Questions from the front lines
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
I typically receive about 100 questions per column or follow-up to a previous column. Of the 98 questions sent this month, remarkably, no two dealt with the same issue.
Here’s a sampling:
Question: "Why is the United States the only country that has one-day surgery programs? How long do patients in other countries, such as Japan for example, stay in the hospital after a cataract extraction?
Response: Actually, most countries have the same type of outpatient programs as the United States. We are working with Australia, New Zealand, Vietnam, and Portugal currently and have worked with hospitals and physicians in South America, Canada, England, and Turkey on same-day surgery programs. There are other counties that are much more aggressive on these programs than the United States.
Question: Our state has a certificate of need requirement that will not allow our physician group to build a surgery center.
Obviously, these programs were designed to restrict physicians from competing with hospitals. When will they go away so we can offer lower cost alternatives to hospital surgery?
Response: Actually the certificate of need (CON) process restricts hospitals from developing surgery centers also — it is not intended to restrict business to hospitals alone. In fact, I know of several hospitals that are being denied a CON for developing a lower cost ASC on their own. Most states have done away with the process, and the remaining states are either holding on or phasing them out. Your state (Georgia) seems like it is actually making the requirements more stringent.
Question: Who decides in a for-profit surgery center the type of surgical cases we do?
Response: Medicare has a listing of roughly 2,200 procedures that are allowed on Medicare patients. If a procedure is not on that list, it cannot be performed on a Medicare patient (and some other plans) unless you tell the patient in writing and in advance that the procedure is not covered by Medicare and the patient will have to pay. Other than that, the center’s physician advisory board or executive committee will make recommendations to the governing body on a particular procedure. Of course, the physician who wishes to perform the procedure also needs to be credentialed by the governing body to perform that case at the center. Some states may oversee types at procedures at an ASC.
Question: Our hospital is building a surgery center in a joint venture with our surgeons. The surgeons are saying that once they "own" the surgery center, there are going to be "massive" layoffs of "deadwood" personnel in the operating room. They cannot run the surgery center without experienced, trained nurses. Right?
Response: One goal of a surgery center is increased efficiency and cost control, which means you want to do more work in less time. That frequently means less staff and shorter days. Most ASCs will send staff home after the schedule is complete. Clearly most surgery centers need a core group of experienced and well-trained nurses to carry out its mission of a high-quality, lower-cost surgical environment. However, that staff may not all come from within the existing facility. Often, they come from other hospitals or surgery centers. If your surgeons think some members of the staff are "deadwood," chances are those personnel will not be working in the center after the transition.
(Editor’s note: Earnhart can be reached at Earnhart and 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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