asc management
It Takes Teamwork to Build an ASC
Key hires included a law firm, architect and ASC consultant. And they were only part of our team.

By Larry Patterson, M.D., and Ray Mays

In part one of this series, we offered an overview of the building process we followed in constructing our new ASC. In this month's column, we'll begin to provide the details of our 2-year project. Our initial priority was assembling a team of professionals to assist us in planning, carrying out and supervising the building process.

Our Team Takes Shape

As we discussed last month, Tennessee is a Certificate of Need (CON) state. We began with hiring an attorney who specialized in the CON application process.

After some research, we located, interviewed and retained an attorney who had successfully prepared and obtained dozens of Certificates of Need for a wide range of healthcare organizations across the state. His firm had complete application packages that outlined exactly the type of information they'd need to prepare our application for state review.

The firm also represented us at the CON hearing before the Health Facilities Board, which is the decision-making body in Tennessee.

To us, hiring the right architectural firm was the most important decision of the entire process. These people become almost a second family over the course of the project, as contact with them is constant.

We talked to several firms, and settled upon Eckert/Wordell, headquartered in Kalamazoo, Mich. We visited some of their previous projects and were impressed with both their building concepts and their "linear flow" concept of patient flow.

It was important to us that the architects not only understood surgery centers and the certificate of need process, but ophthalmology as well. We wanted the firm to be able to work closely with us so that the ASC would look the way we wanted it to look and function the way we wanted it to function.

We also needed -- and chose -- a firm that could work within our budget and be compatible with our local contractor and ASC consultant.

Lessons Learned Early

One of our "lessons learned" was that we didn't include the general contractor early enough in the process. We had almost completed the design of the building when we brought the contractor into the picture. His insight and experience in the local market enabled us to save a tremendous amount of money, but the time needed to redraw the plans cost us several weeks delay.

The last member of our team was our ASC consultant, Dawn Cavanaugh. By the time the consultant comes on board, the project is most likely near completion and several million dollars have been spent. The consultant prepares the center for the state and medicare inspections.

Even a delay of a month in opening an ASC can cost many tens of thousands of dollars of lost revenue. The center must be fully equipped and staffed and be prepared to perform surgeries prior to inspections. We used our consultant to assist us in the interviewing process for our nurse administrator, and also for purchasing of equipment, writing of by-laws, credentialing of staff, writing job descriptions, and overseeing the preparation of our manuals of operation.

Our consultant saved us more money than we paid her. Another lesson learned: We should have brought the consultant on at the beginning of the project instead of near the end.

It Comes Down to Teamwork

In addition to these key team members, we had engineers, designers, ophthalmic industry sales reps, ASC industry reps, and our staff. Building a new facility is a team sport, not an individual one. Next month we'll discuss arranging and negotiating financing.

Larry Patterson, M.D., is practice owner and Ray Mays is practice administrator of Eye Centers of Tennessee, a general ophthalmology practice serving 300,000 residents of middle and east Tennessee. You can reach Ray Mays at raym@ecotn.com.