To succeed in the ambulatory surgery business, you need to have a solid education, gain valuable experience, make and correct many mistakes, be innovative, work long hours, maintain your integrity and, beyond all else, have a good sense of humor.

Those who've had to sit through one of my presentations (and a special apology to those who've endured several) know that I start each of my talks with several industry definitions, plays on words and twists on acronyms meant to entertain and enlighten. These definitions have taken on some relevance in recent years. I'd like to share a few of my favorites with you. As you'll see, these definitions aren't so far-fetched.

• Gross patient revenue billings/case. The retail price for our services that we'll never experience. Ours is one of the only industries on the planet in which the price you charge for your product or services has little or no effect on your revenues. A 5-percent increase in your fee structure typically translates to less than an effective 1-percent change in collections.
• Net patient revenue/case. The amount just below which a surgery center can make a reasonable profit.
• ASC. Another Skyrocketing Cost Center. It's important that you plan, design, develop, staff, equip and manage your surgery center using a cost-center mentality. The only revenue center in a surgery center is the operating room theater. We sell OR minutes. It's nice to build a surgery center worthy of Architectural Digest; but if you do, just don't plan to make any cash distributions.
• Success. In most industries, success breeds profits. In our industry, success breeds additional, costly regulations. Both public and private purchasers of outpatient surgical services attempt to place a governor on our ability to make a profit. After all, if we're making a profit, something must be wrong.
• HIPAA. Huge Incentive Payments to various Professionals Across America. Even Congress admits that the Health Insurance Portability and Accountability Act might have gone too far and places a significant burden on healthcare providers. The costs associated with compliance are greater than anyone projected, and the resulting effectiveness debatable. It has, however, been great for a number of professional service firms.
• Partnership or joint venture. Two or more parties coming together and agreeing to give up something. There is no such thing as a "win-win." While negotiating hospital-physician joint-ventures, the parties need to direct their efforts at what they're willing to give up, rather than trying to get more or gain the advantage. The challenge is agreeing on who owns what: cases, staff, contracts, site, franchise value or management expertise.

Here's one final definition...

• Optimist. One who believes both hospitals and physicians will come to realize they - and the patients they serve - are infinitely better off working together under the right terms than competing.