Become Well-known In Your Hometown
Most people associate health care with hospitals and aren't aware of the benefits of freestanding outpatient surgery centers. Here's some advice for marketing your facility to your community.

The center's owners should go out to educate the public (including local industry, referring physicians and residents) about ambulatory surgery. They can do this by going to different local civic clubs and talking about their centers, working with the local chamber of commerce or having their staff at a health fair to take blood pressures and distribute brochures about the advantages of outpatient surgery. Not only will this potentially bring more patients into your facility, it will also make the self-insured industries aware of how much more cost-efficient you are. That can help you secure more contracts.

You may also want to promote yourself to the local physicians, especially if you're a multi-specialty facility and if there are other places they can perform surgeries. Some great ways to do this are by hosting lunch-and-learn sessions where you educate the schedulers in physician offices about your facility or by going to their practices and meeting them face-to-face.

Gayle Evans, RN, MBA, CNOR
Continuum Healthcare Consultants
Kennesaw, Ga.
gevans@continuumhealthconsult.com

Remember, Patients Are Customers — and Human Beings
Your surgeons are your primary customers, of course, but don't neglect your patients' needs. Recently I visited several facilities, and I was amazed to see how poorly patients are treated over the telephone and, at times, in person. It's not just at the front desk either, because medical personnel seem to ask very few questions to assess the needs of the patient.

We have to remember that not only do patients have a choice of where they receive care as consumers of healthcare services, but also that they are human beings who deserve courtesy and respect. Facilities should periodically survey their patients to find out if they are being treated well and having all their concerns met.

I've seen many facilities do good jobs at customer service but one stands out in my memory. That was the facility that called me back to thank me for having chosen them as the place to have my surgery done.

In the days ahead, with reimbursement changes and new regulations, facilities will have to differentiate themselves from the others. Administrators should review the center's patient satisfaction surveys and put patient customer service at the top of their list.

Cecilia Kronawitter
HDA International
Boca Raton, Fla.
ck@hdaiconsultants.com

Benchmarking Shows the Numbers That Matter
Seek out benchmarking data. If you're not benchmarking your numbers with those of comparable surgical facilities, you have no way of knowing how successful or unsuccessful you really are. Even a figure as important as revenue-per-patient is meaningless unless you can compare it to other centers.

Scott Bergman, MBA
Surgery Center Management Services
Medford, N.J.
sbergman@wagargroup.com

Advice for Picking the Right Consultant
These days, more development and management companies are requiring that they have an equity stake in a new project. However, the amount of equity is often much less than before. Now it's possible to work with a company that will ask for a 10- to 30-percent stake rather than a 51-percent majority that publicly traded companies insist on, says Rick DeHart, CEO of Pinnacle III in Fort Collins, Colo. This flexibility makes creating an corporate partnership more attractive than before. Plus, an equity partner is more likely to stay focused on your center. "It will have an interest in how you do downstream," says Christian Ellison, vice president for business development at Health Inventures in Broomfield, Colo.

Go to industry events and talk with everyone who might deal with a development and management company, including physicians, administrators and vendors. Ask about their experience and reputation.

Many consulting firms exhibit at trade shows, so you can ask questions in a very informal setting, says Tom Michaud, chief executive of Foundation Surgery Affiliates in Oklahoma City, Okla. In the booth, ask if the firm requires an equity share in the facility or if it develops and manages a facility as a fee-only consultant. Find out if you need to own the real estate for the project or if you can lease space. Ask about the management fees once the center is up and running. How much is the management fee, and what is it based on?

Imagine that your daughter announces that she's marrying a man you don't know. "Think about what you'd do to check him out," says Mr. Michaud. That's what you'll need to do with the firms you contact.

Don't skimp on due diligence, says Mr. Michaud. Create a budget of $3,000 or $4,000 for travel expenses to visit the company's projects and offices, and meet with previous clients. When you visit the company's office, ask about the IT technology they use. How are the computers backed up? Which management software programs do they use? Is the software industry-specific? When you visit the facilities, talk with the physicians who perform cases there as well as the administrators.

You don't need to get on a plane to do all your due diligence. Ask for the complete list of physician-partners of any firm you're considering and start calling. Ask each physician-partner to call at least two surgeons, says Jeff Leland, managing partner of Blue Chip Partners Surgery Centers, based in Cincinnati.

Make sure you know who'll be doing the work on your project. Don't base your decision on a good relationship with a sales rep. Often the sales rep just brings in clients and moves on. Get to know the company more intimately. Meet the project managers and the subcontractors that the developer will hire. Make an appointment to talk with the architect, equipment consultants and distributors that the firm uses.

The architect should have experience building a facility similar to yours, in the same state as yours. The same goes for the builder. "Make sure the contractor has done this before, and recently," says Mr. Michaud. Building codes, regulations and the permit process change often. If the contractor builds a facility that's not up to code, your opening date may be delayed.

Local and state regulations and payment structures vary greatly across the nation, so find a consultant that has experience creating and running facilities in your area. Some states are more difficult than others, based on local economics, laws and the mix of private payors.

Find out how deep the consultant's contacts are in the industry, says Gayle R. Evans, RN, MBA, CNOR, CASC, president of Continuum Healthcare Consultants in Kennesaw, Ga. Does the firm have relationships that will enable it to negotiate good pricing contracts with distributors and other vendors?

If a development consultant and equity partner has questions for the physician group, that's a good sign. As an equity partner, the firm should be probing the physicians to gauge their engagement in the project. The firm should ask how many cases and how much time each physician is willing to commit to the project. The firm should also be able to articulate how it will keep physicians engaged. If not, there may be trouble later, says Mr. Leland. "It's all about trust."

— Kent Steinriede

Stay In Close Contact With Your Docs
Don't forget that physicians are your primary customers. Make a routine, conscious effort to keep them informed about all key aspects of your surgery center. Seek their informal and formal input about how the facility is operated. Never inadvertently take any physician for granted or make him feel out of the loop. Some ways to this are:

• Prepare a monthly report for the board. This should provide an update on all financial and operational matters over the past month as well as a category dealing with board education and industry developments. You can also send a copy of this report to the physicians and other key players at your facility.
• Give the physicians copies of the board minutes or standing committee minutes.
• Distribute summaries of patient satisfaction surveys.
• Send out electronic newsletters to highlight your facility's activities.
• Conduct an annual physician satisfaction survey and report the results to all the physicians.

These ideas may not be profound, but the consequences of neglecting physicians can be. The goal is to routinely communicate to make all the physicians involved feel an individual and collective sense of ownership for the facility.

John Smalley
Healthcare Venture Professionals
Franklin, Tenn.
jsmalley@hvpros.com

When to Hire an Administrator?
Your timeline for hiring your administrator depends on your early management strategy. Will a corporate entity work with the partners to complete applications and supply template bylaws, policies and procedures, staffing plans and equipment lists? If so, it's probably sufficient to hire the administrator about three to four months ahead of your planned opening date. If, however, you're planning to have the administrator undertake the above-mentioned items on her own, you'll probably need to bring her on board 6 to 12 months before you open.

Another question when hiring an administrator is whether you'd rather she comes from a clinical or a business background. Each has its pros and cons, and the differences can be seen in consideration of your facility's size, its status as a practice-based vs. freestanding operation and your physician-partners.

Anita Lambert-Gale, RN, MES
Healthmark Partners
Nashville, Tenn.
alambert@healthmarkpartners.com

What to Look for When Reviewing Blueprints
It's amazing the problems you can catch when you review blueprints before construction begins. Some examples:

• Not setting aside spaces for computer and office equipment. There needs to be enough room dedicated for computers. In the office this means allocating a spot for the fax/copier/scanner and making desks big enough for a computer and writing space. Large computer systems for endoscopy may need their own room or at least a lot of space.
• A dedicated space for servers and computer equipment that run the HVAC, phones and computer systems may not be specified on the blueprints. A secure closet is needed for this expensive and sensitive equipment.
• Put additional air conditioning for the servers in this closet. These pieces of equipment generate a lot of heat and the equipment can't be maintained in a hot environment.
• The phone system should be connected to the emergency generator. In the event of a power failure, the phones won't work if not on the generator. Be sure there are enough outlets attached to the emergency generator.
• A sink for washing hands in the soiled utility room is required separate from the other sinks.
• Eyewash stations should attach to manual faucets, not automatic faucets, because the water needs to be able to run continuously for 15 minutes. Also, cabinets or any other obstruction shouldn't hang over the eye wash station.
• The sterilization area also needs additional air conditioning beyond what may be engineered. Sterilizers generate heat and steam, and this room is often very hot during the workday. Temperature control can help you ensure proper sterilization.
• Examine workspaces for traffic flow and plot out what will be done there. Although AAMI's ST79 guidelines include recommended layouts for soiled and clean utility areas, these are frequently undersized because there are no specific size requirements mandated in AIA guidelines. It's best to try and allocate as much space as possible for the instrument processing and decontamination areas of the center.
• Think carefully about the reverse osmosis water conditioning system. First, consider if you really need such a bulky piece of equipment. Test the water in the area where the facility is to be built prior to development to see if the water quality indicates the need for this system, or if the equipment planned for the facility requires a water conditioning system. If it is needed, try to find the best spot where it won't be too unsightly and where it won't be in the way of sterile processing.

Deborah Comerford, BSN, CNOR, CASC
Facility Development & Management
Orangeburg, N.Y.
dcomerford@facdevmgt.com