How important is an ASC administrator? For many surgery centers, they essentially fill the role of CEO. And depending upon the ASC, they could be the CEO of a multimillion-dollar company.
That's why it is imperative that the selection of an administrator is a decision that a center's management should not take lightly. The right administrator can help an ASC maximize its potential, delivering great care and outcomes for patients and a strong return on investment for owners. The wrong administrator can cause an ASC to struggle or even fail.
In choosing an administrator for a new ASC, a fundamental quality you should look for is someone with at least basic knowledge of how a good ASC operates. Some of the best candidates are those who have been "second bananas" at successful ASCs, as they often possess such knowledge and are looking to grow and take on a new career opportunity and challenge.
Beyond this baseline requirement, how you choose the leader of an ASC should depend heavily on the ASC's individual situation and its structure.
Developing ASC
If the leader is going to be expected to obtain the ASC's license, guide the center through successful accreditation, and open the ASC, be sure individuals you are considering have experience in these areas and, ideally, are in the same state as your center. If they lack that experience, then the owners must provide their new administrator with the tools and resources that can help through these tightly regulated events. Depending upon the administrator's knowledge and experience, this may include engaging with an outside consultant for support.
Established ASC
Some people are good "developers," and some are good "operators." For an already established center, choose a good operator. This would be someone with excellent personnel management experience, strong budgeting skills, knowledge about ASC compliance and state and federal regulations, and success in boardsmanship.
HOPD Conversion to an ASC
If you are seeking an administrator to oversee the conversion of a hospital outpatient department (HOPD) to an ASC, look for someone who understands both the hospital and ASC worlds and cultures. This administrator will be tasked with a difficult job: taking a facility that has been operating under one culture and transforming it to a completely different one. This process can be made a bit easier if the leader does not need to bring all the HOPD staff over to ASC. Instead, everyone can apply for a new job in the ASC, thus allowing the administrator to select the staff who understand and are eager to work in the ASC environment.
Administrators overseeing a converted ASC must also have the skills and comfort level to stand up to hospital leadership — and, more often, hospital middle management — who may continue to think of and want to treat the new ASC as a hospital department.
Hospital-Physician Joint Venture ASC
If your ASC is jointly owned by a hospital and physicians, it is best to find someone who knows ASCs well and has also had experience working in or with a hospital. Exposure to hospital culture will help them better understand some of the issues that will likely come up concerning ways the hospital can be a helpful partner and when it is overstepping its "business partner" role. The administrator must also need knowledge of the specific rules governing hospital-physician joint ventures and should keep their ASC's operating agreement close by for regular reference.
Physician-Only Ownership
For ASCs that are solely owned by physicians, the center's governing board — which will most likely be comprised of active surgeons — must be careful not to just look for someone who the surgeons like. They need to look deeper. To keep an ASC running efficiently and cost-effectively, an ASC leader must feel comfortable saying and doing things that are in the best interest of the center, even if these do not necessarily please all the surgeons
Management Company Involvement
When a management company is involved with an ASC, the administrator may not need as much business and regulatory acumen as the leaders of ASCs without this involvement because the management company should bring this expertise to the center. With that said, check the scope of the management agreement to ensure it includes such a level of support. If it does, you should search for an administrator who possesses very strong clinical skills and is able to manage people well, including the ASC's surgeons.
Another piece of advice if you have a management company involved: These companies will often say they will provide the ASC's administrator. If this is the case, check to see if the administrator's salary and benefits expenses are passed on to the ASC. Also, if the administrator is an employee of the management company and not the ASC directly, it may make it more difficult to change the administrator, management company, or both.
Joan Dentler ([email protected]) is president and CEO of Avanza Healthcare Strategies, which provides healthcare organizations with strategic guidance, with a focus on outpatient services. For more than 25 years, Ms. Dentler has been consulting on, developing or operating ambulatory surgery centers, hospital outpatient services and community health initiatives.
