We just put the finishing touches on our 2012 editorial calendar. Not sure what's harder: planning 12 issues a year in advance or coming up with fresh angles for patient warming (do it!) and smoke evacuation (do it!) stories. Yes, it's a challenge. But it's also a wonderful eye opener, because every year in advance of preparing the editorial calendar, we visit with many of our readers and send out an online survey to thousands of you to find out what's going on in your world, what's keeping you up nights and what's driving you to get to work early most mornings. Here's what you told us.

• Times are still tough. As with most everybody else in our country, you're facing tough economic times. For most facilities, surgical volume is down and in hospitals the inpatient census is down. For obvious reasons, cosmetic surgery has declined, but so has elective insured surgery. The reason: Many patients can't afford the deductible or co-pay. Many have switched to high-deductible plans, except that the patient, not his employer, is responsible for the first $5,000 of cost. Patients are also choosing worse insurance plans that don't cover some services or cover them at a much lower level. On top of all this, the patients you're seeing are sicker, in higher ASA categories, with problems like obesity and diabetes.
• Insurers are playing hardball. Insurers are being stingier and stingier with reimbursements. Your costs are rising, but reimbursements aren't keeping up. Adding to the stress is the cost of compliance with new regulations and accreditation standards. Facilities are having to employ FTEs just to keep up with the paperwork.
• Equipment budgets are on hold. In most facilities, capital equipment is being stretched to the limit. Equipment is in desperate need of replacement, but there's no budget to replace it. The required shift to EMRs is also taking capital that may have ordinarily been allocated to capital equipment.
• Your staff is stressed. The lower volume is contributing to stress on staffing. You're giving fewer hours to nurses and losing them as a result. You're postponing raises. Your staff might be under financial strain because a family member is unemployed.

So, what's a facility manager to do? Plenty. To add revenue, many of you are aggressively working to recruit surgeons, particularly in such revenue-producing specialties as spine, retina, vascular surgery, pain, ENT and general surgery. But the competition for surgeons is fierce. Some hospitals are hiring surgeons and forcing them to take their cases only to the hospital. You're enforcing on-time starts and reallocating block time to the highest-volume surgeons. You're adding new procedures, like unicondylar knee replacement. You're collecting co-pays and deductibles up front. To cut costs, you're aggressively negotiating with implant providers, standardizing all supplies and specialty items, using SUD reprocessing and showing your doctors your costs.

Through the good times and the bad, know that we'll be by your side every step of the way.