There's an old joke among prospective builders that goes like this: "A feasibility study is a waste of time because the outcome is a foregone conclusion. Would people whose job it is to help new facilities get built tell you that you should reconsider your hopes for a new surgery center?" The answer is no, they won't - as long as the plan is worthwhile. Before we give our clients the go ahead, this is what we look at:

Case volume.
This is the volume of cases you can realistically expect to perform at the surgery center. The first key area we examine is the level of demand for the service and your ability to meet it. For example, what have been the past case volumes of the surgeons you have on board for the new center? What are the demographics of potential patients relative to your specialty or specialties? If, for instance, your current practice relies on a heavy volume of cataract cases, opening a new ophthalmology ASC in an area with a generally younger population base will probably not be a good fit.

Human resources.
The recruitment challenge is steep and getting steeper. There's usually plenty of case volume to go around, but will you have the nurses and anesthesia providers you'll need to handle them? If so, how much will their services cost you? In the start-up phase especially, you'll have to fight hard for good staff from a variety of sources and clinical backgrounds. As the practice grows, your "product will sell itself" to a greater degree. In a feasibility study, we assess your chances of recruiting the number of quality people you'll need to operate the facility successfully.

Reimbursement climate.
The key to financial solvency is establishing a diverse reimbursement base. When we do a feasibility study, we look at the major managed care and third party payers in the area. Will they commit to work with your facility and, if so, will they give you decent reimbursements? This can be of issue especially if your proposed facility will be in competition with a hospital, although the process is easier than it was in the past. Most payers today are familiar with the benefits of reimbursing cases performed at freestanding centers. Occasionally, however, there are still reluctant players or companies with exclusive policies (such as the infamous Rome, New York case in which an ASC was forced out of business).

Availability of capital.
One of the most important functions that consulting firms perform is exploring the receptiveness of banks and other creditors to provide sufficient financing capital and potential alternative financing options. Your capital piece includes not only design and construction costs but also equipment, supplies and operating capital during the start-up phase.

Access.
This is a much more important issue than location. Patients will go to the center where their surgeon schedules them, but to grow volume, you must be accessible, which is a measure of proximity to major roadways and adequate parking.

Regulatory issues.
This is a broad heading that includes such issues as Stark compliance, HIPAA preparation, ease of compliance with NFPA and OSHA standards and obtaining a Certificate of Need. The CON process differs widely from state to state and is often a massively political process. We gauge potential opposition to your CON application (such as from a competitor) and other possible pitfalls. For example, in Massachusetts, the CON process is much more difficult if there is even a single non-physician partner in the ownership mix. If the practice is entirely physician owned, you could bypass the CON in that state. If not, there is an exceptionally time-consuming CON process to negotiate.