Tackling the Pitfalls and Knowledge Gaps on the ASC Journey

Keep these issues on your radar to prevent time-consuming and costly issues down the road.

The moment the decision is made to build a new ambulatory surgery center there’s a rush to get to the finish line and open up to the public as quickly as possible.

More often than not, however, idealistic early deadlines are pushed back by a series off of challenges stemming from unexpected issues, bureaucratic red tape and an array of unforeseen obstacles. Problems are virtually unavoidable in any new ASC build. The key is knowing ahead of time the types of issues that have derailed your peers’ best-laid plans. Having a plan of your own — and a back-up plan and a back up for the back-up plan — in place will help prevent a disaster.

Here are the ASC construction pitfalls experts see surgical leaders falling for most often — and how to avoid them.

Relying on a team without ASC-specific experience

For various reasons, owners and key stakeholders will rely on a team that doesn’t have an in-depth understanding of the intricacies of surgery center builds. That’s a risk you don’t want to take. “You need to make sure your design team and your construction manager have knowledge and experience as well as a proven track record in constructing ASCs,” says Taylor Cera, MBA, chief operating officer at The Orthopaedic Surgery Center in Youngstown, Ohio. Mr. Cera points to the detailed CMS Life Safety Code guidelines as one of the many reasons why surgery center-specific experience is essential for the members of your design and construction team.

The lack of ASC-building experience is something Jason Miller, chief investment officer for Grand Sakwa Properties, a metro Detroit area real estate investor, owner and developer, has encountered as well. Specifically, Mr. Miller points to construction costs as an issue that can spell disaster for a team that doesn’t have a handle on the ins and outs of the ASC market. Like most real estate projects, Mr. Miller says construction costs for ASCs have exploded in the past few years. “While it may have cost $400-$500 per square foot to build an ASC three to five years ago, I’ve heard of estimated costs nearly two times that amount fora new construction project today,” says Mr. Miller. “And that’s just for the hard costs to build the property — land can be pricey, and there are often challenges inherent to securing permits, entitlements from municipalities, not to mention all the time it takes.”

Failing to right-size your build

One of the trickiest aspects of surgery center construction is striking that delicate balance between sizing correctly for the space you can use immediately without boxing yourself into a facility that’s too small to account for future growth. Mr. Cera puts it bluntly. “Don’t overbuild, but don’t underbuild,” he says, fully acknowledging that this is much easier said than done. Specifically, Mr. Cera believes it’s crucial to focus on the center’s future growth when designing the sterilization area. “If your facility performs or plans to add outpatient spine or total joints, you need to design with enough space and equipment for that,” he adds.

While it may have cost $400-$500 per square foot to build an ASC three to five years ago, I’ve heard of estimated costs nearly two times that amount for a new construction project today.
Jason Miller

As difficult as this is, it’s a mission-critical part of opening a new surgery center. It’s also a perfect example of the importance of having a team in place — from architects, lawyers and construction managers to vendors and facility leaders — that fully understands the subtle nuances of ASC construction.

There are countless stories of overzealous stakeholders who never got that memo about ASC distinctions and failed as a result. For instance, Mr. Miller is currently involved in an ASC project in which an orthopedic surgery tenant was evicted only months after the opening for repeatedly failing to pay rent on the premises.

While it’s impossible to say for sure exactly what combination of problems led to the center’s demise without speaking directly with the evicted ortho group, Mr. Miller sees a lot of signs that space, and subsequently usage, was an issue. “I’m not sure what the original tenant had in mind for this building, but it was clearly for more than just a surgical center,” he says. “The building included five surgical suites, but also 10 prep rooms, 14 exam rooms, an X-ray/MRI room and other support areas. It was on two levels, but built into a berm so both levels were accessible on a grade, and probably two times the size necessary to operate a standard ASC.”

Preempting the problems

A major part of any successful ASC build is avoiding the pitfalls that have caused others to fail — namely not involving the right people and not properly factoring the space needed for current and future growth. But there’s one other piece of advice that Mr. Cera believes all prospective new ASC stakeholders should heed: creating a physician stakeholder committee and including them in every step of the process. “They will be the ones using the facility,” he says. OSM

Note: This three-part article series is supported by Stryker.