Single-specialty vs. multispecialty ASCs
Single-specialty vs. multispecialty ASCs
Each has its own challenges
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Internet Web Page http://rampages.onramp. net/~surgery
Internet address: [email protected]
Several weeks ago, a nurse asked me to compare the degree of management difficulty between running a single-specialty ambulatory surgery center (ASC) with one or two physicians and running a multispecialty center with 50 to 100 surgeons. That seemed like a reasonable request since I’d be a wealthy man if I had a dollar for every time someone complained to me about the difference between the two.
This is a typical scenario: Billie comes up to me at a conference and points to a friend of hers and says, "Mary has no idea how easy she has it. Running an ophthalmology surgery center with only one doctor to take care of."
I saunter over to Mary, the manager with the great life. "Mary," I say. "How’s it going for you? Center doing well?"
Mary places a tightly clinched fist to her chest. "Steve, it is sooo bad.You have no idea how tough it is," she tells me. Well, actually I do, but I keep those thoughts to myself.
"The doctor is driving me crazy." She stops and scans the crowded room. "Look at Billie over there. What a life she has. Lots of doctors working at her center; she doesn’t have to worry if she is going to have to close her surgery center because her surgeon slams his hand in a car door."
Okay. This is the "grass is always greener" column. Let’s talk about the two. I may be in a unique position to discuss it because I have run both a single-specialty and multispecialty center. The trend for single-specialty centers is to go multispecialty. Guess what? The trend for multispecialty is to go single. Really.
Let’s use ophthalmic centers as an example since I’ve run a number of them. A typical ophthalmic ASC is only open, on average, two, maybe three days a week and then probably only in the mornings. The owners of these centers are starting to realize that they have a licensed facility that is only about 30 or 40% utilized. With the declining reimbursement for ophthalmologists on the professional side of the business, the owners are looking for ways to increase their revenue. Their surgery center is a potential gold mine, but they have to expand their service. I’m working with a number of them now that want to do something else with this underutilized asset. So guess what we’re doing? Right. Making it multispecialty. Mary is about to get her wish.
What about Billie and her multispecialty ASC? Some of the multispecialty centers have become so big and crowded that certain groups of doctors or a lone physician wants out to open a single- specialty center. Who is that lone physician going to call to run it for her? Guess. Billie! Usually the first person a doctor thinks about running a single-specialty surgery center is the person running the center she currently uses. (Just another reason why you should never burn a bridge in this industry). This scenario is not restricted to the freestanding industry. In fact, I see it more from the hospital side of ASCs.
It really is an odd phenomenon to observe. The specialties that are leaving the ASCs are typically ophthalmology, orthopedics, GI, GU, pain management, and podiatry. These physicians are "tired of working around everyone else’s schedules" or I get the "I contribute the bulk of the cases to the center, and I’m tired of not getting the times I want" complaints.
The irony of this is that those are the very specialty groups you look to plug into the single-specialty centers that want to go multi. So that’s what is going on in the industry right now. But let’s compare Billie and Mary’s jobs.
Billie, the multispecialist, has 85 surgeons working in her ASC, and they cover every major specialty. She has a huge inventory that someone is always after her to reduce. Her cost of supplies and equipment cost is higher than Mary’s (single-specialist) because she has five ophthalmologists, each using a different IOL, six gastroenterologists, each wanting a different size scope and sterilization method, seven orthopedists who cannot agree on the shaver they want, and the OB/GYNs who want different light sources for their cases.
Billie is splitting her vendors so much that none of them have a sense of loyalty to her because she doesn’t give them an exclusive. She never sees the surgeons’ office staff. Wouldn’t know them if they walked in her office. Billie has so many employees that her payroll is astronomical. Each group of specialists wants its own scrub nurse and "don’t you dare give me a new circulator on my cases."
She is mother and parent to 85 different doctors, each demanding a piece of her undivided attention. Her capital expense requests is as thick as "War and Peace," and every doctor on the staff wants to know why the turnaround time couldn’t be as good as the single specialty center down the street. Billie finally gets some time to close the door to her office, yearning for just one surgeon to deal with like that lucky Mary.
Mary, on the other hand, lies in bed at night, worrying that she will say or do something that will upset her sole surgeon. She does everything for her physician: making sure his car is washed, his laundry taken care of, his pool guy can find him, etc. Her staff is always on her about not getting enough hours, being forced to take vacations when the surgeon is away, and how their careers are wrapped around the one surgeon’s whims. Working with the physician’s office staff is almost intolerable because they won’t fill out the paperwork or check insurance coverage on his patients before they come to the OR .
Her vendor relations are a mess. Yes, she’s getting good pricing, but the vendor is difficult because he knows her surgeon will always use his IOLs or suture. It’s always the same the same cases, the same equipment, the same doctor day in and day out. Turnaround time is always around eight minutes, and the physician complains about that anyway. A good day is when he doesn’t call her at home, during dinner with her family, asking why the payroll is so high when "we’re only doing surgery 20 hours a week!" She tries to explain that it is hard to get experienced nurses who will only work 20 hours a week or that she has other things to do in the center when he isn’t there. Mary finally sits down and yearns for a large group of surgeons, a bustling, action-filled center like that lucky Billie.
Have a nice day.
• 100th Annual Meeting of the American Academy of Otolaryngology Head and Neck Surgery. Sept. 29-Oct. 2, Washington, DC. For more information, contact the American Academy of Otolaryngology Head and Neck Surgery, One Prince St., Alexandria, VA 22314-3357. Telephone: (703) 836-4444.
• 82nd Annual Clinical Congress. Oct. 6-11, San Francisco. Sponsored by the American College of Surgeons. Contact Nancy Sutton, Registration Coordinator, American College of Surgeons, 55 E. Erie St., Chicago, IL 60611. Telephone: (312) 664-4050. Fax: (312) 440-7143.
• Nursing in the Ambulatory Surgery Setting. Oct.7-8, Fort Lauderdale. Sponsored by the Federated Ambulatory Surgery Association (FASA). For more information, contact FASA, 700 N. Fairfax St., Suite 520, Alexandria, VA 22314. Telephone: (703) 836-8808.
• Centennial Annual Meeting of the American Academy of Ophthalmology. Oct. 27-31, Chicago. For more information, contact the AAO, P.O. Box 7424, San Francisco, CA 94120-7424. Telephone: (415) 561-8500. Fax: (415) 561-8533.
• Linking Cost Containment and Quality in Same-Day Surgery. Nov. 3-5, Washington, DC. Sponsored by American Health Consultants, publisher of Same-Day Surgery. For more information, contact Customer Service, American Health Consultants, P.O. Box 740056, Atlanta, GA 30374. Telephone: (800) 688-2421. Fax: (800) 850-1232.
• 50th Anniversary of the PostGraduate Assembly. Dec. 7-11, New York City. Sponsored by the New York State Society of Anesthesiologists. For more information, contact the society, 360 Lexington Ave., Suite 1800, New York, NY 10017. Telephone: (212) 867-7140. Fax: (212) 867-7153.
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