Whether it is simply pent-up demand or a shift in thinking, physicians and medical groups are showing greater interest in licensing and building private Ambulatory Surgery Centers as part of their practices. Ambulatory Surgery Centers, or ASCs, have been popular for some time as they offer a lower cost alternative to performing procedures and operations in hospital settings. Insurance companies often favor this approach. ASCs offer increased convenience for patients and the centers help generate revenue for physicians that may receive smaller reimbursements for routine services. The ASC licensing, certification and construction pose many challenges. The elements an ASC may need to contain tend to drive up construction costs in an already price inflated market.
Partner with a Surgical Consultant Specializing in ASCs
Before a single screw should be turned, or for that matter, a single line drawn, we recommend doctors contact a specialty surgical consultant like Tina DiMarino of Custom Surgical Consultants www.customsurgicalconsultants.com. Consultants are experienced at listening to the needs and desires of the physician and assessing the viability of the project quickly. These surgical consultants can handle tasks such as determining the proper level ASC, navigating the rules and regulations, obtaining accreditation, and in some instances, proving medical necessity (Certificate of Need). It’s hard to deal with such daunting tasks without a pro at your side. Engaging a surgical consultant is a vital first step towards a successful project.
Create a Comprehensive Design and Construction Team from the Beginning
KasCon uses a “Design-Build” approach, meaning that the design team (architect and engineer) are joined with the contractor at inception to insure a consistent value driven product with single point accountability. We lead the RFP process for design team selection and contract these services directly or simply facilitate and have the medical group hold the design contract. Whatever the preference, the key is to have architect, engineers and contractor work together up front. This group, in conjunction with the surgical consultant, will work to determine the best fit and most accurate preliminary construction cost so informed decisions can be made.
Prepare for ASC-Specific Complexities
The complexity of ASC construction doesn’t end at the licensing and certification issues. These facilities offer a number of building challenges that all must be considered. ASCs require additional space, not only for the operatory or procedure rooms, but for required ancillary functions like pre-op, post-op, and clean and dirty segregated areas. Access is important: can the facility be accessed at grade or will an elevator be needed? If an elevator, is it large enough? What about power? Will a battery back-up system suffice, or will a generator be required? An ASC has HVAC and plumbing demands that exceed those of a medical office. Also, the ability to sanitize floor and wall surfaces require products that may differ from a typical medical office. Other aspects such as fire separation, use of medical gases and the need for automatic doors – just to name a few – must be considered and accounted for in both design and pricing. There will be fewer surprises when you are working with an informed contractor and design team, experienced in ASC projects.
The private ASC offers some great advantages for both physician and patient. The key to making the build process pleasant and cost effective is to gather the right team and allow them to guide you through the challenges, as well as provide information and options for consideration, so the physician can focus on the medical practice.
In our role as commercial General Contractor, we have had the opportunity to see first-hand how strong corporate cultures with solid values drive success both internally and externally.
KasCon has developed a culture over our 20-year history which mirrors those values so vital to establishing and growing our client relationships. The cornerstones of the KasCon culture include transparency, personal and timely communication, empathy, equity and respect.
Transparency is a popular buzz word that captures the importance of playing it straight. On the client side it means just that, providing complete information in a candid and timely way. Within the organization, transparency comes with open and full disclosure regarding expectations, performance and compensation. Open communication is the norm at KasCon, but it is supported by having two sit-down reviews per year with each employee. Everyone knows exactly where they stand relative to expectations and there are no surprises.
Accessibility, timely communication and responsiveness are keys of our client service. When questions or issues arise on a construction project, they are usually time-sensitive; clients need to know they can reach out on the moment and get answers. Internally, our employees feel they can share openly any concerns or issues related to their work and lives. If an employer wants its team to share what factors are affecting performance the firm’s managers need to be accessible and approachable.
Empathy & Equity
A sense of loyalty and respect is generated when communications between client and contractor include empathy. Understanding the pressures the client faces is a key contributor to a successful relationship. The same holds true inside the organization. A climate of caring and understanding facilitates communication and good communication drives performance.
Fairness in the contracting relationship creates a backdrop for a successful project by reducing the need for parties to jockey for position and leverage each other. The result is a win-win arrangement that assures less stress, so common in many construction projects and better collaboration. Individuals within an organization will much more likely thrive in a climate of equitable compensation, merit based evaluations and opportunity.
Building a company culture rooted in values of transparency, accessibility, empathy and equity sets a foundation for success inside and outside the organization. Greater employee satisfaction and self-worth promotes both performance and employee retention. These same values in the marketplace fosters relationships and repeat business. This allows the organization to sustain itself and assure that it will thrive.
While the success of any construction project is based upon a variety of factors, one is that the final product meets the client’s needs and expectations. Obvious? There are some unique aspects of design and construction that don’t make that so simple. Focusing on a few things during the planning or pre-construction process can help ensure that after all of that work, you get what you need and want.
Construction has a language of its own that is further complicated by the use of acronyms and abbreviations that rival our Federal government. As a client, you should no more be expected to understand that language than someone stepping onto a sailboat for the first time should understand “starboard” and “port”.
While we possess the technology for virtual reality tours, the standard construction project is still documented on large format, two dimensional sheets (images) covered with layers of lines, symbols, shading and cross-referenced keys. A complete set of drawings can be daunting to a lay person. Despite this, the client is asked to “sign off” with their approval. Imagine, if you were asked to review your brain MRI and agree to the prescribed treatment without any translation or explanation of the image.
The importance of pre-construction, (getting it right on paper) has only been amplified in the post COVID-19 world as there are far fewer site visits and opportunities to see the product in progress “full scale”. Here are a few things that can be done to dramatically increase the likelihood that when you walk into your completed construction project there are no surprises.
- Architects, Designers, Engineers and Contractors need to be careful about the language and abbreviations they use in client meetings and discussions, not take knowledge for granted and take the time to explain and confirm understanding. As a client, you should not be shy about asking questions or risk glossing over items hoping they will turn out right.
- Everyone has different spatial abilities and talent to discern color and shape in concept. The pre-construction team needs to learn the extent of their client’s abilities and customize presentations to meet those needs. That could mean more samples, visits to other locations to see actual installations, renderings or even mock ups. Ask for more information if you’re not sure about any detail.
- There is no substitute for time. The number one thing an end user can do to facilitate success is to provide the time needed for their input during the entire project, but especially at the onset. A few long and detailed review sessions during pre-construction will save days of anguish later.
- When selecting a design team and contractor there are lots of criteria to consider. Place patience, empathy, insight and willingness to take the time to ensure understanding high on that list. When you check references, asks specifically about those qualities.
Getting what you want at the end of a construction project is possible and any decent construction professional wants to exceed your expectations. Make sure your construction team is presenting details in language you understand, willing to take the time to answer your questions and ensuring you understand the implications of your decisions.