Ten ASC-focused physicians discuss best practices that contribute to the development and operation of a successful ASC.
1. Fix physicians' problems to attract them to your ASC. To recruit more physicians to your center, Philip Grossman, MD, FACP, FACG, AGAF, FASGE, CEO and medical director of Kendall Endoscopy and Surgery Center in Miami, advises ASCs to think of the fable of the lion and the mouse, in which the mouse fixed a splinter in the lion's paw and was later remembered and rewarded. Find out what the physicians in your community are missing, and fulfill that need, he says. "I've done a tremendous amount of computer consulting at a variety of levels, including healthcare, and I use that as a driving force," he says. "Find out the things that are making life difficult for people and then fix them."
He says these difficulties will vary. "Is it the fact that they go to the hospital and can't start on time? Is it the fact that they don't have a particular piece of equipment that would really allow them to distinguish themselves and their specialty?" he says. "Is it that clerical staff can never get a patient registered without 15 follow-up phone calls?" Physicians will be pleasantly surprised if you fulfill a need they've been struggling with for a long time, and will be more likely to bring cases to your ASC.
From: 5 Proven Ways to Increase ASC Case Volume
2. Stay updated on trends in the device industry. John Cherf, MD, president of OrthoIndex, says although the cost of orthopedics-related supplies, such as implants and other devices, continues to rise, orthopedic-driven ASCs can maintain leverage by learning more about the device industry, as well as effectively coding and managing the cost of orthopedic devices. Orthopedic-driven ASCs can also manage costs by consulting third-party orthopedic technology management specialists.
"A third-party firm can educate ASCs that don't have the experience or knowledge to capture appropriate pricing," Dr. Cherf says. "These firms can help propagate buyer power, develop and manage supply chain contracts, leverage provider alignment, maintain compliance and much more."
From: 5 Ways to Reduce Supply Costs at Your Orthopedic-Driven ASC
3. Work with nurses to draw up patient discharge guidelines. According to Thomas Wherry, MD, medical director for Health Inventures and principal with Total Anesthesia Solutions, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. "Anesthesiologists should help determine discharge guidelines," he says. "Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it's all on [the nurses'] shoulders, they'll take the more conservative approach and keep the patient an extra half hour." He says all these "extra half hours" add up to significant extra staffing hours over time.
To speed up patient discharge and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. "You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged," he says.
From: 6 Ways to Cut Anesthesia Costs in Your ASC
4. Designate a managing partner for an independent ASC. The independent ASC needs a physician-owner who has the interest and the skill set to actively manage the center, says Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich. The managing partner does not need an MBA or even training through the business course, but since the job requires a significant amount of commitment, compensation should be in the six-figure range.. "You can't impose this job on anyone," Dr. Metz says. "It involves a great deal of commitment."
From: 6 Ways to Keep Your ASC Independent and Prosperous
5. Find an administrator with excellent communication skills. To balance the needs of surgeons, anesthesiologists, patients, staff and sometimes a management company or hospital partner, an ASC administrator needs to be able to communicate. Good communications skills also include diplomacy, says Rob Welti, MD, the COO of Regent Surgical Health's Western Region. Dr. Welti began his career as an anesthesiologist and then became the medical director at a surgery center before becoming an administrator himself and then moving to the corporate side of the business. So he knows the business "from the trenches up," he explains. "The first and foremost thing is interpersonal skills, of course," he says. "You have to be outgoing and enjoy working with people."
From: 10 Qualities That Make a Great ASC Administrator
6. Invest in software to facility quality improvement studies. Investing in software can seem daunting, especially for a smaller facility, but software and technology are essential to conducting quality QI studies. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says this technology works best when it is specifically tailored to the needs of the facility.
"We bought various software for the staff to use on their desktops so they can produce meaningful information," says Dr. Dooley. "In some cases, we've had staff members save a document to a hard drive and then someone else accidentally deletes it. We've had to go to a new software system so that accidental deletion doesn't happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don't work. In that case, we've had to switch to a larger database like Microsoft Access."
From: 4 Best Practices for Implementing an Effective Quality Improvement Program
7. Pick the right size space for your ASC. Most ASC industry experts agree that getting the size of your ASC right during the development process is absolutely essential to optimum profits. "There are only two ways to make square footage work: either get it right in beginning, or sublet to make it work later," Jim Reichheld, MD, board-certified gastroenterologist and director of Northeast Endoscopy Center in Lowell, Mass., says. "There are many restrictions on subletting space for other uses, so that can be difficult. Not building a Taj Mahal is critical because your building is a fixed, recurring expense and you can’t change that.
From: 10 Best Practices for Improving GI Efficiency in ASCs
8. Sign or initial approved privileges to keep an accurate record. According to Jack Egnatinsky, MD, one of three medical directors at the Accreditation Association for Ambulatory Health Care, the governing body of an ASC should carefully examine submitted privilege lists before making a recommendation about which privileges a physician should be allowed.
"What typically happens when physicians are applying for privileges is they have a list of privileges they are requesting," he says. "Most of the time, the list is prepared for that specialty, and physicians check off privileges they are qualified to do in the ASC." He says he frequently finds that no one has checked off the privileges they are recommending for approval. To improve this process, someone should sign off on each privilege requested so accrediting bodies understand that the list has been reviewed.
"I recommend that the requested privileges be signed or initialed line by line. I say initials or signature because anyone can mark an "x", and it could be changed or tampered with at some time in the future," he says. "This way it clearly shows that they have reviewed this line by line to make sure that individual is qualified for that privilege."
From: Importance of Outlining Privileges: Q&A With Dr. Jack Egnatinsky of AAAHC
9. Meet with physicians to decide a process for filling out medical records. According to James Leavitt, MD, of Galloway Endoscopy Center, the accurate completion of medical records is essential for an ASC. "We took it very seriously and had a meeting with all the physicians to explain the importance of accurately and completely filling out medical records," he says. "We came up with a process that would ensure physicians follow those standards. Now when physicians are scheduled to do procedures, nurses won't allow patients into the procedure rooms until those charts are updated."
He says the physician office and ASC started using a system called GMed, which allowed physicians to construct a history and physical template and fill in patient records. "Previously, approximately 15-20 percent of our medical records were non-compliant to AAAHC standards, but now 100 percent of our medical records abide by the standards," he says. "The electronic system made it easier for physicians. We were able to develop a process together as a team, which led the physicians to buy into it."
From: Critical Steps to Improving Medical Records: Q&A With Dr. James Leavitt of Galloway Endoscopy Center
10. Consider strategic partnerships. According to Brent Lambert, MD, of ASCOA, ASCs may benefit by entering into strategic partnerships with third-party management companies or a potential joint-venture party. Independent ASCs that go it alone may not have capable billing and collection systems or administrators with managed care contracting experience, both of which are required for success. ASCs need to be realistic about their own capabilities, and seek out third parties for their expertise, when necessary. ASCs should be careful to evaluate any partners as the quality of various management and billing and collection companies varies substantially.
An ASC may also consider bringing in a hospital joint-venture partner. Hospitals are increasingly recognizing the competition ASCs create for them as well as the value and the efficiency of ASC-based outpatient surgery. As a result, they are now more than ever willing to consider partnerships with ASCs. A hospital partnership can bring more patients to a center and may help obtain managed care contracts that would not be available otherwise.
From: 10 Steps to Improving ASC Profitability With Dr. Brent Lambert of ASCOA
1. Fix physicians' problems to attract them to your ASC. To recruit more physicians to your center, Philip Grossman, MD, FACP, FACG, AGAF, FASGE, CEO and medical director of Kendall Endoscopy and Surgery Center in Miami, advises ASCs to think of the fable of the lion and the mouse, in which the mouse fixed a splinter in the lion's paw and was later remembered and rewarded. Find out what the physicians in your community are missing, and fulfill that need, he says. "I've done a tremendous amount of computer consulting at a variety of levels, including healthcare, and I use that as a driving force," he says. "Find out the things that are making life difficult for people and then fix them."
He says these difficulties will vary. "Is it the fact that they go to the hospital and can't start on time? Is it the fact that they don't have a particular piece of equipment that would really allow them to distinguish themselves and their specialty?" he says. "Is it that clerical staff can never get a patient registered without 15 follow-up phone calls?" Physicians will be pleasantly surprised if you fulfill a need they've been struggling with for a long time, and will be more likely to bring cases to your ASC.
From: 5 Proven Ways to Increase ASC Case Volume
2. Stay updated on trends in the device industry. John Cherf, MD, president of OrthoIndex, says although the cost of orthopedics-related supplies, such as implants and other devices, continues to rise, orthopedic-driven ASCs can maintain leverage by learning more about the device industry, as well as effectively coding and managing the cost of orthopedic devices. Orthopedic-driven ASCs can also manage costs by consulting third-party orthopedic technology management specialists.
"A third-party firm can educate ASCs that don't have the experience or knowledge to capture appropriate pricing," Dr. Cherf says. "These firms can help propagate buyer power, develop and manage supply chain contracts, leverage provider alignment, maintain compliance and much more."
From: 5 Ways to Reduce Supply Costs at Your Orthopedic-Driven ASC
3. Work with nurses to draw up patient discharge guidelines. According to Thomas Wherry, MD, medical director for Health Inventures and principal with Total Anesthesia Solutions, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. "Anesthesiologists should help determine discharge guidelines," he says. "Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it's all on [the nurses'] shoulders, they'll take the more conservative approach and keep the patient an extra half hour." He says all these "extra half hours" add up to significant extra staffing hours over time.
To speed up patient discharge and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. "You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged," he says.
From: 6 Ways to Cut Anesthesia Costs in Your ASC
4. Designate a managing partner for an independent ASC. The independent ASC needs a physician-owner who has the interest and the skill set to actively manage the center, says Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich. The managing partner does not need an MBA or even training through the business course, but since the job requires a significant amount of commitment, compensation should be in the six-figure range.. "You can't impose this job on anyone," Dr. Metz says. "It involves a great deal of commitment."
From: 6 Ways to Keep Your ASC Independent and Prosperous
5. Find an administrator with excellent communication skills. To balance the needs of surgeons, anesthesiologists, patients, staff and sometimes a management company or hospital partner, an ASC administrator needs to be able to communicate. Good communications skills also include diplomacy, says Rob Welti, MD, the COO of Regent Surgical Health's Western Region. Dr. Welti began his career as an anesthesiologist and then became the medical director at a surgery center before becoming an administrator himself and then moving to the corporate side of the business. So he knows the business "from the trenches up," he explains. "The first and foremost thing is interpersonal skills, of course," he says. "You have to be outgoing and enjoy working with people."
From: 10 Qualities That Make a Great ASC Administrator
6. Invest in software to facility quality improvement studies. Investing in software can seem daunting, especially for a smaller facility, but software and technology are essential to conducting quality QI studies. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says this technology works best when it is specifically tailored to the needs of the facility.
"We bought various software for the staff to use on their desktops so they can produce meaningful information," says Dr. Dooley. "In some cases, we've had staff members save a document to a hard drive and then someone else accidentally deletes it. We've had to go to a new software system so that accidental deletion doesn't happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don't work. In that case, we've had to switch to a larger database like Microsoft Access."
From: 4 Best Practices for Implementing an Effective Quality Improvement Program
7. Pick the right size space for your ASC. Most ASC industry experts agree that getting the size of your ASC right during the development process is absolutely essential to optimum profits. "There are only two ways to make square footage work: either get it right in beginning, or sublet to make it work later," Jim Reichheld, MD, board-certified gastroenterologist and director of Northeast Endoscopy Center in Lowell, Mass., says. "There are many restrictions on subletting space for other uses, so that can be difficult. Not building a Taj Mahal is critical because your building is a fixed, recurring expense and you can’t change that.
From: 10 Best Practices for Improving GI Efficiency in ASCs
8. Sign or initial approved privileges to keep an accurate record. According to Jack Egnatinsky, MD, one of three medical directors at the Accreditation Association for Ambulatory Health Care, the governing body of an ASC should carefully examine submitted privilege lists before making a recommendation about which privileges a physician should be allowed.
"What typically happens when physicians are applying for privileges is they have a list of privileges they are requesting," he says. "Most of the time, the list is prepared for that specialty, and physicians check off privileges they are qualified to do in the ASC." He says he frequently finds that no one has checked off the privileges they are recommending for approval. To improve this process, someone should sign off on each privilege requested so accrediting bodies understand that the list has been reviewed.
"I recommend that the requested privileges be signed or initialed line by line. I say initials or signature because anyone can mark an "x", and it could be changed or tampered with at some time in the future," he says. "This way it clearly shows that they have reviewed this line by line to make sure that individual is qualified for that privilege."
From: Importance of Outlining Privileges: Q&A With Dr. Jack Egnatinsky of AAAHC
9. Meet with physicians to decide a process for filling out medical records. According to James Leavitt, MD, of Galloway Endoscopy Center, the accurate completion of medical records is essential for an ASC. "We took it very seriously and had a meeting with all the physicians to explain the importance of accurately and completely filling out medical records," he says. "We came up with a process that would ensure physicians follow those standards. Now when physicians are scheduled to do procedures, nurses won't allow patients into the procedure rooms until those charts are updated."
He says the physician office and ASC started using a system called GMed, which allowed physicians to construct a history and physical template and fill in patient records. "Previously, approximately 15-20 percent of our medical records were non-compliant to AAAHC standards, but now 100 percent of our medical records abide by the standards," he says. "The electronic system made it easier for physicians. We were able to develop a process together as a team, which led the physicians to buy into it."
From: Critical Steps to Improving Medical Records: Q&A With Dr. James Leavitt of Galloway Endoscopy Center
10. Consider strategic partnerships. According to Brent Lambert, MD, of ASCOA, ASCs may benefit by entering into strategic partnerships with third-party management companies or a potential joint-venture party. Independent ASCs that go it alone may not have capable billing and collection systems or administrators with managed care contracting experience, both of which are required for success. ASCs need to be realistic about their own capabilities, and seek out third parties for their expertise, when necessary. ASCs should be careful to evaluate any partners as the quality of various management and billing and collection companies varies substantially.
An ASC may also consider bringing in a hospital joint-venture partner. Hospitals are increasingly recognizing the competition ASCs create for them as well as the value and the efficiency of ASC-based outpatient surgery. As a result, they are now more than ever willing to consider partnerships with ASCs. A hospital partnership can bring more patients to a center and may help obtain managed care contracts that would not be available otherwise.
From: 10 Steps to Improving ASC Profitability With Dr. Brent Lambert of ASCOA