the timing of the “to follow” cases.
The result for hospitals, however, can be frustrated physicians who are waiting
for their cases to start. Also, the typical freestanding ASC’s patients usually
are healthier and spend less time being worked up. In addition, the time they
spend in the recovery room is often shorter. The greatest incentive for
physicians to start to work in an ASC is efficiency of their time.
Cost is
another factor. Freestanding ASCs market themselves as less expensive than
their hospital counterparts. In many cases this is true, but unfortunately,
some ASCs shift their uninsured or Medicaid patients to the hospital. Hospitals
often receive a greater reimbursement from the insurance companies for their ASC
cases, however. While pricing may be an issue, it is not an insurmountable one.
Sleeping with the enemy?
So what are
the advantages to working more closely with the competition?
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· The more you know about what the other is doing, rightly or wrongly,
the greater advantage you have.
While no one
really has “trade secrets” in this field, both sides often know why a
physician works where he or she does and what it would take for them to
change that practice.
· You can keep physicians happy by sharing equipment.
It is
usually easier and faster for physicians to obtain the equipment they
need at a freestanding ASC. Often in the hospital environment, the
physicians are in a queue behind radiology, laboratory, and other
significant departments of the hospital, and they have to wait their
turn in obtaining the sophisticated equipment they may need to market
their practice to attract new patients. This is especially true for the
newer staff members. The wait can be years, if at all.
Conversely, the hospital usually has the bulk of specialized instruments
that physicians use on most of their routine cases. Most freestanding
ASCs just simply cannot stock these instruments for each surgeon. Most
of these classes of equipment can be shared between the hospital and
freestanding ASC.
At our Professional Surgery Corp. centers, we have a sign in/sign out
sheet. When we borrow a piece of equipment from the hospital, we are
responsible for picking it up and for taking care of it until we return
it and vice versa. It works. It unburdens both facilities from the
duplication of equipment and dollars. Hospital and freestanding ASC
managers know they would be hard-pressed to capture 100% of any
physician’s cases, and they recognize the need to provide him or her
with the necessary tools.
· Personnel pooling can offer significant advantages.
Agency personnel often can be much more expensive than the staff at
either facility and are often unaware of the nuances of a busy OR
department or recovery area. Valuable time often is spent bringing them
up to speed in the department.
Most RNs and technicians will admit they would like to keep their skills
sharp by doing a good “belly case” instead of the usual cataracts, M&Ts,
and arthroscopies performed in a freestanding ASC. On the other hand,
they also would like the faster pace of a rapid turnaround with
healthier patients at a freestanding ASC. |
Double your staff
Personnel
pooling is good for both the institutions and the professional staff’s resumes.
The greatest reward often can be that the surgery center, overnight, can almost
double its staff of dual-trained, cross-educated, less-expensive staff. Often,
the physicians can be the greatest beneficiary, because now they can have the
staff at either facility assist them.
In some instances, the local freestanding ASC may completely dominate a certain
specialty. This often is the case of ophthalmology and ENT, where there may be
a minimum of those cases being performed in the hospital. It can be frustrating
for the physician, who, when he or she has a trauma case come in through the
emergency department, may not have the necessary equipment or trained personnel
at the hospital level that can set up the equipment or assist in the emergency
surgery. I hear this complaint frequently, and it has merit. Having
cross-trained personnel from both facilities removes this obstacle.
The easiest way to accommodate crossover personnel is to allocate
their time from one center to the other, at their respective pay rates, on a
monthly basis that easily can be set up in the payroll department of both
facilities. The less complicated the system, the easier it is to accommodate
changes.
What is the approach to starting this type of program? Call and
meet your counterpart at the other facility. Go to lunch and see if you have a
basis for working together. Then tour each other’s centers and introduce staff
to each other. The rest of the process might involve sharing physician bases
and preference cards. The program will naturally fall into place if both sides
want it to.
Health care and its delivery are changing rapidly, and both
hospitals and ASCs must compromise to stay on track. Do not let “bricks and
sticks” stand between you and a comprehensive surgical center.
(Earnhart & Associates is an ambulatory surgery consulting firm
specializing in all aspects of surgery center development and
management. Contact Earnhart at 13492 Research Blvd, Suite 120-258, Austin,
TX 78746. E-mail: searnhart@earnhart.com. Web: www.earnhart.com.)
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