One way to keep your surgical department on the cutting edge is to continually add new services and specialties. Here's what you need to keep in mind when it's time to grow.

Develop a checklist
Launching new services means mastering truckloads of information and remembering countless steps. Regardless of how detail-oriented you or your project manager (think you) are, something is bound to fall through the planning cracks. To wit: We nearly bought a piece of equipment that wasn't compatible with the outlets in our ORs.

To avoid such gaffes, our hospital requires department heads to complete a comprehensive checklist in order to bring a new service or piece of equipment into the organization (download a sample checklist at www.outpatientsurgery.net/forms). It provides a step-by-step guide of what our department needs to accomplish: talking to the information services department to determine computer or networking needs, for instance, or contacting the biomed team for its input when considering the purchase of any new equipment.

The checklist stimulates conversation between departments - something that isn't done enough in hospital settings. Adding new services can affect many departments and managers; the checklist forces us to ask the right questions. Who will be the end users of the service you want to bring in? What equipment is needed? Are there safety concerns? What about marketing the new service - does the marketing team know enough about the new procedure to get the word out to prospective patients?

Seek out your surgeons
Be sure to meet with the surgeon who may have an interest in or wants to bring a procedure to your hospital. In most cases, docs initiate the idea for starting a new service anyway, so rely on their expertise and enthusiasm to further your cause.

Physicians are a great source for what you'll need to know. Ask your surgeons about facilities that perform the procedure you want to add; it makes no sense to call around to other hospitals when a surgeon can quickly tick off a list of HOPDs you'll want to contact. Once you locate another hospital that has the service up and running, go on a site visit and meet with the surgical director. As I'm sure you know from conferences and seminars, talking with colleagues is an ideal way to assess the problems or issues you'll face on the front line.

Surgeons who want to bring a new service line on board can serve as champions for the cause. We relied on one of our physicians to promote our new endovascular treatment for abdominal aortic aneurysm by having him talk to the staff of every key nursing department in the hospital. Not only was the surgeon a very good public speaker, but he also dedicated himself to getting the word out by staying after hours and going to many staff meetings. We also introduced him to representatives from information systems so they could discuss network integration, and he was willing to meet with our corporate compliance officer to discuss reimbursement issues. By the time he concluded his tour of duty, his talks had the desired effect - the entire facility learned about the new things we were doing in the OR.

His talks did something else, too. They generated excitement about the hospital's willingness to expand its presence in our community, and also gave the staff a solid background about the service line we wanted to add. Our nurses got a full explanation of the forthcoming policy and procedures, the benefits the new technology would bring to the hospital, the learning process the staff would face, and the improved outcomes, patient expectations and possible complications associated with the procedure.

So what's the bottom line?
How much will the new service cost? And how much will your hospital make by adding the surgical procedure? I guarantee those questions will be at the top of administration's list of things it wants to know. Researching the financial ramifications is obviously critical.

Our director of surgical services, Brenda Kendall, RN, BSN, MS, is vital to the success of our expansion efforts. She separates the questions and information she wants to gather about new services into specialties throughout our hospital, and then goes to the managers of those departments to inquire about their needs. When Brenda looks at the equipment needed, she asks herself, "Is this feasible?" In other words, is it beneficial to spend her budget dollars on one service, or would the money be better spread throughout the entire surgical department? How many patients or what patient population will benefit the most? Can this procedure be done outpatient, or significantly reduce a hospital stay? Finally, reimbursement codes must be researched fully. For equipment needs the vendor can be of some assistance, but ultimately it is the director's investigative efforts and collaboration with corporate compliance that will make the presentation to the financial officer a sound and accurate one.

To determine our case costs for the procedure we're adding, we proceed with three cases, each with a different payer: usually one under Medicare and the others under a private insurer. About a month after the procedure, we audit the records of those three patients. We check to make sure the proper codes are in place, that we were properly reimbursed and that we achieved the desired outcome.

Performing the audit will tell you - and your hospital's administration - how much your facility will make, what patient outcomes will be and what you need to work on before adding the procedure to your full-time case list. Sounds basic, but also make sure the procedure you want to add has a procedure code or codes already in place. Trying to add a procedure that isn't properly or clearly coded will result in unnecessary headaches caused by cases that are nearly impossible to get reimbursed from the start - and that won't make your quest for approval any easier.

When trying to get the go-ahead from the higher-ups, arm yourself with patient population research and the benefits the new service will bring to your community. As with profit-minded ASCs, hospitals need to be aware of the bottom line, but another concern is improved patient outcomes and how the procedure will benefit the community as a whole. Those valuable factors are still important to hospital administrators and are selling points that will work in your favor when trying to expand services.

Another key selling point for your hospital's financial team: compatibility. Look at the equipment necessary for the service you're adding, and try to purchase items that the hospital's main ORs can use for other types of surgical cases. Your request will be easier to approve if the capital outlay can be spread across different departments in your facility.

Stay current
Above all, be careful in what you decide to add. The new service line needs to serve the community, but it also needs to generate revenue. Work through the checklist, and it will serve you well. We're not going to do every new procedure that comes across our desks, but we want to stay current, and if it makes sense for the hospital as a whole, we'll consider adding it to our case mix.