Surgical Billers

Developing an Ambulatory Surgery Center (ASC)

The rising costs of medical services, and decreasing payments for those services, continue to put pressure on physicians. More and more, physicians are seeking additional sources of income by providing ancillary services related to their practices. This also provides control of operating room scheduling when the procedures are outpatient. This freedom many surgeons are finding beneficial to managing their practice.

So what do you need to know to about developing and operating an ambulatory surgery center? First, that it is a very complicated endeavor. Of vital importance is a careful analysis of the user/investors, their caseloads and the payer mix. This is what ultimately determines whether the project should be undertaken in the first place. Once a feasibility study establishes that the caseload will support a surgery center, a management team with surgery center experience, preferably in your own state, is essential. This should be a team of experts with solid experience in developing successful centers on time and within budget. The task of developing a surgery center is too complex, too technical and too regulated by multiple government agencies to be undertaken by just a physician or physicians unless they are doing it full time as a business.

Throughout the process, strong leadership, coordination and input from physicians are critical components in building a surgery center. A health care attorney and accountant are also essential to protect investors’ interests and to establish the best tax structure for the organization. Contracts, leases and other documents had to be negotiated and drawn up between the management company and the entity, between the entity and the investors and for the entity itself.

After the legal entity is established and the surgery center designed, the plans
required approval from the city. The design must meet the local government’s building, fire and updated earthquake codes. Also, to ensure that the design would meet the size, electrical and plumbing requirements of necessary
equipment, major pieces need to be selected prior to the completion of the design. You may want to utilized the services of a medical equipment consulting firm with extensive ASC experience to assist you in the selection and procurement of your equipment needs. Once plans are approved, construction of your project can expected to take three to four months.

Another important step is finding a nurse administrator who would be responsible for day to day clinical operations. The smooth and successful operation of a surgical center depends directly on the quality of the staff hired. The nurse administrator must supervise the selection of—and then manage—the nursing, technical and custodial staff. The services of our management team can advised and hire your nurse administrator.

Sound financing was another critical component in our successful project. Adequate cash reserves must be available to cover start-up costs, construction or regulatory delays and salaries and expenses until there is adequate cash flow from operations. Inadequate cash reserves to tide a business over until cash starts flowing from operations is the leading cause of business
failure.

Insurance company contracts also play a significant role in the success of your center. We suggest having a limited number of contracts with insurance companies and sign only those that clearly offer a financially sound arrangement. We can assist you with the contractual negotiations.

While the most interesting part of the process is construction of the operating
room with all of its technical intricacies, the most challenging is the licensing, Medicare certification and accreditation process. This is the most unpredictable part of the entire process. You should consider the experience of Surgical Billers to assist with the process. It is imperative throughout construction to maintained communication with the DHS. DHS inspectors have very specific ideas on what they want in a surgery center. Consulting with the DHS throughout the planning and construction phase will avoid delays in your center's certification.

Summary
In summary, if your practice has a sufficient caseload to support an outpatient surgery center—and again, it depends very much on the payer mix—or if you can put together a group of physicians with an adequate caseload, there are many companies with the expertise to build and manage an ASC for you. In all cases, the active involvement of a ASC advisor throughout the process will greatly affect how successful your venture will be. Surgical Billers can assist with the startup to ensure your ASC is a success!