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Renovate or Build New? Points to consider before making a decision BY ROBERT KURTZ


T


hinking about renovating your ASC? Do not be too quick to


break down a wall; you may be wiser to break ground. “The key issue here is if you are dealing with an ASC built under older state and Medicare regulations,” says Ronald Blair, president of Surgery Center Services of America, an ASC management and development com- pany in Mesa, Arizona. “If you reno- vate an ASC that would not meet cur- rent rules and regulations, you may be forced by the state to bring the entire center up to the new codes.” Building


codes for health care


facilities tend to change every few years and are often significant, says John Marasco, principal and owner of Marasco & Associates, a health care architecture and consulting firm based in Denver, Colorado. “We regularly have clients that want to remodel and remain in their facility, but because of what the state would require them to do, the economics do not pan out. It can be a more financially sound deci- sion to start over somewhere else than attempt to stay.” There are other potential challenges ASCs should consider before moving ahead with a renovation, Blair says. “If you are expanding to accommodate a new specialty, can you effectively meet its needs in your current space?” For example, if you are an ophthalmic cen- ter interested in bringing in orthope- dics, your ASC will face greater pres- sure on its recovery area because those stays will tend be longer than your typical ophthalmology case. “You will likely need bigger operating rooms to account for large orthopedics proce- dures and upgraded clean and soiled workrooms to support the new instru- mentation,” he says.


We regularly have clients that want to remodel and remain in their facility, but because of what the state would require them to do, the economics do not pan out. It can be a more financially sound decision to start over somewhere else than attempt to stay.”


—John Marasco, Marasco & Associates Construction has its own set of


issues ASCs must consider, Marasco says. “It is loud, dirty and you have workers coming in and out of the facility at all hours.” You might have to shut down part or all of the facility if you are replacing or adding a large mechanical or electrical system. “Can your ASC afford not to perform proce- dures for a few days or weeks?” There also are surprises that come with renovating. “When you start knocking down a wall or ceiling and examine what is inside, you may discover something different than expected,” he says. “This could force you to shift gears on the run, which will add time and money.” New con- struction surprises, on the other hand, tend to be minimal, and those that come up often have straightforward solutions, he adds. Building a new ASC has its own risks, Blair says. “It will typically cost you more than renovating a facil-


26 ASC FOCUS NOVEMBER/DECEMBER 2018| ascfocus.org


ity you already occupy and may own. Now you are taking on debt to build the new center. The economics—in the form of your taking on a significant number of new cases—must exist to support that new ASC.” The good news is that the higher


investment brings benefits, Marasco says. “When you build new, you get new mechanical, electrical and other systems. Most older centers are fighting their likely outdated systems to meet requirements and their evolving needs.” Do not dismiss the value of a new


facility just because you are fond of your current center, Marasco advises. “Some people will get transfixed on location because of patient and staff familiarity and convenience but ambu- latory surgery is almost entirely a referral business. No one is driving down the street and stopping into an ASC. Do not worry: People will find your new location.”


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