Here are answers to your current SDS dilemmas
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Frequently asked questions is now the No. 1 request I get for this column each month. I finally figured out why: We all have questions about things but are often fearful about asking at the risk of sounding stupid, or it is understood we should know the answer already. That certainly shouldn't be the case, but we all know it often is in real life.
I will never forget one of my first management jobs in a large hospital. I was asked to do an analysis on the gallbladder DRG for the CEO of the hospital. When asked by the CEO if I had any questions, I replied, "No, sir. I should have this for you in a couple of days." Well, the first thing I did after our meeting was call a friend of mine and ask her, "What is a DRG?" True story.
We all pretend we know more than we do. So this month, I'll share some of the latest questions with you from your peers and give you a synopsis of my reply.
Question: What is the Internet, and how much does it cost to have a home page? Does it make sense for a surgery center or hospital to be on the Internet?
Answer: My column in last month's issue was about the same-day surgery manager and the Internet. But to directly answer the question about cost, I built my own home page -- myself. It cost me about a day of my life and some software I was able to download right from the Internet.
Check with your local computer retailer about software for building your own 'page,' or check out sites on the 'Net just for building one. My home page can be found at http://rampages .onramp.net/~surgery. Check it out to see what you can do yourself. I had quotes for building my page from $250 to $8,000, and I finally did it myself for my labor only.
Remember to keep it simple. Don't load your front page with a lot of images that look good but take forever for the reader to download to read. I have very few images on my page, and it loads very fast at either 14.4 or 28.8 bps. It does make a difference. As last month's column stated, you definitely should have your page on the Internet! It gives you a very high tech image and projects the forward thinking of your organization.
Question: When do you send your patients to a collection agency?
Answer: As a rule of thumb, I would never suggest sending a patient to a collection agency without first checking with his or her surgeon. Many of you will disagree; however, I have been burned so badly in the past by not checking, that I make it a rule now to inform the doctor. Often, especially in ophthalmic surgery, a patient may have a total of four surgical procedures: two cataracts and two YAG laser procedures. I can almost guarantee that if you send the patient to collection after one procedure, you are going to hear from the surgeon!
That does not mean that you should not attempt to collect what is due to you. You should make and even have a legal obligation from the government to make every effort to collect the copayment and deductible, but a collection agency should always be the last resort. You should, as a courtesy only, inform the patient's physician before you send it out.
Question: We have a group of orthopedic surgeons using our hospital ASC. They are very demanding about turnaround time -- even though ours is about 16 minutes -- and block booking. They constantly demand a larger block that we just cannot give them. They have threatened for years to build their own ASC if we do not give them what they want. Now, they say they can build their own center and will start construction soon. Has anything changed in Ohio that suddenly makes this easier for them to do, or does this sound like another bluff?
Answer: Look out! Ohio recently changed their tough certificate of need (CON) laws. In a simplistic answer: Yes, they now can build and manage their own ASC with other physicians from your center without the lengthy and costly CON process. It sounds like it's time for a heart-to-heart talk with the group.
Question: (From a group of physicians) We are interested in building our own ASC and do not want a corporate equity partner. We want to own the center 100% ourselves, but the corporate companies keep trying to scare us with Safe Harbor issues. They say we should not own more than 40% of the center. It is our labor and efforts that will make the center successful, and we don't wish to share it with others. Does one have to have 'Safe Harbor' with an ASC?
Answer: First, I advised the group to seek legal counsel. I am not an attorney and cannot advise on such issues; however, the issue of Safe Harbor does come up very frequently. Not having a 'safe harbor' just means that you may or may not be asked at some point in the future to furnish information about your partnership, equity distributions, and the like. Many people think that Safe Harbors are too conservative, and one is passing up opportunities if they meet the standards. Others think they just don't want the potential hassle of not having a Safe Harbor. I believe as long as you are comfortable with someone investigating your center, I wouldn't worry too much about compliance with the recommendations for Safe Harbor.
Retina equipment may cost plenty
Question: A group of ophthalmologists using our ASC want to have their partner start doing her retina procedures at the center. They say she does about 10 procedures a week, and the center will make a lot of money doing them. They said the equipment to perform the procedures (scleral buckles, vitrectomies, etc.) wasn't that much. What do you think?
Answer: Well . . . all the retina equipment I'm used to costs about $128,000, and I personally think that is a lot of money. Reimbursement for these procedures, while it has increased significantly, is often woefully inadequate for the supplies used and the time these cases can take. Unless you have significant, historical volume to offset the expense, walk very carefully down this road.
Question: Would you rather have 20 FTEs on a full-time salaried basis working in an ASC or 45 part-time nurses?
Answer: (The above question is exactly how it came to me via e-mail.) Not knowing the situation, I would opt for the 45 part-time nurses around a core group of four or five full-time individuals. Flexibility is going to be one of the keys to surviving the margin reductions and combating the increasing pressures to cut costs.
Question: How often do the folders the patients' charts are stored in have to be changed?
Answer: I didn't know they had to be.
Question: We have a surgeon at our center who insists upon buying the staff lunch once a week. What would be the best approach to get him to stop?
Answer: You say that like it's a bad thing. Who cares if he buys lunch?
Question: (My favorite) I caught a staff member writing fictitious thank-you notes to the ASC where we work, praising her efforts and saying what a great nurse she is. In other words, making up patients and comments about herself. We do about eight thousand cases a year at the center, and this nurse -- who is actually quite good -- has been doing this, we found out, for over a year. How do I confront her about it? Have you ever heard of this?
Answer: Actually, no. But what a great idea! I wish I had done it before with some of my bosses in the past. We all want recognition for the hard work we do, and if she is as good as you say, make up some of your own about her and show them to her. Maybe she'll stop when you give her some recognition of your own. You certainly will run a risk of losing her if you embarrass her about them. Sometimes we as managers have to make up the rules as we go.
Options to opening a day-care center
Question: Our center is in a rural area, and we are having a difficult time recruiting RNs to work in the center. We are thinking about opening a child day-care center at the ASC as a benefit to attract more working mothers. Any thoughts?
Answer: Yes, and they are all negative. They just don't make money and are becoming a highly regulated industry. I would do one of the following:
* Take the money you are going to spend on the day-care center and increase your pay.
* Give an allowance for child day care at an established center.
You really don't want the hassles of running an ASC with a day-care center. You don't have the time!
[Editor's note: To provide feedback or suggest ideas for future columns, contact Stephen W. Earnhart. Earnhart and Associates, 5905 Tree Shadow Place, Dallas, TX 75252. Telephone: (214) 713-6626. E-mail: [email protected].] *
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