“We probably wasted about $250,000 to $300,000 when we built our cosmetic surgery facility. Following these points is a way not to fall into the same pitfalls that we did,” says Mark K. Mandell-Brown, MD, of Cincinnati OH.
Dr. Mandell-Brown’
“We wanted to be within two blocks of a hospital so that if there is ever an emergency we are very close,” he says, adding that the land does cost more.
However for cases, such as for malignant hypothermia, patients can be transported to the hospital in about three minutes.
Proximity is not the only concern when it comes to land acquisition. An environmental study has to be performed, usually at the buyer’s expense. Buyers should make sure that the seller agrees that in the event of any environmental problems they are responsible for clean up. “We bought a little old house and kerosene was dumped there. When the soil borings were done, they found contamination so we went back to the seller and told them to clean it up and of course they didn’t want to. Make sure seller cleanup is stipulated in the contract,” he says.
Design & the Architect
Choosing an experienced architect can be a tricky and expensive proposition. Architects typically charge a minimum of $1000 whether the design is acceptable or not. “We went through three architects to get to what we wanted. We finally found someone who listened to us,” he explains.
Also, it is usually best to demolish an existing building more than 10 years old and rebuild, says Dr. Mandell-Brown, who selected the architect who first wanted to save the building, but later changed his mind.
“We wound up spending $40,000 to try and save money and it turned out we should have just knocked it down in the first place,” he says.
In addition, make sure the architect has experience designing operating room (OR) facilities. (A call to a national association of architects can provide a list of names of architects who have designed medical facilities).
Then go and see the architect’s work to make sure it is functional and acceptable.
Finally, the contract with the architect is very important. “The architect should agree in writing to have the facility meet all the accreditation standards of AAAHC, the national accrediting body, state regulations for ambulatory surgery centers, and Medicare regulations. This needs to be stipulated in the contract,” he explains.
Local Support
Choose people from your own state to support your business. This includes the companies that will provide supplies, maintenance, and consultant services if necessary.
On the recommendation of a colleague Dr. Mandell-Brown hired a consultant from California and paid him $2000 to go over the plans and make sure they were Medicare certified. However, the consultant was not familiar with Ohio law so hiring an experienced consultant from Ohio would have been better. Also, out-of-state consultants will have increased travel expenses.
Outside consultants are not always needed. “Typically if you have questions you can call AAAHC or Medicare or the state bodies and speak to them directly,” he says.
Builder Considerations
There are several different types of standard builder contracts. However, according to the contract, the builder should be held responsible for meeting the standards of Medicare, state, and AAAHC as far as the environment.
Also, check out the builder’s reputation. In Dr. Mandell-Brown’
Despite the added costs and the headaches, Dr. Mandell-Brown is glad he pursued the building of his freestanding cosmetic surgery office.
“We made mistakes along the way, but we finally found a quality builder and we are very happy. Now we have a safe, high quality, gorgeous facility,” he notes.
The facility has received state, AAAHC, and Medicare certification. However, Medicare’s strict evaluation flagged a faulty generator set up and a new system was put in place at the architect’s expense.
Certifications
Only state certification is necessary for a cosmetic facility. However, the more accreditations acquired the better.
When a facility is nationally certified, quality control factors are tracked and the AAAHC evaluates the site every few years. “Typically any malpractice suits are defensible because the standards that are nationally advocated have been achieved and documented,”
Even though the Medicare certification was not necessary Dr. Mandell-Brown wanted it. “Medicare is the most stringent and we thought if we could meet that then we really had a quality center as far as patient safety,” he says.
