Expanding a Surgery Center
By Thomas Mallon,
Regent Surgical Health Chief Executive Officer
Reprinted from Today's Surgicenter, July 2006

In many industries, smaller is in. Yet in ambulatory surgery centers (ASCs), bigger seems to be increasingly common. As more procedures take place in an outpatient setting, operators of surgery centers have expanded their centers to accommodate new physicians and new procedures.

Pain management, gastroenterology (GI) and neurology are just three specialties increasingly involved in ASCs. From 2001 to 2003, outpatient GI procedures covered by Medicare increased by 55 percent from 842,000 to more than 1.3 million.

In addition to new procedures, technology advances are driving expansion of operating and procedure rooms. New equipment - and more of it - calls for larger operating rooms (ORs). And if you are converting an ASC to a physician-owned hospital as we are at Regent Surgical Health, state regulations dictate that ORs get bigger.

At one of our centers in Munster, Indiana, we are preparing to convert to a hospital, which required reconfiguring rooms, adding equipment and improving workflow and patient flow. While the process is time consuming, it has gone relatively smoothly, thanks to clear direction and careful planning.

At one of our centers in Las Vegas, we have added cervical fusion surgery, which requires an extended patient stay of 23 hours. In turn, that calls for a separation between the OR and the recovery area and an additional 3,000 square feet. And as the center takes on more GI procedures, we have had to add a procedure room separate from the three ORs.

If you’re considering a renovation or expansion, here are several issues to consider:

• Hire an architect and general contractor with healthcare experience.
  Designing and building an ASC is a specialized field with state regulations a critical factor in determining what can be done and where. We prefer having one or the other take the lead with a design-build contract. This avoids inevitable finger pointing when the architect and builder disagree.
• Involve staff along with board and physicians.
  Staff members know how the center works and what makes sense for physicians and patients. At Calumet Surgery Center in Indiana, center administrator Denise Cheek posted the architect’s drawings on a wall, prompting a nurse to suggest that a door be moved to improve patient flow. Instead of having to go out a door and down a hallway, the suggestion keeps the patient from being moved into the hall. When you’re upgrading décor, staff can be helpful choosing colors and materials. And it’s a great way to increase morale; everyone likes to be asked their opinion, and more importantly, know that their input was valued.
• Learn to live with delays and cost overruns.
  Construction always takes longer than expected and costs often exceed original estimates. Joe Dylag, administrator for one of our Las Vegas centers, estimates that renovation or expansion will occupy one-third of his time as an administrator.

Expanding a center, or converting from an ASC to a hospital, can be challenging, expensive and time-consuming. Yet it generally means you’re headed in the right direction: a larger facility should mean you’re taking on additional cases and becoming a strong healthcare business. In this case, smaller isn’t necessarily better.