asc management
We Learn to Operate Efficiently
Many consultants say you can own an ASC if you do 500 cataracts a year. We found a better benchmark.

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

After all of the frustration and complications, we finally arrived at the day when we had been inspected, certified, credentialed, enrolled and licensed by every government agency in the state, and we could actually start conducting normal business in our ASC.

In this month's article, I'll explain the basic philosophy we've used to enable us to operate our ASC efficiently and cost-effectively.

Those of you who've been following our story may remember that we came from a multi-specialty ASC, so we had experience operating in a surgery center and had already made the transition from a hospital-based surgical practice to an ASC-based surgical practice.

While planning our new ASC, we had made a list of all of the things that we liked about the multi-specialty ASC, and another list of all of the things that we would change in our own facility.

Debunking a Misconception

We've had the privilege of hosting doctors and consultants from around the country over the past 2 years and I think the most common misconception regarding owning your own ASC is the sentiment that "I have my own ASC now. I can do cases whenever I want to."

Many ASC consultants use the 500 cataracts per year figure as a benchmark for the number of cases needed to justify opening an ASC. This is a good benchmark number, but more important is the number of cataract surgeries per hour that are performed. Using 500 as a number suggests that if you average 10 cataracts per week, then you're at least breaking even. It's vital to remember that, for the most part, you're paying staff by the hour, anywhere from $18 to $30 for RNs and $100 for CRNAs. If you only do 10 cases in an 8-hour day, then staff costs alone approach 20% to 25% of the gross income for that day, before the cost of IOLs, viscoelastic, surgical packs and other supplies are subtracted. We've settled on 2.5 cases ($2,500) per hour as the break-even point for our ASC.

Scheduling for Profitability

We prepared our budget with the assumption that the only procedures we would perform would be cataract surgeries. If cataract surgery alone couldn't support our plan, we wouldn't have built the ASC.

We believed that revenue from YAGs, blephs, glaucoma and corneal procedures would also be forthcoming, but wouldn't be used to determine financial feasibility. This line of thinking led us to determine that we would schedule surgical "blocks." We would have a morning block of 4 hours and an afternoon block of 4 hours. We further determined that to support a block we would need a minimum of 10 cases.

As we've progressed and become more efficient, we can now schedule four cases per hour. If we perform 16 cases in the morning, we need only four cases in the afternoon to justify opening that block to finish up the day. Our volume has been such that we generally perform 24 to 26 cases every Tuesday, so we're surpassing our block requirement. Procedures such as endocyclophotocoagulation (ECP) have been added to the surgery schedule, but our basic assumptions are still valid and continue to serve as our internal benchmark for productivity.

Space limitations prohibit a step-by-step explanation of how we perform four cases per hour out of our one operating room, but Dr. Patterson will be addressing this in detail during the Academy meeting in Anaheim. He will be speaking at the Bausch & Lomb booth (time will be posted at the booth).

Next month, in the final article in this series, I'll provide an overview of our entire experience, and our most valuable lessons learned.

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.