Here are 10 best practices for achieving improved financial, operational and clinical success from 10 leaders from the ambulatory surgery industry.
1. Establish a plan to reduce medical supply costs over several years. To reduce the amount of money spent on medical supplies, Tom Wilson, managing partner of Monterey Peninsula Surgery Centers and board member of the California Ambulatory Surgery Association, suggests ASCs follow a simple guideline to reduce overall medical supply expenses over a three-year period.
"What our centers have done and what centers should do is reduce the cost of medical supplies by 20 percent in year one, 10 percent in year two and another 10 percent in year three," he says. "Of course, centers can only drive medical supplies costs down so far, but this is achievable. For example, our three facilities perform over 25,000 procedures annually and spend approximately $4,000,000 in supply-related expenses. We were able to reduce this expense by $900,000 in 2010."
From: 5 Things Every ASC Should Do to Reduce Supply Costs
2. Keep an eye on reimbursement and coding changes. Make sure your ASC is up-to-date on reimbursement changes that could benefit or hurt your facility. Michigan Endoscopy Center in Farmington Hills is currently preparing to adjust to the addition of the -PT modifier for free screenings, which will allow screenings that result in polyp removal to still be paid by Medicare. "People have screening benefits, and during their screening we find polyps and remove them," says Brien Fausone, administrator of Michigan Endoscopy. "Then they yell at me, saying, 'I came in for a screening and you coded it for polyps.' Once we take the polyps out, it changes the diagnosis because it's based on the discharge diagnosis, not the admitting diagnosis."
This confusion for patients often means collecting payment is more difficult. Fortunately for GI/endoscopy-driven centers, Medicare's addition of the -PT modifier means screenings that result in polyp removal will still be paid for. By keeping an eye on such changes, your center can make sure to explain changes to patients and prepare for increased or decreased reimbursement.
From: Case Study: 4 Ways Michigan Surgery Center Cut Costs and Improved Profits
3. Pay special attention to the purchasing manager and other business office functions. Hiring a skilled purchasing manager will help keep costs under control, says Tona Savoie, administrative director of Bayou Region Surgical Center in Thibodaux, La. Bayou Region purchases through a GPO and now has an in-house purchasing agent who is devoted to placing orders, staying on top of new vendors entering the market, meeting with physicians to discuss their needs and keeping track of how often certain procedures are performed.
"One of the biggest problems with revenue when a center doesn't do well is because they purchase lots of supplies that their physicians don't use," Ms. Savoie says.
Other key staff positions include a collector to keep on top of billing issues and a business office manager. Diligent collection efforts by the business office staff have helped Bayou Region keep its accounts receivables in the more-than-90-days category below industry standards, Ms. Savoie says.
From: 6 Key Practices for Growing Volume and Profits: Bayou Region Surgical Center
4. Consider payment plans or alternative payments. Melody Winter-Jabeck, administrator at Ravine Way Surgery Center in Glenview, Ill., says if patients find they are unable to pay the rising cost of deductibles for surgery, ASCs should communicate early and often payment plan options or some other flexible payment arrangement to patients. Not offering up alternative payment methods or plans from the start can push back payment collection by a significant number of days, directly affecting the ASC's A/R.
"We are currently looking into setting up payment plans or some sort of financing in cases where there is a financial issue for the patients," Ms. Winter-Jabeck says. "The trend we're seeing is that more and more of the financial responsibility is being put on the patient with higher deductibles and out-of-pocket fees."
From: 5 Best Practices to Improve Your ASC's Revenue Cycle
5. Focus on collaborative teamwork. Although efficiency can be maintained in a wide variety of ways, at the heart of efficiency is collaborative teamwork and a staff with a high level of expertise. The culture of teamwork also should be incorporated and fostered in all other areas of an ASC, whether in an OR, patient waiting rooms or PACU.
"If you ever watch an orthopedic surgical team work together during a surgery, it's always a team process that's occurring in the OR," says Elaine Thomas, administrator at St. Francis Mooresville (Ind.) Surgery Center. "It's all about having a confident and detail-oriented staff so that the physician feels confident during the surgery as well."
From: 3 Success Factors for Orthopedic-Driven ASCs
6. Benchmark patient flow. Benchmarking patient flow involves a number of different things, including measuring where patient flow is most frequently backed up and how long delays are drawn out in certain areas of an ASC. Ms. Twiford says two main areas ASCs should focus on for patient flow is the admit area and the recovery room.
"There may be a back-up in the patient admit area because an ASC has multiple physicians working with patients in multiple rooms, so unless those patients are being moved along efficiently and the physician is keeping on time, you're going to have some delays and irate patients," says Bunny Twiford, RN, president of Twiford Consulting in Warminster, Pa. "Also, a common reason for back-ups in the recovery room is that patients are simply waiting for the physician to come in and discharge them."
The key behind benchmarking patient flow is determining specific patterns and finding the cause of throughput problems. "It's not definitive enough for an ASC to know that it is always backed up on Thursdays. It's better for an ASC to know that it has been backed up in the recovery room every Thursday for the past two months because oftentimes ASCs think it's one problem causing the back-ups when the root of the problem is something totally different," she says.
From: 4 Core Things ASCs Should Benchmark
7. Standardize to simplify processes. Individual departments or surgical teams in surgery centers often perform the same work by using different processes. This variation in processes, from scheduling to equipment used for similar procedures, can be the root cause of these breakdowns of communication.
According to Joshua Manuel, industrial supervisor of IET, a full-service industrial and manufacturing engineering firm that serves healthcare providers, standardization is the best way to keep pathways simple and direct. "Most healthcare leaders understand what it is but not how important it is," he says. "Standardization is really the only way to get control of a process. That way if a problem occurs, you can trace the issue to the step in the process and can adjust immediately."
From: 6 Toyota Production System Concepts to Improve ASC Efficiency
8. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," says Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
From: 3 Easy Steps to a More Effective Quality Improvement Program
9. Appoint a leader to spearhead infection control initiatives. Carol Blanar, RN, CNOR, executive director of the Indiana Federation of Ambulatory Surgical Centers, says this individual does not need to be a certified infection preventionist but does need to demonstrate ongoing training in infection control practices. Training programs are available through various organizations that are reasonably priced, and some programs can be completed online.
From: 7 Steps to Improve Infection Control Programs in ASCs
10. Focus on hand hygiene. ASCs should put up visible signage around the facility to increase hand hygiene compliance among the physicians and other staff members. Karen Smith, nursing director at Central Illinois Endoscopy Center in Peoria, says her center used posters about the hand washing protocols established by the Centers for Disease Control and Prevention and taped them to the walls of the facility. Not only were signs put up to encourage stricter compliance, but each physician and employee also received hard copies of the CDC guidelines. One measure physicians were not complying to, Ms. Smith says, was the regulation of washing hands with soap and water after taking off latex gloves.
"Some of the signs we put up for the physicians were 'Make sure you wash your hands after you take off your gloves' and 'Are you gellin'?' in big bold letters," she says. "We adopted the Dr. Scholl's campaign for the shoe inserts. It's corny, but it works. Once we did that, we all of a sudden saw compliance was really high."
From: Case Study: 6 Practices for Improved Infection Control at Central Illinois Endoscopy Center
For improved financial success
1. Establish a plan to reduce medical supply costs over several years. To reduce the amount of money spent on medical supplies, Tom Wilson, managing partner of Monterey Peninsula Surgery Centers and board member of the California Ambulatory Surgery Association, suggests ASCs follow a simple guideline to reduce overall medical supply expenses over a three-year period.
"What our centers have done and what centers should do is reduce the cost of medical supplies by 20 percent in year one, 10 percent in year two and another 10 percent in year three," he says. "Of course, centers can only drive medical supplies costs down so far, but this is achievable. For example, our three facilities perform over 25,000 procedures annually and spend approximately $4,000,000 in supply-related expenses. We were able to reduce this expense by $900,000 in 2010."
From: 5 Things Every ASC Should Do to Reduce Supply Costs
2. Keep an eye on reimbursement and coding changes. Make sure your ASC is up-to-date on reimbursement changes that could benefit or hurt your facility. Michigan Endoscopy Center in Farmington Hills is currently preparing to adjust to the addition of the -PT modifier for free screenings, which will allow screenings that result in polyp removal to still be paid by Medicare. "People have screening benefits, and during their screening we find polyps and remove them," says Brien Fausone, administrator of Michigan Endoscopy. "Then they yell at me, saying, 'I came in for a screening and you coded it for polyps.' Once we take the polyps out, it changes the diagnosis because it's based on the discharge diagnosis, not the admitting diagnosis."
This confusion for patients often means collecting payment is more difficult. Fortunately for GI/endoscopy-driven centers, Medicare's addition of the -PT modifier means screenings that result in polyp removal will still be paid for. By keeping an eye on such changes, your center can make sure to explain changes to patients and prepare for increased or decreased reimbursement.
From: Case Study: 4 Ways Michigan Surgery Center Cut Costs and Improved Profits
3. Pay special attention to the purchasing manager and other business office functions. Hiring a skilled purchasing manager will help keep costs under control, says Tona Savoie, administrative director of Bayou Region Surgical Center in Thibodaux, La. Bayou Region purchases through a GPO and now has an in-house purchasing agent who is devoted to placing orders, staying on top of new vendors entering the market, meeting with physicians to discuss their needs and keeping track of how often certain procedures are performed.
"One of the biggest problems with revenue when a center doesn't do well is because they purchase lots of supplies that their physicians don't use," Ms. Savoie says.
Other key staff positions include a collector to keep on top of billing issues and a business office manager. Diligent collection efforts by the business office staff have helped Bayou Region keep its accounts receivables in the more-than-90-days category below industry standards, Ms. Savoie says.
From: 6 Key Practices for Growing Volume and Profits: Bayou Region Surgical Center
4. Consider payment plans or alternative payments. Melody Winter-Jabeck, administrator at Ravine Way Surgery Center in Glenview, Ill., says if patients find they are unable to pay the rising cost of deductibles for surgery, ASCs should communicate early and often payment plan options or some other flexible payment arrangement to patients. Not offering up alternative payment methods or plans from the start can push back payment collection by a significant number of days, directly affecting the ASC's A/R.
"We are currently looking into setting up payment plans or some sort of financing in cases where there is a financial issue for the patients," Ms. Winter-Jabeck says. "The trend we're seeing is that more and more of the financial responsibility is being put on the patient with higher deductibles and out-of-pocket fees."
From: 5 Best Practices to Improve Your ASC's Revenue Cycle
For improved operational efficiency
5. Focus on collaborative teamwork. Although efficiency can be maintained in a wide variety of ways, at the heart of efficiency is collaborative teamwork and a staff with a high level of expertise. The culture of teamwork also should be incorporated and fostered in all other areas of an ASC, whether in an OR, patient waiting rooms or PACU.
"If you ever watch an orthopedic surgical team work together during a surgery, it's always a team process that's occurring in the OR," says Elaine Thomas, administrator at St. Francis Mooresville (Ind.) Surgery Center. "It's all about having a confident and detail-oriented staff so that the physician feels confident during the surgery as well."
From: 3 Success Factors for Orthopedic-Driven ASCs
6. Benchmark patient flow. Benchmarking patient flow involves a number of different things, including measuring where patient flow is most frequently backed up and how long delays are drawn out in certain areas of an ASC. Ms. Twiford says two main areas ASCs should focus on for patient flow is the admit area and the recovery room.
"There may be a back-up in the patient admit area because an ASC has multiple physicians working with patients in multiple rooms, so unless those patients are being moved along efficiently and the physician is keeping on time, you're going to have some delays and irate patients," says Bunny Twiford, RN, president of Twiford Consulting in Warminster, Pa. "Also, a common reason for back-ups in the recovery room is that patients are simply waiting for the physician to come in and discharge them."
The key behind benchmarking patient flow is determining specific patterns and finding the cause of throughput problems. "It's not definitive enough for an ASC to know that it is always backed up on Thursdays. It's better for an ASC to know that it has been backed up in the recovery room every Thursday for the past two months because oftentimes ASCs think it's one problem causing the back-ups when the root of the problem is something totally different," she says.
From: 4 Core Things ASCs Should Benchmark
7. Standardize to simplify processes. Individual departments or surgical teams in surgery centers often perform the same work by using different processes. This variation in processes, from scheduling to equipment used for similar procedures, can be the root cause of these breakdowns of communication.
According to Joshua Manuel, industrial supervisor of IET, a full-service industrial and manufacturing engineering firm that serves healthcare providers, standardization is the best way to keep pathways simple and direct. "Most healthcare leaders understand what it is but not how important it is," he says. "Standardization is really the only way to get control of a process. That way if a problem occurs, you can trace the issue to the step in the process and can adjust immediately."
From: 6 Toyota Production System Concepts to Improve ASC Efficiency
For improved clinical outcomes
8. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," says Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
From: 3 Easy Steps to a More Effective Quality Improvement Program
9. Appoint a leader to spearhead infection control initiatives. Carol Blanar, RN, CNOR, executive director of the Indiana Federation of Ambulatory Surgical Centers, says this individual does not need to be a certified infection preventionist but does need to demonstrate ongoing training in infection control practices. Training programs are available through various organizations that are reasonably priced, and some programs can be completed online.
From: 7 Steps to Improve Infection Control Programs in ASCs
10. Focus on hand hygiene. ASCs should put up visible signage around the facility to increase hand hygiene compliance among the physicians and other staff members. Karen Smith, nursing director at Central Illinois Endoscopy Center in Peoria, says her center used posters about the hand washing protocols established by the Centers for Disease Control and Prevention and taped them to the walls of the facility. Not only were signs put up to encourage stricter compliance, but each physician and employee also received hard copies of the CDC guidelines. One measure physicians were not complying to, Ms. Smith says, was the regulation of washing hands with soap and water after taking off latex gloves.
"Some of the signs we put up for the physicians were 'Make sure you wash your hands after you take off your gloves' and 'Are you gellin'?' in big bold letters," she says. "We adopted the Dr. Scholl's campaign for the shoe inserts. It's corny, but it works. Once we did that, we all of a sudden saw compliance was really high."
From: Case Study: 6 Practices for Improved Infection Control at Central Illinois Endoscopy Center