spreadsheets tell you where to look. You use the data to find the
problems and to correct the problems before they fester and
become long-term problems."
Objective benchmarking may be tougher for independent facili-
ties, but it's still crucial. "If you listen to what the staff says all the
time, that's great, because they're the ones closest to the center,"
says Mr. Zasa. "But they don't have perspective. Having an outside
source provides balance and ensures that you're fulfilling your
duty to the center if you're on the governing board."
Organic changes
There have also been centers that did everything right, but still
ended up shuttering their doors.
A surgery center in Oklahoma was closed for 6 months when a
water line running under the edge of the building broke and
began shooting water into the OR in the middle of a case.
Fortunately, the center survived, but as Mr. Péo points out, it's
hard to predict where the next hurricane, tornado or earthquake
may hit. That's why it's important to have business continuity
insurance.
Sometimes there are simply "organic changes in the market,"
says Mr. Zasa. Take so-called economic credentialing, for exam-
ple. Hospitals may buy up groups of physicians and tell them they
can't operate at your surgery center anymore. Or surgeons may
leave the area.
"Years ago, surgeons stayed put," says Ms. Biedermann, recall-
ing the glory days of the Harrison Surgery Center. "But now they
can go anywhere. They have so many more opportunities."
Their leaving is compounded because most fixed costs are left
behind. "Usually it takes 150 to 200 cases a month for a smaller
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