1. Are we efficiently scheduling OR time? Block time and scheduling of ORs should be managed to allow for the most contiguous use of case times, Mr. Alexander says. "The more contiguous your schedule, the better." In the course of preparing for and receiving AAAHC accreditation, Mr. Alexander's surgery center did extensive benchmarking of its OR use. While the center ultimately increased OR use rate and block utilization rate, it had to balance efficiency against physicians' desire to have operating room time available when they wanted it, which Mr. Alexander concedes can be a delicate balancing act.
Measuring utilization rates is necessary to improve efficiency. "It is something we now track on a quarterly basis," Mr. Alexander says. Measurement, however, is only the starting point. The goal is maintaining and continually improving upon what has been measured.
2. Where is the potential for growth in the ASC? ASC can help increase its salability by identifying new physicians who can be recruited to the surgery center and new procedures can be performed at the facility. "If you can recruit new physicians to the ASC, this will almost always increase the value of the center as soon as they start to perform procedures, but just identifying who they are will make your center more attractive to the buyers," says Jon Vick, president and founder of ASCs Inc., which advises surgery center owners on strategic partnering and joint ventures. He adds that it is also important to concentrate on attracting in-network business as out-of-network business is being significantly discounted, sometimes at 50 percent or more.
3. How will we approach legal and regulatory issues? Physicians must be aware of Stark Law and referral issues to avoid accidentally breaking the law. They must also be aware of the potential for malpractice suits and be prepared for any action that could come their way. Select a competent "health lawyer" who can guide you through any issues that might arise. They will be helpful in assessing partnership contracts, as well as regulation issues. "The physicians have to understand how the wording in a contract could increase their liability," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments.
4. Do all staff members understand EPA precautionary signals? It's important for all surgery center staff familiarize themselves with EPA precautionary signals. On the front of each disinfectant's label there should be one of four of what are known as "precautionary signals" from the EPA, says Jack Wagner is president of Micro-Scientific, a producer and distributor of anitmicrobial products based in Illinois. The least restrictive one is the signal word "caution" which means you can use this product but there some precautions you need to take. The next one is "warning" — it's a bit higher [in restrictions]. It says there's a warning with this product; you not only have to follow precautionary statements but there are some other things you have to follow because this product may produce some untoward effects if it's splashed in the eye or gets on the skin.
The next one is "danger." If you see danger, you really better make certain that you follow the instructions for handling that product so you don't splash it on your skin and you don't spill it in your environment because it's an extremely hazardous product. The fourth one you will very seldom see on disinfectants that are approved for healthcare use is the most restrictive one called "poison." The label will provide instructions concerning any of the precautions your ASC should take with the disinfectant. The label will also provide any first aid instructions in the event that there is an exposure to the product that is not in keeping with the use of the product.
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