By Stephen W. Earnhart, MS
CEO
Earnhart & Associates
Austin, TX
I always get a great response from readers when I do these Q&A articles. Here are some ones from the past six months.
Question: Our new surgeon wants to do total joints in our facility. (He read your article. Thanks, and I am being sarcastic!) We just cannot do these on all these old, sick patients, and it is going to make us fail! You need to be careful what you write about, because these docs read it and then put it in our face and tell us to do it!
Answer: Well, not really a question, more of a statement, but let me share a little bit of info. According to the 2010 numbers from the National Center for Health Statistics, there were 148,000 total hip replacements done at hospitals in the United States on patients 45-64 years of age. There were 168,000 done on patients 65 and older.
Regarding 2010 statistics on knee replacement: There were 317,000 done at hospitals on patients 45-64 years of age, and 385,000 done on patients 65 and older. Our personal experience suggests that about 20% of eligible candidates for joint replacement are too “sick” to be done in ambulatory surgery centers (ASCs).
When you consider that all insurance payers are looking to “bundle bill” these procedures, the advantage goes to ASCs because of their lower overhead cost on the facility fee. Almost all of our new facilities will include joint replacement. I think your surgeon is giving you good advice. (To read my previous column on total joints, go to bit.ly/1Ub6bQ7.)
Question: We are a not-for-profit hospital that is considering doing a surgery center and letting local surgeons join us. We have had several meetings with the docs, but the only ones who seem interested are the local plastic surgeons. We are offering surgeons up to 40% ownership, and the hospital will bill for the ASC and manage it. We also will rotate the hospital surgical team through the center. What are we doing wrong that no one is interested?
Answer: Consider changing your terms to the following: Hospital 30%, surgeons 70%. Outsource billing to a professional ASC billing company. Outsource management to a professional ASC management company. Have 100% dedicated ASC staff, with no rotating hospital staff members.
Question: This question came up at a staff meeting last week at our ASC: How much profit-sharing should the ASC staff request of our surgeon investors (who are open to suggestions — shockingly)?
Answer: Congratulations on getting there! Now, don’t get greedy. I usually recommend 3% of the profit (be prepared for negotiations) be placed in an employee distribution pool. That arrangement usually works. Do not look to take it off the top (revenue). Your surgeons will want it off of the bottom line (profits).
Question: Is it a good idea to hire family members of current employees?
Answer: While I am sure it works well for some, in my experience, nepotism is not a good idea in a small work environment like a surgery center. It frequently can lead to animosity among other staff members, especially when it deals with pay rates and work schedules if other staff members believe there is favoritism between the parties, whether that favoritism is real or not.
Question: We want to set aside a dollar amount for birthday presents for staff members each year. What are other facilities contributing?
Answer: Nothing. Why would you do that?
Question: I am thinking of getting out of healthcare for a career path that is more secure. What would you recommend?
Answer: Healthcare.
Question: It was recommended that our front office staff, receptionist, intake staff, and scheduler become certified in BLS (basic life support). Is that common, and what would you recommend?
Answer: I recommend it. First of all, it is inexpensive. Almost every one of your front desk staff members will welcome it, and it provides a higher level of commitment to patient safety. Remember that most facilities have a large number of patients sitting in their waiting rooms. Wouldn’t it be a great service to have those staff members recognize when a visitor is in distress and be prepared to offer assistance to your other staff members?
Thanks to everyone who continues to submit great questions! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Phone: (512) 297-7575. Email: [email protected]. Web: www.earnhart.com]
