We Have the Answers!
Many physicians interested in building their own ambulatory surgery center have questions like:
- Who will negotiate third party contracts for me?
- What does it cost to build an ASC?
- How many square feet will I need for my specialty?
- Will my case volume support the overhead?
- What kind of overhead could I expect?
- Where do I find all the regulations?
- Where do I find an architect?
- How do I get financing?
- Should I go for single-specialty or find other specialties to partner with me?
- How about partnering with the hospital?
- Where do I start?
Review these common questions and more....
Question: What does it cost to build an ASC?
This is dependent on your location, local building costs and any unique building requirements in your area. The ADA Group, in conducting an interview with you, will help you define your special needs based upon your specialty and volume. We research building costs specific to your area. We are also able to provide information about costs regarding architects and equipment, supplies and instrumentation by performing a thumbnail feasibility for you that identifies all your construction costs, design and development, overhead, staffing needs and equipment costs.
Question: How many square feet will I need?
This is dependent upon your specialty, whether or not you want to bring in other specialties, your projected volume, equipment needs, the number of physicians utilizing the center, staffing, supply requirements, sterilization requirements, the support areas needed to support the services you plan to provide and the local and federal codes defining required spaces.
Question: What about my case volume? Will it support an ASC? What about overhead costs?
The ADA Group analyzes your volume, insurance mix, reimbursement schedules based on the insurance mix and proposed procedures to be performed in the ASC. We compare this to the anticipated overhead expenses to determine profitability. We will guide you to specialties that will enhance the surgery center, and those that will not be profitable.
Question: Where do I find an architect?
The ADA Group can help point you in the right direction with our list of experienced ASC architects. You can also contact the various ASC professional organizations. A word of caution here: You want to make sure you are working with an architect AND construction firm who have adequate experience not only in healthcare design and construction, but in ambulatory surgery centers, specifically. An architect who only has hospital experience may over-design your center, while one who has only ever designed physician office space may grossly under-design the ASC leaving you with a center that does not meet all the requirements for a licensable and certifiable ASC or tearing down walls to get the sterilizer into the sterile processing area, etc.
Question: Where do I find the regulations governing ASCs?
The Medicare regulations can be found in the Federal Register. The Guidelines for Design and Construction for HealthCare Facilities define the construction and design requirements and are used by architects and state agencies reviewing plans. You should also contact your state licensing agency department of plans and construction, or go on-line to their website for the state requirements. The ADA Group offers design review and assistance. We work with your architect bringing to the table the wealth of information we have gleaned from working with over 600 ASCs in the US and abroad.
Question: Where do I find financing?
The ADA Group has found that even with a thumbnail feasibility, local banks continue to finance our physician base in building their ASCs. Most of our physician clients have not elected to partner with hospitals in order to tap into that revenue source. Of course, the more physician partners involved, the less the financial burden is for any one physician. We have also not found it necessary to go to management-owner corporation for funding. The physicians need to remember not to over-design, over-develop, over-equip or over staff while remaining competitive in the market place. Gone are the days when the building of a Taj Mahal impresses patients who may be hard put to come up with their deductibles. Rather, feedback relays to the organization that these patients “now know where their hard-earned money is going.”
Question: Who will negotiate third party contracts for me?
We suggest you hire or contract with an experienced manager for this activity. We suggest you hire an Administrator early in the project to negotiate fees, contact third party carriers and procure workable contracts. Most of these carriers will not finalize their negotiations until you have received your license and
Question: What about Group Purchase Organizations? Should I join one?
The ADA Group always recommends you belong to a GPO. Again, your experienced Administrator, with a strong financial background, can negotiate terms that will be beneficial to your organization.
Question: I understand there is a mountain of paperwork that has to be done to get through all the regulatory bodies. How will I get this done?
The ADA Group will help get all the licenses, CLIA Waivers, CMS, accreditation and other applications completed and submitted.
The ADA Group works with you to develop a complete set of policies and procedures that are fully customized to your organization and the planned services. These policies and procedures are presented to you and your staff on-site in a two-day training and orientation.
We develop your QI, Risk Management, Emergency Response, Infection Control, Biohazard/OSHA, Medication Management, Human Resources, Staff Development/ Inservice/Competency, HIM, Orientation, and Credentialing programs (to name just a few).
Furthermore, The ADA Group will stay with you throughout the years monitoring and updating your programs to ensure ongoing compliance. We put together all your “Officers" Workbooks, employee and physician files and do the credentialing of staff FOR you.
Question: How long does all this take?
You should figure a year for the purchase of the land, the design, plan approval and construction, but this is also dependent on your location. In the U.S. south, physician owners and construction crews aren’t dependent of getting under roof before winter freezes, but they may be concerned about getting under roof before a rainy season starts. Remember that those parking lots have to be poured and both freezing weather and rain can interfere.
The ADA Group provides a time line chart that corresponds to the one provided by your architect and works with you to see that the project moves forward according to the time to the extent natural occurrences, lumber, steel and cement shortages could impact the defined time line.
Question: Where do I start?
Attend national ASC meetings, but be aware that not all speakers presenting papers are experts in their field, and may give out information that is not necessarily so everywhere and for all attendees.
Contact us. We can start you in the right direction by asking you the questions that start to formulate the design and scope of the center.
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