The Case For Equipment Planning

You’ve decided to build an ambulatory surgery center. You’ve agonized over the risk. Excitement about the prospects of independence, freedom, control and even profit fills your thoughts!

Hundreds of key decisions are being made. The right location, the size of building, layout, the structure of the organization, the right partners, financing…etc. all huge decisions. After a while, you start to get comfortable with the process. In fact, you begin to think it’s not all that hard. You can run your clinic, perform surgeries, spend quality time with your family and spend a few more hours each week overseeing the progress of your new ASC. Perhaps you are blessed with a great administrator or a superb nurse who have started up a new ASC before. “No problem! Just delegate! There is no need to spend thousands of dollars on consultants. We can save a lot of money and minimize the risk and do the work in-house.”

This oft-repeated scenario can be a ticket to disaster. In most cases, the ASC gets built but is often needlessly delayed and the process is fraught with cost over-runs. If there are mistakes, time and money can usually fix them. However, the associated stress is an unbelievable burden to you and your staff. Sometimes it leads to good people quitting.

By this time in your career, you have invested a considerable amount of time developing a strong team to run your clinic. Having the right people makes all of the difference in the world. Learn from your experience and apply this same logic to creating a team to build your ASC and you will benefit greatly.

Your team will include many people. The obvious choices are a good architect, an efficient contractor, a banker and a surgical coordinator to run the center.

Stop for a minute and consider what has made you a good surgeon. Experience is often at the top of the list. Your experience tells you instinctively to know when things are going right and what to do when things go wrong. Look for people that have experience building ASC’s.

Building an ASC is likely the most risky and costly investment you have ever made. One of the best investments you can make is to employ the services of people who have experience creating ASC’s. Your team list should also include a development consultant, a policy and procedures expert and a medical equipment planner.

Once you have tried to navigate the bureaucratic morass of CON’s, state and local permits, Medicare, business plans and other government hurdles, it becomes pretty easy to recognize the value of the development consultant. Likewise, considering writing your own policy and procedures manuals is out of the question.

By this time, it feels like you have given in to everyone. “There must be some way to economize…”

“Medical equipment planning can’t possibly be that hard.” With the accumulated experience of your staff it shouldn’t be that hard to order the right equipment. Most of this equipment can be ordered over the Internet!

This is a classic mistake that occurs in many ASC projects. The role of the equipment planner is perceived to be nothing more than an equipment salesman. His or her consulting fee is thought to be nothing more than an unnecessary inflated commission fee on equipment that could have been purchased for far less.

If all I did as an equipment planner is take orders for equipment, I would be the first to admit that it is a waste of money. Most of the time, the doctors I work for never know what I have done for them. It is hard to place a value on preventing something bad from happening but that is what I am most proud of on all of my projects.

The truth is there are literally thousands of different combinations of equipment that could be used to set up an ASC. Most of them will work just fine. As long as you have the proper categories of equipment covered you will be able to perform surgery. Choosing the best ASC equipment is just a small part of what an equipment planner does.

In most cases, the biggest impact I have on the success of a project is in the initial months of design and the rough-in of the building. Architects are given the credit of creating the design for the ASC. What is not generally known is that the architect typically doesn’t know much about the specific equipment that will go into the ASC. The architect’s work is critiqued frequently in the early design phases by the equipment planner, development consultant and a staff nurse. We spend many hours checking to make sure that the conceptual flow of the center works. Sizes are checked and double-checked. Electrical, plumbing and HVAC utilities are scrutinized. Research is done to get the right information to the right person at the right time. In the end, the architect gets the credit.

Any one mistake at this juncture can result in tens of thousands of dollars in cost over-runs and delays at the end of the project. In some cases a mistake can prevent getting certified at all.

The corrections that are fed to the architect by the equipment planner can make the facility far more efficient and a much more pleasant place for staff and patients. Sometimes it is something small like the strategic placement of an electrical outlet to prevent interference or make it easier to access. Other times it is dramatic. For example, knowing how an autoclave is operated and serviced can help determine if the placement of the autoclave in the sterile room will actually work. To miss this key item can cripple an otherwise perfect ASC.

Getting the design right can indirectly save tens of thousands and sometimes hundreds of thousands of dollars worth of cost over-runs, delays and lost revenue. It doesn’t end here. There are many other ways in which an equipment planner impacts the development of the ASC.

Efficient construction demands a tight schedule. Making the right decisions at the right time takes experience. Not all of the equipment needs to be decided at the start. It is crucial to know which items can delay the project. The equipment planner will force the doctor to make the right choices at the right time to keep the construction schedule on track. He can also keep the doctor from spending too much time making decisions on equipment that won’t make a difference.

Announcing that you are building an ASC is akin to throwing blood in the ocean. It will attract sharks! Every salesman in the area will come knocking on your door. The equipment planner can be used as a “professional funnel” to deflect these salesman from your valuable staff time. Salesman can be directed to present their proposals to the equipment planner. The proposal can be summarized and evaluated by the equipment planner for the doctor to review without the hype of a sales pitch(if he or she chooses).

You have a clinic to run and patients to care for. It is important that you not decrease the efficiency (and profitability!) of your clinic at this time by burdening your staff with ASC issues.

Creating purchase orders and paying invoices takes time. These responsibilities are handled by the equipment planner instead of your staff.

Tracking and receiving shipments are also coordinated by the equipment planner. Contractors need specific items at specific times. If a needed item is damaged in shipment or lost, the equipment planner has the relationships and experience necessary to deal with the crisis and keep the project moving. Shipments are tracked. Missing and late arriving items are identified and dealt with. When the project is finished, the equipment planner coordinates the delivery and installation of all the equipment.

I can’t speak for other equipment planners, but I like to be on-site when the equipment arrives. I know what is supposed to be there. I know how to unpack it and I know what to do if something is damaged or the wrong item is delivered. One of the worst things you can do at this point is have a room full of new staff unpacking every box like it was Christmas. Parts get lost and freight damaged items get overlooked. Critical boxes disappear. It is a much more orderly process if I can be there to control it.

I also like to be on-site when the bio-med service provider certifies the equipment to answer any questions. Sometimes they are not familiar with a particular manufacturer and I can save them valuable time by directing them to the proper resources.

In-services need to be coordinated with new staff arrivals. Mountains of cardboard and packing materials need to be removed. I also like to introduce the staff to the new equipment and give them anecdotal information. They also get to associate a person with the equipment so they feel more comfortable calling me when they have problems.

Many months after the center is opened there is still a considerable amount of accounting that occurs. It takes time for all of the vendor invoices to arrive and for all of the minor last-minute equipment issues to be resolved.

Equipment planners have a variety of ways in which they charge for their services. Some companies charge a flat fee and sell the equipment for wholesale. Occasionally a low fee may mean that a planner is being “back-doored” by the vendor with hidden “spiffs.” In some cases, a percentage of the wholesale value of the equipment becomes the fee. Sometimes a discounted retail price is charged for the equipment and the equipment planning fee is rolled into the package price. One way or another, the equipment planner has to make a profit or he can’t survive.

When evaluating the merits of a proposal for equipment planning services for an ASC, remember what it is that you are purchasing. It should not be for equipment only. The real value is in the intangible services that will make your new ASC a success. Interview your potential service provider and be very careful in determining which services will be provided. Find someone who will get involved with the process rather than dropping some equipment on your doorstep. The benefits will be worth it.

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