Here’s two new services for your outpatient program
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
At Earnhart & Associates, we are always looking for new ideas and procedures to enhance our bottom line — as we should. However, sometimes the ideas dry up, and we need to become a bit more creative.
Let’s look at some new things we have been doing and see if they might work for you.
• A surgery center within a surgery center: The esthetic plastic surgery center.
Plastic surgeons, for the most part, shun the average surgery center because they think it doesn’t meet the needs of their clientele’s image. (I said, "average." Your center is perfect and beautiful; this is directed to other people’s centers.)
Unfortunately they are often right. As much as we like to think that our center is pleasing to the eye, if you look closely, most do not live up to the average operating suite in most plastic surgeons’ offices.
In my travels and meetings, I have been in many of these. They are ornate, lavish, and tastefully done. They are complete with The New Yorker magazine, attractive receptionists, and multicolor brochures. From somewhere there is a light source, although I can rarely find a lamp or overhead fluorescent lighting. And the music; where do they get this soothing music? And where the heck is the radio?
Now, those of us who have been in the industry for more than three months know that much of what the administrator does in dealing with plastic surgeons is to try to negotiate a reasonable facility fee from them that at least covers the cost of the sutures they use. Not an easy task. Obviously, the surgeons want the facility fee as low as possible, so their global fees are competitive with their peers. That will probably always be an issue; however, the cash upfront reimbursement is looking more attractive. To attract more esthetic procedures to our facilities, we have been creating a new image for these patients.
Creating an attractive atmosphere
Essentially, we are creating a new entrance to the surgery center — a distinctly different entrance from the main door. Often, this will be off on another part of the building or a different corridor. The signage will read "Esthetic Surgery Center" and will have, usually, the name of the surgeon operating that day on the door. Depending upon the number of plastic surgeons you have, this may or may not work for you.
Once the patient enters that door, there is a small, but highly appointed waiting area. The size is usually 120 square feet. There is a window for the receptionist to register the patient. You can use your own select staff member here, or you can have the surgeon bring over their own. Beyond the door, there is a single changing area that can double as the phase-two recovery area. Again, you need to evaluate the numbers of patients you are going to accommodate during the day. From this point, the patients share the general population operating rooms and phase-one recovery.
Will it work for you? I don’t know. Clearly, before you would consider the expense, which isn’t that much, you would want a commitment from the surgeons on potential new volume.
• Kidney stone lithotripsy or fragmenting of kidney stone (CPT code 50590).
This procedure is on the list to be approved for Medicare reimbursement for surgery centers by the Health Care Financing Administration with the implementation of the new ambulatory payment classifications (APCs). This procedure holds a lot of promise for new and existing facilities. The proposed reimbursement from Medicare is $2,107. We’ll have to wait and see if that holds up.
In the meantime, strong consideration should be given, especially for new construction, for adding this service. For the majority of facilities, a mobile machine will be required — a fixed site probably doesn’t make much sense. However, there is new equipment out there now that doesn’t require a truck.
Most providers use the mobile 18-wheeler truck, which requires a specially constructed "pad" in the parking lot for the large truck to pull up and make water and electrical connection. The average price for the construction of the pad, overhang, hook-ups, construction of a door into the surgery center, etc., is about $25,000 (assuming you have no other construction issues). The services — there are several in the United States — usually have the staff and all the equipment to perform the procedures and usually schedule time once or twice a month, depending upon your schedule and number of patients.
The fee for the truck, machine, staff, and supplies can exceed $1,000 per patient — but there is very little incremental cost involved beyond that fee. This is also a great way to get the urologist involved in the facility. Keep your eye on this new opportunity. To research companies, perform a search for "mobile lithotripsy" on the Internet.
(Editor’s note: Earnhart can be reached at Earnhart & Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. World Wide Web: http://www.earnhart.com.)
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