DOING BUSINESS


hospital for those services. A different set of services, however, must be ded- icated to the ASC. ASCs need certain firewall separations that might not have been considered when building the HOPD. A life safety expert should be able to identify what can and cannot be shared between a hospital and an ASC. Engagement of and buy-in into the conversion by surgeons should not be overlooked, particularly if the reason for the flip from an HOPD to an ASC is to offer a joint-venture relationship between the hospital and surgeons. A frustration often expressed by sur- geons involved in such projects is that their opinion on the facility design and related costs were not wholly consid- ered or appreciated. The financial projections for the HOPD conversion must include all renovation expenses, which should be continually updated as more defini- tive costs are determined. Renova- tion decisions are often made with- out a strong understanding of the work required. Once costs are fully calculated and disclosed, everyone involved has “sticker shock.” To build a facility that can truly be a lower cost venue for surgery, which is the point of many HOPD-to-ASC conversions, maintaining the renovation costs at the lowest cost possible will allow the center to open poised in an environ- ment favorable for financial success. The specific location of the HOPD must be assessed to ensure it will work as an ASC. Existing hospital outpa- tient buildings and/or occupied medi- cal office buildings will often contain ORs or procedure rooms in desir- able locations for ambulatory surgery. However, they may be deep within a building and require navigation past other departments. Understand that to renovate such a space might require contractors to enter the building dur- ing off hours or non-peak times, which can extend renovations and cost.


Conversion Due Diligence Exploring whether to convert an HOPD to an ASC will often be a good idea, but a hospital and its physi- cian partners must understand that the facility might not allow for the conver- sion. Even if the conversion is possi- ble, it can be as costly as or even more expensive than a new build. It is important to have someone who understands


ASC regulations


One of the first steps the hospital and physician partners should take before proceeding with an HOPD-to-ASC conversion is to bring in a life safety expert with ASC knowledge and experience.”


— Julie Hamberis, RN Avanza Healthcare Strategies


Then, there is the matter of the


space’s square footage. Since HOPDs tend to be designed by hospital archi- tects, there is often space that would be considered excessive for the converted ASC. As part of the assessment of the space, opportunities to scale back the footprint while still maintaining com- pliance should be considered. Lower- ing the square footage to the minimal amount necessary—while still permit- ting future projected growth—is crit- ical to achieving the cost-effective, cost-efficient design that helps make ASCs successful.


If they can be accomplished with-


out blowing the budget, renovations and an accompanying redesign rep- resent a great opportunity to build in operational efficiencies that might not have been considered when the HOPD was originally designed and built.


at all levels—local, state federal and accrediting bodies—as well as ASC engineering and construction experts assess the facility and determine how much it will cost and how long it will take to convert the facility. This will help greatly reduce the likelihood of significant surprises down the road. Some of the risks associated with not involving these experts early in the


conversion consideration process are ■


Construction renovation budget may significantly impact the financial viability of the ASC.


■


Renovation could take longer than a new build. This is especially impor- tant if surgeons have other opportu- nities for ASC investment.


■


Patients may feel displaced by nav- igating construction zones while experiencing an already anxiety- producing surgical encounter. Opening an ASC that is the result of


a renovated HOPD will take the same thought, planning and early engage- ment with experienced facilities teams as building an ASC from the ground up. Leveraging a multi-faceted team approach that involves ASC experts plus hospital and surgeon represen- tatives should allow the new ASC to best position itself to ensure optimum patient outcomes, a lower cost site for ambulatory surgery and a strong return on investment for the reduced reim- bursement ASC environment.


Julie Hamberis, RN, is a senior consultant for Avanza Healthcare Strategies in Austin, Texas. Write her at jhamberis@ avanzastrategies.com.


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