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Should you be fearful of the future?
By Stephen W. Earnhart, MS
Earnhart & Associates
Question: Our surgeon group has been approached by the local hospital to buy an interest in our surgery center. We (the nursing staff) are fearful of this for our jobs and also dealing again with the "hospital culture" that we came to this center to get away from. We found one of your articles that you do these types of mergers, and we want to know what we can expect from the nurses point!
Answer: First and foremost, you should not see this as a threat to your jobs. That is always the no. 1 concern of employees at the acquired facility: that they are going away and be out of a job. The reality is that usually in these situations, part of the deal is that the current staff remains unchanged. Some contracts even have it in writing. Most hospitals that purchase surgery centers usually know that that is a "culture" that they typically cannot match and are usually content to stay out of the way when it comes to management and operations. Good way to check is to ask the surgeons that own it and see what they say. If they are vague and don't look you in the eye, you might want to polish up that resume!
Question: What is going to happen to ambulatory surgery centers (ASCs) when (and if) healthcare reform ever fires up?
Answer: Likely nothing. It should be business as usual. Specialty hospitals might have some challenges, but by and large I have seen nothing that will adversely affect ASCs. Some leaders are projecting that because more patients will be insured, more will undergo elective surgery.
Question: Our hospital is bringing in an outside consulting group to manage our surgical department. Have you ever heard of this? To us it seems like a pretty serious move. Thoughts?
Answer: It is not that uncommon actually. Often there is a specific reason they are bringing in outside people: adding new procedures or specialties, assessing staff and leadership, anticipating new or rapid growth within the department, and the like. Usually the staff has nothing to worry about and can learn from having an outside group come in.
Question: Social media is running rampant, and I think it could help our hospital surgical department communicate with the community and the surgeons. My supervision disagrees and has pooh-poohed the idea. What do you think?
Answer: I think it is a great idea! We just did it as a company and have had great results. Bear in mind patient privacy issues, and see if you cannot get him to change his mind. Show him this article! (Editor's note: For more information on using social media, see these Same-Day Surgery stories: "Are you Twittering, getting friends on Facebook, and YouTube? – Social media embraced as marketing, educational, and recruitment tools," November 2009, p. 105, and "Social sites continue posing risk problems," November 2010, p. 126.)
Question: We just opened a new surgery center, and we (the nurses) think we need to open up the third operating room that is just shelled in right now because the owners don't want to pay to open it up. They say that we should be doing more cases in the other two rooms before we spend that money. (They are very cheap.) Isn't there some regulation that requires you to only do so many cases in a room per day?
Answer: Cheap though they might be, you should have a quantifiable reason to open up a shelled operating room. The rule of thumb that I go by is that you should be utilizing about 76% of your available time before you take that next step. Once you go above that utilization benchmark, you lose the ability to "flip-flop" cases into other rooms.
Question: Our orthopedic surgeon is going to open up an "office-based surgery center" and is trying to get some of the staff, me included, to join him at the new center. He says it is much cheaper to build than a fully licensed and state-certified surgery center and that he will share that savings with the staff. How good of an idea is this?
Answer: Well, probably not too good. Maybe your surgeon does not know that rarely can an office-based center receive reimbursement from health care providers for the facility fee/charge. There are exceptions, but not many. Because these centers are not state licensed, they are not eligible for Medicare certification and therefore not eligible to enter into those contracts. These are good for plastic surgery centers and some others, but not for a typical orthopedic practice. You might want to ask him about that before you and others jump ship. It will make you look cool when he realizes his potential error, but he probably will hate your pointing it out to him. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: firstname.lastname@example.org. Web: www.earnhart.com. Twitter: SurgeryInc.]