Start: a quick snapshot of your outpatient goals

• How many outpatient surgical cases does your practice schedule in a typical month? Options: 0-10, 11-25, 26-50, 51-100, 100+
• Which specialties or procedure types does your team most commonly send to ambulatory settings? Options: Orthopedics (minor joint), Orthopedics (arthroscopy), Ophthalmology, Gastroenterology/endoscopy, Pain management/interventional, Plastic/cosmetic, Other
• Tell me about the most common patient profile you operate on for those cases, including typical age, ASA class, and notable comorbidities.
• When was the last time limited hospital OR availability forced you to delay or move a case, and what was the practical impact on scheduling and patient care?
• What single concern would make you hesitate to move a case to an ambulatory surgery center? Options: Anesthesia capability for comorbid patients, Lack of essential equipment, Slow credentialing, Unclear transfer protocol, Payer coverage uncertainty, Other
• Would you be willing to switch a recurring block of cases to an offsite ambulatory facility within 8 weeks if credentialing and transfer agreements were confirmed? Options: Yes, Maybe, with conditions, No

Where space, staff, and turnover meet your workflow

• What single mismatch between a facility's layout or staffing and your workflow would make you stop using that site? Options: Inadequate PACU capacity, Insufficient scrub or circulating staff, No dedicated turnover team, Incompatible room setup for specialty equipment, Slow sterilization or supply restock, Other
• Describe the ideal PACU footprint and procedure room turnover time you expect for a standard case in your specialty. Options: PACU bays per OR: 1, PACU bays per OR: 1.5-2, Turnover target under 20 minutes, Turnover target 20-35 minutes, Turnover target over 35 minutes
• How much control over scheduling and room turnover do you need to maintain your productivity targets? Options: Full control of block and start times, Partial control, shared with facility, Flexible scheduling only, I need guaranteed start windows
• Who on your team must be present or have privileges at a facility for you to feel comfortable operating there? Options: The operating surgeon, A dedicated anesthesiologist/team, A scrub tech trained in your implants, A circulating nurse familiar with your workflow, A named clinical director, Other
• When a staffing gap occurs on the day of surgery, what contingency is acceptable before you would cancel or move a case? Options: Swap with another facility staff, Use an approved traveling clinician, Delay by up to 2 hours, Cancel the case, Other
• If the facility uses a different anesthesia model than you prefer, what specific safeguards or agreements would make it acceptable for you to operate there?

Safety and transfers, the nonnegotiables

• Under what circumstances would you refuse to schedule a patient at an ambulatory site even if billing and credentialing are in place? Options: ASA 4 or higher, Uncontrolled cardiopulmonary disease, Anticipated blood loss risk, Need for inpatient post-op monitoring, Complex airway concerns, Other
• Which specific comorbidities or ASA levels do you consider acceptable for same day discharge for your primary procedures? Options: ASA 1, ASA 2, ASA 3 with stable comorbidities, ASA 3 with unstable issues, Not accepted
• Describe the last time a transfer from an outpatient center to a hospital was required, what triggered it, and how long the transfer took.
• Estimate the percentage of your current cases that you would classify as high risk and unlikely to be safe in an ambulatory setting. Options: 0-5%, 6-15%, 16-30%, 31-50%, 50%+
• Who has final say on whether a patient is cleared for an ambulatory procedure in your practice, and could that person veto moving cases to an outside site? Options: Operating surgeon, Medical director, Lead anesthesiologist, Pre-op nurse coordinator, A committee, Other

What's getting in the way now, the real operational blockers

• Name the top three operational hurdles that have blocked you from moving more cases to ambulatory sites. Options: Credentialing delays, Anesthesia coverage, Equipment incompatibility, Payer restrictions, Staffing model concerns, Patient preference, Other
• In the past year, how many of your cases were delayed or rescheduled because of facility constraints rather than clinical reasons? Options: None, 1-3, 4-10, 11-25, 25+
• Why have credentialing or privileging processes been a barrier in previous facility transitions, and who within your practice typically handles escalation?
• List the equipment or supply items you consider non-negotiable for your core procedures. Options: Procedure-specific instruments, Specialized imaging, Procedure carts/kits, Vendor-supplied implants or disposables, Sterilization capacity, Other
• If your primary anesthesiology support were not available on a planned day, would you postpone cases, use an approved backup, or stop operating at that site? Options: Postpone cases, Use approved backup anesthesiologist, Proceed with local anesthesia alternatives, Stop operating at the site that day

The other options you are weighing

• Tell me which options you are actively evaluating today as alternatives to moving cases to an ambulatory center. Options: Remain in hospital OR, Negotiate more hospital block time, Build or buy an ASC, Partner with a different ASC operator, Mobile surgery unit, Delay cases, No change
• Under what conditions would your current approach remain acceptable instead of switching to an outside facility? Options: Stable OR hours and blocking, Improved hospital turnover, No added credentialing burden, Lower patient out-of-pocket cost, Other
• Has anyone on your clinical leadership proposed solving capacity by hiring more hospital OR time rather than partnering with an outside facility? Options: Yes, No, Discussion underway
• Select the single priority that would make you pick the incumbent approach over an external ambulatory partner. Options: Cost predictability, Continuity of care with hospital, Faster credentialing, Better clinical outcomes, Administrative simplicity

Will this actually get done, operational readiness and constraints

• Can your team commit to a single credentialing owner who will complete privileging within 30 days? Options: Yes, identified and committed, Yes, but needs support, No, not currently
• Name the primary clinical and billing systems your practice uses for scheduling, documentation, and claims. Options: Hospital-affiliated EHR, Independent ambulatory EHR, Practice management system, No centralized system, Other
• Estimate how many active providers will need privileges at the site within the first 3 months. Options: 1, 2-5, 6-10, 11-20, 20+
• Is your team's malpractice coverage written to allow operating at an external ambulatory facility, and are there exclusions the seller should know about? Options: Yes, no exclusions, Yes, with exclusions, No, Unsure
• Are there contractual or payer restrictions that would prevent cases covered by your main payer from being performed outside a hospital? Options: Yes, No, Some payers, unsure which
• Provide the name and role of the person who will coordinate logistics with the facility if you move forward.

Decision criteria and signals that move you to yes

• List the top three measurable outcomes that would convince you the ambulatory solution is successful for both patient safety and your practice economics.
• To what extent would a 30 percent reduction in per-case facility cost change your willingness to move cases? Options: It would be decisive, It would strongly influence the decision, Some influence, No material influence
• Identify the approvals or signoffs that must occur inside your organization before you can sign a contract. Options: Clinical director signoff, Legal review, Finance/CFO approval, Payer verification, Board or committee, Other
• Are any of your stakeholders likely to require a pilot or shadow day before approving regular scheduling at a new site? Options: Yes, clinical leadership, Yes, quality/risk, Yes, payers, No, Unsure
• Could you commit to a 90 day pilot with a defined case list and success criteria if operational readiness items are documented and owners assigned? Options: Yes, Maybe, need specifics, No

Next steps, immediate flags, and final blockers

• Before we proceed, name the single highest risk that would stop your team from proceeding within the next 60 days.
• Do you have current copies of provider privileging documents, malpractice certificates, and anesthesia agreements ready to share within 10 business days? Options: Yes, all available, Partial, some documents, No
• Select your preferred timing to start credentialing and onboarding, assuming approvals are signed: within 2 weeks, 2-4 weeks, 1-2 months, or 3+ months. Options: Within 2 weeks, 2-4 weeks, 1-2 months, 3+ months
• Provide any additional constraints, non-negotiable terms, or redlines your team needs addressed before a draft agreement is prepared.

• Facility Experience Session

• Confirm the current state
• You confirm that the demonstrated facility workflow eliminates the scheduling delays and cancellations you described.
• Provide the top three case types and average weekly volume for the cases you want to move to an ambulatory center.
• You confirm that the anesthesia coverage and transfer protocol meet your safety requirements for the identified patient selection criteria.
• Confirm what it is costing you
• Provide your patient selection criteria and the comorbidity thresholds that would require hospital backup.
• Deliver a tailored per-case cost and throughput model for the provided case mix and a comparison to current hospital costs within 5 business days.
• You agree on the remaining evidence and timeline needed to move toward enrollment and a pilot schedule.
• Map one of your typical cases end-to-end in our facility
• Deliver a credentialing and enrollment checklist with estimated timelines and required documentation for each provider type.
• Show anesthesia coverage, escalation, and transfer workflow for higher-risk patients
• Confirm credentialing, privileging, and scheduling cadence
• Propose up to three pilot start dates and associated go/no-go criteria for an initial 4-week pilot of scheduled cases.
• Validate the future state

• Facility Experience Session
• Facility Experience Deck
• Facility Experience Solution Brief

• meeting
• slides
• document

• Per-case operating room access
• Dedicated surgical nursing team
• Ambulatory anesthesia services
• Procedure-specific equipment and instrument sets
• Sterile processing and instrument reprocessing
• Pre-operative clinical testing and medical clearance
• Same-day recovery unit (PACU) care
• Post-operative follow-up visits and wound checks
• Patient financial counseling and price estimation
• Per-case billing and insurance claims submission
• Implant and disposable supply inventory management
• Emergency hospital transfer activation and handoff

Per-case operating room access

• Which case types and example CPT codes do you expect to run per-case (e.g., arthroscopy 298xx, cataract 66984, colonoscopy 45378)? Options: Orthopedic arthroscopy (e.g., 298xx), Cataract extraction (e.g., 66984), Gastroenterology endoscopy/colonoscopy (e.g., 45378), Pain injections/nerve blocks, Plastic/minor procedures, Other
• How many per-case OR hours do you require on average per week? Options: Less than 8, 8-20, 20-40, 40+
• How much lead time do you require to secure a per-case OR slot (for example 48 hours, 1 week)? Options: 24-48 hours, 3-7 days, 2+ weeks
• Who on your team will own day-to-day case scheduling and conflict resolution (role or title)?
• What acceptance criteria will confirm per-case room access is contractually available (for example signed weekly schedule or system confirmation of slots)? Options: Signed weekly schedule, Online system confirmed slots, Both signed schedule and system confirmation, Other
• Are there room configuration changeover tasks we should budget between cases (for example arthroscopy tower setup, microscope repositioning, C-arm drape changes)? Options: Yes, No
• Provide a sample weekly case mix by specialty and average expected room turnover time (minutes).

Dedicated surgical nursing team

• Which nursing staffing model do you prefer for your cases: fixed dedicated perioperative team, rotating pool, or a hybrid? Options: Fixed dedicated perioperative team, Rotating pool, Hybrid
• How many registered nurses do you expect scrub and circulate per OR for high-acuity orthopedic cases versus cataract procedures? Options: 1 RN scrub + 1 RN circulate, 2 RNs scrub/circulate for ortho, Other
• Do your cases require specific certifications for nursing staff (for example CNOR, ACLS, pediatric advanced life support)? Options: Yes, No
• If you answered yes, list the required nurse certifications and minimum years of ASC or OR experience.
• Who should perform pre-op nursing intake calls (facility staff, your office staff, or both)? Options: Facility staff, Your office staff, Both
• Specify the competency checklist items you require completed for each nurse before they work on your cases (for example instrument handling, meds verification, specialty instrumentation).
• Describe any shift or weekend coverage constraints for your surgical nursing team.

Ambulatory anesthesia services

• Which anesthesia modalities must be available at the center (select all that apply: local with sedation, monitored anesthesia care (MAC), general anesthesia, regional nerve block)? Options: Local with sedation, Monitored anesthesia care (MAC), General anesthesia, Regional nerve block (ultrasound-guided)
• Which American Society of Anesthesiologists (ASA) physical status classes will you accept at this ambulatory site (for example ASA I-II, ASA I-III)? Options: ASA I-II, ASA I-III, Up to ASA IV with specific clearance
• How much on-site anesthesia coverage is required per OR (anesthesiologist present, certified registered nurse anesthetist supervised, or anesthesia on-call)? Options: Anesthesiologist present in room, CRNA with physician supervision, Anesthesia on-call only
• Do you require regional anesthesia capability with ultrasound machines and dedicated nerve block kits on site? Options: Yes, No
• Who signs and owns intraoperative airway and emergency anesthesia protocols in your preferred model (role or title)?
• List the anesthesia documentation artifacts you require in each chart (for example anesthesia record, controlled substance log, MAC consent).
• What is the preferred maximum case duration under anesthesia for scheduling at this center (for example under 2 hours, 2-4 hours)? Options: Under 2 hours, 2-4 hours, Over 4 hours

Procedure-specific equipment and instrument sets

• Which procedure-specific items must be present on day one (for example arthroscopy tower, phacoemulsifier, flexible endoscopy tower, portable C-arm)? Options: Arthroscopy tower, Phacoemulsifier, Endoscopy/colonoscopy tower, Portable C-arm, Other
• Which implant handling model do you require: consignment trays, site-owned inventory, or surgeon-owned instrument sets? Options: Consignment trays, Site-owned inventory, Surgeon-owned sets, Mixed model
• Provide a prioritized list of instrument set identifiers or SKUs you need available for initial launch.
• Are there specific instrument case dimensions or weight constraints that affect storage or sterilization workflows? Options: Yes, No
• Specify required preventive maintenance or service documentation for major devices (for example current PM sticker, maintenance contract reference).
• Who will maintain surgeon preference cards and instrument tray configurations (facility staff, surgeon office, vendor)? Options: Facility staff, Surgeon office, Vendor-managed, Shared
• Describe any single-use versus reusable instrument preferences that will affect purchasing or sterile processing.

Sterile processing and instrument reprocessing

• How many instrument sets per specialty do you estimate require daily reprocessing (for example 5 ortho sets/day)? Options: Less than 5, 5-15, 15-30, 30+
• Which sterilization methods do your instruments require (steam autoclave, low-temperature hydrogen peroxide, ethylene oxide)? Options: Steam autoclave, Low-temperature hydrogen peroxide, Ethylene oxide (EtO)
• Do any of your instruments require EtO reprocessing or extended aeration times before reuse? Options: Yes, No
• What turnaround time do you require from dirty tray to sterile ready for reuse between cases? Options: Under 30 minutes, 30-90 minutes, Over 90 minutes
• Please reference your instrument preference cards or note whether trays include single-use items that affect reprocessing.
• What acceptance evidence will confirm sterile processing readiness at go-live (for example biological indicator logs, sterility test records, staff competency records)? Options: Biological indicator logs, Sterilizer PM records, Staff competency checklists, All of the above
• Who will own daily sterilizer cycle documentation and record retention (role or title)?

Pre-operative clinical testing and medical clearance

• Which pre-operative tests are mandatory for your procedures (for example ECG, CBC, pregnancy test, COVID-19 testing)? Options: ECG, CBC/basic labs, Pregnancy test, COVID-19 test, Coagulation panel
• What medical clearance criteria will you accept for ASA III patients or patients on anticoagulation (for example cardiology clearance, INR threshold)?
• Do you require on-site phlebotomy and point-of-care testing or can testing be completed at an external lab prior to arrival? Options: On-site phlebotomy, External lab only, Both options
• Who signs the final medical clearance for cases at this site (surgeon, anesthesiologist, or primary care provider)? Options: Surgeon, Anesthesiologist, Primary care, Other
• What lead time do you require for medical clearance before the scheduled procedure date (for example same day, 1-7 days)? Options: Same day, 1-7 days, 8-21 days
• Do you require all pre-op test results and clearances uploaded to the electronic chart prior to patient registration? Options: Yes, No

Same-day recovery unit (PACU) care

• Which PACU nurse-to-patient ratios do you require for sedation cases versus general anesthesia cases (for example 1:1 for GA, 1:2 for MAC)? Options: 1:1 for GA, 1:2 for MAC, 1:2 for all, Other
• What discharge criteria must be met before release (for example Aldrete score threshold, stable vitals, pain control parameters)?
• Do you require dedicated monitored PACU bays for high-risk or overnight-observation patients? Options: Yes, No
• Who prepares and signs post-anesthesia discharge instructions and prescription orders at the center? Options: Anesthesiologist, Surgeon, PACU RN under protocol, Other
• Estimate average PACU length of stay by case type (for example under 60 minutes for cataract, 60-120 minutes for ortho). Options: Under 60 minutes, 60-120 minutes, Over 120 minutes
• Do you require capability for extended observation beyond standard PACU (for example up to 6 hours) and under what clinical indications? Options: No extended observation, Up to 6 hours, 6-24 hours

Post-operative follow-up visits and wound checks

• Which locations will you use for routine post-op wound checks: the ambulatory center, the surgeon's clinic, or telehealth visits? Options: Ambulatory center, Surgeon clinic, Telehealth, Combination
• Which timeline do you expect for first wound check after discharge (for example 24-72 hours, 7-14 days)? Options: 24-72 hours, 7-14 days, Other
• Do you require the facility to provide suture removal and simple wound care supplies at follow-up? Options: Yes, No
• What documentation artifacts must be retained for each follow-up visit (for example wound photos, nurse note, pain score)?
• Who handles escalation of post-op complications to the on-call surgeon or emergency department referral and how should that communication occur?
• Do you require automated follow-up reminders or two-way patient messaging for post-op symptom checks? Options: Yes, No

Patient financial counseling and price estimation

• Which party should deliver pre-procedure financial counseling: the facility financial counselor, the surgeon office, or both? Options: Facility financial counselor, Surgeon office, Both
• Which pricing artifacts do you require before consent: an itemized estimate, a bundled procedure quote, or an estimated patient responsibility amount? Options: Itemized estimate, Bundled procedure quote, Patient responsibility estimate
• Do you accept upfront deposits or structured payment plans for self-pay patients? Options: Accept deposit, Offer payment plan, Do not accept
• Who verifies insurance eligibility and obtains prior authorizations for specific CPT codes (facility billing, surgeon office, or shared responsibility)? Options: Facility billing, Surgeon office, Shared
• Do you require capture of estimated patient responsibility on a standardized consent or financial form prior to scheduling? Options: Yes, No

Per-case billing and insurance claims submission

• Which payers will the facility bill for the facility fee (for example Medicare, Medicaid, specific commercial payers)? Options: Medicare, Medicaid, Commercial insurers, Self-pay
• Do you require electronic claims submission through a specific clearinghouse or payer portal? Options: Yes, No

• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Fee Schedule & Order Form
• Provider Enrollment & Privileging Addendum
• Billing & Claims Processing Agreement
• HIPAA Business Associate Addendum (BAA)
• Emergency Transfer & Medical Escalation Agreement
• Insurance & Professional Liability Requirements
• Credentialing Authorization & Background Check Release
• Operational Commitments & Performance Targets
• Termination & Transition Plan

• Go-Live Health Check (weeks 1-4)
• First Outcomes Measurement (weeks 4-10)
• Operational Incidents and Corrective Actions Review (monthly)
• Quarterly Outcomes Review

• If any legacy systems remain in use, document the wind-down plan to ensure the team is not split across platforms.
• All incidents are documented and trends for unplanned hospital transfers per 100 cases and anesthesia adverse event rate are tracked against targets recorded in Clinical Outcome Discovery.
• Open corrective actions have agreed closure dates and clear acceptance evidence requirements.
• Emergency transfer arrangements are confirmed operational or a remediation plan is in place with deadlines.
• Complete root-cause analyses for all high-severity incidents and publish the findings with mitigation steps.
• Update the corrective-action tracker with required evidence for closure and target completion dates.
• Schedule and document a transfer protocol simulation if no drill has occurred in the prior quarter.
• Quarterly metrics presentation
• Confirm whether post-op complication rate and cases per OR per day meet targets recorded in Clinical Outcome Discovery or require remediation.
• Prioritized backlog is updated with execution decisions for the next quarter and associated acceptance criteria.
• A clear set of measurable operational commitments and checkpoints for the next quarter is agreed.
• Publish the quarterly outcomes report highlighting pass/fail status versus targets recorded in Clinical Outcome Discovery.
• Move the top three corrective actions into the execution pipeline with target completion dates and verification criteria.
• Re-confirm agreed success criteria and owners
• All go-live success criteria from Clinical Outcome Discovery are re-confirmed with owners, and any gaps are documented.
• Critical blockers are identified, prioritized, and have agreed remediation actions with target completion dates.
• A short-term verification checkpoint is scheduled to confirm remediation progress.
• Publish a launch-gap register with each gap, its acceptance criteria, and a target remediation date.
• Complete any missing provider credential uploads and confirm credentialing status in the credential registry.
• Inventory and replace or loan any missing critical equipment required for committed case types.
• Present first outcomes data vs targets
• Determine whether same-day discharge rate and unplanned hospital transfer rate per 100 cases are on track against targets recorded in Clinical Outcome Discovery.
• Agree a prioritized list of corrective actions with target dates and verification checkpoints.
• Confirm the timeline to the stabilization/acceptance milestone in Go-Live Verification and outstanding dependencies.
• Deliver a corrective-action plan that lists each action, expected impact on the named metric, and a target completion date.
• Adjust staffing or block schedules to address throughput bottlenecks identified in the data.
• Schedule a targeted training session on the revised perioperative workflow to reduce room turnover time.
• Incident log review
• Deployment validation
• Corrective action status
• Detailed review on off-target metrics
• Diagnose gaps and root causes
• Enhancement request and corrective-action backlog
• Agree corrective actions and timelines
• Early operational signals
• Transfer protocol and drill outcomes
• Confirm path to the acceptance milestone
• Escalation and next steps
• Next-quarter operational commitments
• Open blockers and risks
• Agree immediate remediation actions