7 Essential Factors to Consider Before Acquiring an Ambulatory Surgery Center

If you were to purchase a used automobile, you would look under the hood, test 
drive it and probably have a trusted mechanic thoroughly evaluate the car. If 
you are purchasing a used surgery center, it is critical to give it the same 
kind of scrutiny. Doing so will protect you from pitfalls like failed 
inspections, disruptive shutdowns, loss of revenue, and expensive retrofits.
 
An architect experienced in surgery center design should review the construction 
drawings and inspect the facility as built. The architect will usually bring in 
engineers as well to verify the adequacy of the mechanical, plumbing and 
electrical systems.
 
Following is a short list highlighting seven important types of facility issues 
to be considered when purchasing an existing center.
 
1. Determine whether design regulations have changed since the facility was 
constructed, and if so, whether the facility will be grandfathered under the 
original approvals. Depending on the state, you may have to update the facility 
to meet current regulatory standards, more likely if the purchase is an asset 
purchase than if a stock purchase. Inquiries of regulators should be handled 
discreetly to avoid a possible shutdown if there are serious deficiencies. There 
is a greater likelihood of being required to update if the center ceased 
operation before changing hands. If you will be seeking accreditation, the 
requirements of the accrediting agency must also be taken into account.
 
2. Even if updating is not mandated, patient safety should be taken into account 
when deciding whether or not to upgrade a facility. Whether or not it has been 
accepted by authorities, if the emergency power system is overloaded and does 
not function properly during a power failure, patient safety could be seriously 
compromised.
 
3. The facility obviously needs the capacity for your anticipated case volume. 
Will the numbers of pre-op stations, ORs, procedure rooms and post-op beds be 
adequate? There are rules of thumb for all of these, varying by specialty.
 
4. The ASC must accommodate the specialties you intend to offer. An eye surgery 
facility may not meet the needs of a multi-specialty center. A recovery area for 
orthopedics would need more stations than for cataract surgery; likewise the ORs 
need to be larger. A backup power system designed for local anesthesia would 
probably not be adequate for general anesthesia.
 
5. If the center is to be split away from an adjacent practice office, all of 
the functions required for a surgery center must be present or able to be 
created. Patient pickup space, waiting room and front office are functions that 
are sometimes shared, and it may not be possible to accommodate these after the 
fact. Shared utilities may need to be sub-metered or divided when the ASC 
becomes a separate business entity.
 
6. A common trouble spot is the continuity of fire and smoke partitions, 
particularly in concealed locations like above ceilings. These are common 
targets of officials in life safety inspections and often are the source of 
deficiencies, especially in older facilities.
 
7. The design and condition of the mechanical, plumbing and electrical systems 
should be evaluated by knowledgeable engineers. HVAC systems can be particularly 
problematic with respect to regulatory compliance, infection control, patient 
safety, and physician comfort. We have also too often found that backup power 
systems in older facilities do not even meet code requirements in force at the 
time of construction, let alone current codes.
 
In addition to design issues, the condition of major building components should 
be evaluated. HVAC equipment, emergency generators, and roofing have finite 
lives and can be expensive to replace. Your architectural and engineering 
consultants will be able to comment on this matter, and may recommend 
inspections by local maintenance contractors.