Management woes in the outpatient surgery field

By Stephen W. Earnhart, MS
CEO
Earnhart & Associates
Austin, TX

“There’s something happening here. What it is ain’t exactly clear …”

Remember those lyrics from the old song? Oddly, there really is something happening in the surgical industry that isn’t restricted to ambulatory surgery centers (ASCs), but includes hospitals as well.

We first noticed it about a year ago with some odd phone calls from past hospital and ASC clients. At first it was just interesting. Now it is almost routine, with several calls per month. It seems, again, seems, that folks who have been self-managing their hospital surgical departments and ASCs are throwing up their hands and wanting someone else to manage it for them. At first, we asked “Why?” Management services can be expensive, to say nothing of the sense of “loss of control” that is so critically important to many of these institutions and surgeons. Some of the answers we received and continue to receive are revealing. They are, in order of their frequency:

1. Lack of strong leadership personnel.

Many of the original department heads and ASC administrators have moved on, retired, or “burned out” (their words, not mine). Replacements are more focused on family issues, time off, vacations, and a general sense of “not being married to the job” and putting in the 60-70 hours per week often necessary. (For more information on that topic, see “How do you successfully manage employees ranging from Millennials to Baby Boomers?” January 2015, SDS Salary Survey Report supplement.)

2. Overburdening regulations from the state and federal levels.

With increasing cutbacks in support staff in hospitals and ASCs, the time required to complete paperwork and stay updated on issues surrounding reimbursement, electronic medical records, and compliance issues is often too much for entities to keep up with on a day-to-day basis.

3. Surgeon expectation issues.

Surgeons are expecting and demanding better efficiency and outcomes for their surgical patients, who are increasingly difficult to find. For busy surgeons, the ability to flip-flop two rooms is now the norm, and woe be to the administrator who cannot accommodate them. That ability to placate surgeons is often a higher priority for professional management companies than it is for a single hospital or ASC.

4. No backup.

Related to the first reason, but different in the sense that should a facility lose a key person in the surgical department, it takes a long time to replace them. Should the unexpected happen, typically (but not always, so make sure you ask!) the management companies have someone they can immediately put into place until a new person they can train steps in.

5. Hassle factor.

Hospital administrators and ASC owner/operators are tired of dealing with the burdensome issues of running the business that they don’t have expertise in. They are weary of the late night or early morning phone calls from department heads or ASC administrators with problems they cannot handle. They want someone else to deal with the problems and are willing to pay for that release of duty and obligation.

6. Liability issues.

All seem to want a cognitive intermediary between them and the problem. I don’t know how else to put that.

7. Decision-making at the 30,000-foot level.

Most facilities are so self-absorbed they often miss significant events or opportunities that are happening in the industry that they simply don’t have access to or are too busy to notice.

8. Cost of supplies and equipment.

Most facilities don’t have access to the purchasing power of management companies, which often purchase for many rather than one or two.

Should you decide to take this route, be careful, as there are many twists and turns ahead of you. There are good and bad things to look for in the local “mom and pop” and corporate management companies you should be aware of and vet accordingly. There are many issues to look at that we will highlight next month. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be contacted at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. E-mail: [email protected]. Web: www.earnhart.com.]