Building an ambulatory surgery center is a business risk. Each year in the U.S., about 100 ASCs open—and the same number fail—according to the August 2015 issue of Outpatient Surgery Magazine. If you’re developing an ophthalmic ASC, you’ve likely already conducted a feasibility study to prove its financial viability. But how else can you ensure your ophthalmic surgery center’s success and longevity? Follow our lead:
Ophthalmic ASC Task List
A profitable ophthalmic ASC is one that you design to maximize efficiency. It gives patients, staff, and caregivers the environment they deserve, says architect John A. Marasco, AIA, NCARB. Here’s where to begin:
Finding the Right Architect for Your Ophthalmic ASC
A knowledgeable firm should have experience designing ophthalmic ASCs. “A truly experienced architectural firm has helped develop 250+ ASCs; not one, five, or even 25. Without hundreds of ASC projects behind them, an architectural firm simply doesn’t have a big enough learning curve,” according to Marasco.
“Don’t rely solely on client testimonials; a satisfied client may not even know what they are missing and [be] perfectly happy with a poorly designed ASC.”—John Marasco, AIA, NCARB
Ophthalmic ASCs necessitate design tweaks that an inexperienced architect could miss. In ophthalmology, you’ll want to have more space for prep than for recovery, especially in the morning. At the end of the day, the opposite may be true. “The pre and post op areas should be developed for flexibility,” advises Larry R. Brooks, AIA, principal of design firm Practice Flow Solutions. “Cataracts are the majority of surgeries in most eye ASCs and that is high volume, doing 20-30 per MD per day. The bays need to be flexible to be used as needed.”
Location, Location, Location
Don’t over-prioritize cost of land, Marasco advises. “Often people just buy what they need and no more and that’s a huge mistake,” he says. Concerned about the cost of not-yet-needed space? You don’t necessarily need to shell out for an expensive, premier commercial lot. It’s not really important that an ophthalmic ASC be highly visible or attract a lot of foot or drive by traffic—that’s not where your business is coming from.
Go Big or Go Home?
There’s no data that tells us the number of ASCs that have failed because they overbuilt, but it’s a common mistake. To right-size your facility, think about your needs, not your wants or expectations, Marasco says. Your architect should be asking a lot of questions about your needs.
Building too big for your case volume can quickly put your ophthalmic ASC on shaky financial ground. Be cautious, make your projections based on the actual cases your physicians do, and then round that number down.
Also look at your physicians’ payer mix, and what types of cases he is doing, and reimbursement trends for those cases. Come up with a conservative estimate, then build based on that.
When you draw up your plans, make sure you’re able to add on to your building later. “It’s far cheaper than starting from scratch,” Marasco notes.
If you buy a piece of property to build on, do your due diligence to confirm zoning requirements. One big mistake? Assuming that a space used for an ASC in the past is automatically qualified to support one now. Zoning requirements and building codes change, and new ownership will trigger the need to meet current specifications. That could be expensive, or even impossible.
Most state health departments have a fairly sophisticated group of people who deal with ASCs. “It is very difficult to stay current on what design/engineering requirements will be enforced when licensing and certifying your ASC,” Marasco notes. If your architects aren’t going to the state to review your plans early and often, they aren’t doing their job. “Missing the mark can be disastrous,” he warns. You’ll need an understanding of local building issues, planning and zoning, parking ratios, loading zones, landscape percentages, waste management systems, and more.
Don’t forget equipment budgeting and planning. Marasco advocates using an independent, experienced equipment planner in conjunction with the early design stages to ensure proper integration of the equipment into the layout. It’s all about limiting staff steps and placing equipment to keep things efficient.
“You are much better off maximizing staff and surgeon efficiency by minimizing their travel distance than you are by minimizing the facility size itself to save costs.”—John Marasco, AIA, NCARB
“The addition of the femtosecond laser has created a little wrinkle in that the surgeon and patient have another stop,” Brooks notes. “We place it so patients can enter from the pre-op area and exit into the clean corridor at the ORs. The surgeon can enter and exit from the clean corridor and stay close to the ORs.”