News Room
NEWS ROOM |
| November 6, 2008 |
| 13 Management Companies to Watch |
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Written by Scott Becker for his ASC Review Thursday, 30 October 2008 It would be hard to find better and more hands-on leadership than what Rob Carrera and Rick DeHart and their team bring to ASCs and practices and physician/hospital joint ventures. Aside from management and development, they also have an outstanding focus in central business office functions. They are truly outstanding people and we have seen them in specific action moving challenging projects to closure and helping make them successful thereafter. |
| October 29, 2008 |
| Great Place to Work: Boulder Surgery Center (Boulder, Col.) |
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Written by Rob Kurtz with ASC Communications and Cindy Parsons of the Boulder Surgery Center Monday, 20 October 2008 The Boulder (Col.) Surgery Center (BSC) has made itself a great place to work by focusing on teamwork and keeping the number of staff small so as to encourage closeness and a vested interest in the success of the center, says Cindy Parsons, clinical manager for the center’s PACU. “BSC is the best place I’ve ever worked because of the people with whom I work,” says Ms. Parsons. “We truly do have an all-star team. The physicians have a very collegial relationship with all of us. They are easy to get along with, and they truly care about our business, our staff and our patients.” The center opened in March 2005. It has three operating rooms and a procedure room used for pain management. BSC specializes in orthopedics, podiatry and pain management, and will likely see more than 2000 orthopedic/podiatry patients and 800 pain management patients in 2008. The center is a partnership between the physician owners and Boulder Community Hospital. BSC currently has 15 partners and a medical staff of 55 independent licensed practitioners Staff members work hard during the day to ensure that the center continues to receive excellent patient satisfaction surveys and maintain its commitment to care, as demonstrated by its Joint Commission accreditation. “Our management team holds ourselves and our staff to an above-average standard,” says Ms. Parsons. “People know what the requirements are and strive to achieve them. We are goal-oriented, and it’s just part of the norm to do our best every day. The staff maintains a wonderful balance of being competent, professional and fun.” The owners reward staff members for their work and dedication to patient satisfaction and quality care. “The staff receives bonuses every quarter based on meeting mutually agreed goals,” says Ms. Parsons. “BSC is a very positive and upbeat place to be, and we have an annual holiday party with the physicians and a summer party just for the staff. “It’s the innate commitment we all hold to provide excellent patient care and have fun doing it that makes this the best job I’ve ever had,” she says. |
| October 14, 2008 |
| What do you believe was the top event/issue of 2008 and why, and what will the repercussions be for the industry? and What do you believe will be the most critical issue(s) for 2009 and why? |
| Today's Surgi Center Magazine reached out to our CEO Rick DeHart to ask these two questions. Here are Rick's responses:
Without question, the recent financial market corrections will establish itself as the top event for 2008. The proposed change to CMS language restricting over-night stays is also a heavily weighted issue. The financial market changes will definitely impact many ambulatory surgery centers especially in those situations where business growth is tied to the need to secure capital. Capital needs could occur when making leasehold improvements to your facility or purchasing large equipment items. If your facility is established and possesses a good credit history with a lending institution, then you are probably alright. However, if you are a start-up with questionable cash flow, it will likely be very difficult to obtain the additional capital necessary to sustain your facility. De novo facilities will also be impacted as the financing criteria will change with enhanced scrutiny. If the proposed CMS language change on over-night stay passes, it will have a significant effect on the industry and healthcare in general. Many states have a 23 hour restriction, allowing a significant number of ASCs the option of performing higher acuity cases. The language change will have a huge financial impact on some facilities, removing the higher acuity volume and pushing it back to the hospital setting. This move will not only hurt ASCs but increase the financial burden on the patient. In regard to the question "What do you believe will be the most critical issue(s)for 2009 and why?" Rick responded Politics! The elections and a new president will probably be the most critical issue for 2009. Even though the healthcare proposals from both political parties do not seem to impact the ASC environment, the concern is what could potentially materialize if one party corners the political market. I believe there is a lot of speculation of what might happen but, at this point, the crystal ball is not clear which places us into a “wait and see” mode. |
| October 2, 2008 |
| How Is the Economy Affecting ASCs? |
| Written by Stephanie Wasek
Thursday, 02 October 2008 A recent analysis of claims from 250,000 people in several dozen mid-Atlantic employer health plans suggests that "even people with coverage are cutting back on care," reports the Wall Street Journal. This includes elective surgical procedures. According to the study, conducted for the WSJ by research firm D2Hawkins, knee replacements per 1,000 people fell 18.6 percent between March 2007 and March 2008. The story, which ran on page A10 of the Sept. 22 edition, notes that the "current economic slump's impact on demand for medical services has been surprisingly swift." However, the news is not necessarily all bad for ASCs, and there are ways to minimize the downturn's effect on your facility. Here's some advice from Rob Carrera, president of Pinnacle III. 1. Take advantage of the fourth quarter. "As we reach the fourth quarter, people's deductibles are met, so our centers' physicians report that they're seeing an influx of patients with both commercial insurance and health savings accounts," says Mr. Carrera. With volumes strong through the end of the year, take advantage of the surge and book all the cases you can, while you can. 2. Don't have a false sense of security. While revenue will be coming in on the front end thanks to strong case volumes through the end of the year, now is the time to buckle down in the business office. "Cash collections, and staying on top of them, are the key," says Mr. Carrera. "As the economy starts to stretch people's budgets, they start to make medical bills a secondary expense. You need to make sure patient payment responsibilities are taken care of up front, and to be focused on accounts receivable. You might consider outsourcing billing functions, because you simply can't afford to let those 30- and 60-day buckets push into the 90- and 120-day area. It will kill cash flow." To ensure deductibles and other fees are paid up front, you can offer patients the ability to use credit cards or partner with specialized medical financing companies. One caution on credit cards is that the margins can be low, because a percentage of the charge is deducted; Mr. Carrera suggests avoiding that option unless it makes "the difference in getting the co-pay and doing the case." 3. Prepare for the drop-off. Some specialties, such as plastics — for which the majority of patients are self-pay and the majority of procedures are not medically necessary — are already seeing a drop-off, so you may be tightening the belt in these areas already. However, in the first and second quarters, there likely will be a slowdown; now is the time to brace your center. "Depending on how all this shakes out, there may be some employment concerns for the new year," says Mr. Carrera. "If people don't have jobs or insurance, it could be tight for all of us. Unless we see a turn in the economy in the meantime, people may start putting off some elective things come January, February, March." |
| July 21, 2008 |
| PINNACLE III Welcomes New Director of ASC Billing and Announces the Creation of a New Corporate Position, Vice President of Corporate Finance & Compliance: |
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Due in large part to PINNACLE III’s steady growth, Kim Woodruff, previous Vice President of Business Office Operations at the company’s centralized billing office (CBO), has taken on a new role as Vice President of Corporate Finance and Compliance. In this position, she is responsible for corporate financial oversight, strategic planning, CBO compliance and infrastructure development, product line expansion and development of additional billing service lines. She will continue to provide support to PINNACLE III’s operations team via statistical analysis and financial review. Shawna Burdick, Director of ASC Billing, has assumed responsibility for daily operations of the company’s ASC billing division. She brings over 14 years experience in medical billing for ancillary medical providers, including surgical pathology, laboratory and pharmacy. Shawna graduated with honors from Regis University with a degree in Business Administration and Human Resource Management and is currently pursuing an advanced degree in Leadership and Communication. Shawna is Certified Six Sigma Green Belt and has successfully completed Six Sigma projects assisting in reducing financial liability for facilities, implementing claims tracking processes, and increasing productivity and cash flow. |
| May 12, 2008 |
| Wanted Director of Operations Ambulatory Surgery Division |
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PINNACLE III, an industry leader in turnkey operational development and management for ambulatory surgery centers is seeking an experienced Regional Ambulatory Surgery Center Director of Operations. Specific experience in surgery center or hospital development, management and/or operations is required, along with the ability to travel. Clinical OR experience is preferred. PINNACLE III attributes our outstanding growth to the leadership and dedication of our valued employees. Come join our dynamic team as we continue to grow and excel in the surgery center industry. Please submit resumes by June 6th, 2008 to: bestes@pinnacleiii.com or Fax to 303-683-2748 |
| May 9, 2008 |
| Lisa Austin, RN, Vice President of Operations achieves CASC Recognition |
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Congratulations to Lisa Austin, PINNACLE IIIs VP of Operations for achieving CASC, the credential that connotes expertise in ASC administration. Lisa has been an RN for over 27 years, having worked in ambulatory care for the majority of those years. Lisa’s extensive ASC operational, development, management, and consulting experience provides clients with expertise in facility administration, budget development, regulatory compliance, staff recruitment and retention, equipment procurement, policy and procedure development and implementation, and organizational interfacing. Lisa’s national ASC development and management expertise affords clients, who are opening new ASCs, unparalleled success. Lisa is a board member of CASCA, the Colorado Ambulatory Surgery Center Association, and is currently chairing the committee on Emergency Preparedness Plan for ASC’s in Colorado. Lisa also served as co-chair of the Public Policy Symposium, Government Relations Committee, and is now serving on the Surgery Center Advisory Board of Med Assests. |
| May 9, 2008 |
| Northwoods Surgery Center Opens for Business |
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WOODRUFF, Wis. – Northwoods Surgery Center, an Aspirus Partner, opened for business on March 10, 2008. The 7,349 square foot ambulatory surgery center located at 611 Veterans Parkway features two operating rooms, pre- and post-op recovery space, along with state of the art equipment and the capability to do 23-hour stay. “I am excited to see the Northwoods Surgery Center open,” said Dr. Kevin Tadych, one of the partners in the Northwoods facility. “I am pleased to be able to provide the residents of Lakeland community with exceptional customer service in an outpatient setting committed to providing exceptional, affordable health care.” Northwoods Surgery Center represents a partnership between Dr. Mark Balas, Dr. Tadych, Dr. Michel Gelinas and Aspirus Wausau Hospital, specializing in orthopaedics and ophthalmology. “This was a unique opportunity to establish a partnership with excellent local physicians which aligned our strategic, clinical and business interests,” said Robert Erickson, Senior Vice President of Business Development for Aspirus, Inc. “The project fits perfectly with our mission to offer convenient access to high-quality health care in the communities we serve throughout our growing region." PINNACLE III, the physicians and Aspirus Wausau Hospital began developing the project in June 2006 and PINNACLE III will continue with the day-to-day management of the center. Northwoods Surgey Center passed its AAAHC/Medicare accreditation on April 8 and is currently performing cases. |
| May 9, 2008 |
| Two Key Issues for ASCs: An Interview With Rob Carrera |
| After all these years, physician-driven surgery centers still have to battle to survive in the healthcare marketplace. Currently, there are two key issues ASCs have to be concerned about, says Robert Carrera, the President of PINNACLE III, a provider of consulting and management services to surgical centers through both equity and non-equity models.
First, he says, is the need, on both sides of the equation, for hospital partnership.” We are really seeing hospital-physician joint ventures heat up," says Mr. Carrera. "Hospitals are assessing how they can use outpatient surgery to grow their market share in other areas. I think the savvy ones have realized that they have to partner with physicians to survive." As CMS has added more challenges for physician-driven ASCs to overcome, hospitals are also seeing partnership as "an opportunity to bring physicians in from the cold … instead of reacting to physicians’ going out on their own, which often ends up costing twice as much down the road than it would have been to partner in the first place," says Mr. Carrera. PINNACLE III specializes in services to physician-driven surgery centers in the areas of hospital joint-ventures, turnarounds and hospital outpatient strategies. "Ideally, we come in early in the situation, either on behalf of the hospital or the physicians, and help them define their approach," he says. "We perform feasibility studies and do market research, and help them craft the relationship between the hospital and the surgeons, because surgery is still the strongest area to develop that relationship over the long-term — the question we focus on is where the operation will be in five to 10 years, not how to get the biggest bang for the buck next year." They other key to succeeding in the current ASC market is the age-old problem of getting paid; how you handle coding, billing and collections, especially with the new payment system changes, "There are a large number of facilities struggling with accounts receivable as it is and the changes to the Outpatient Prospective Payment System are only going to make that more acute," says Mr. Carrera. "We offer a centralized billing service, which works particularly great for facilities in areas with fewer resources to choose from. It's hard to find people with expert experience, especially in new centers, and sometimes, it's better to outsource." As an example, he cites an ASC that PINNACLE IIIwas able to help cut A/R days by 33 percent and to help increase the percentage of successful collections on top of that. "And that's simply from diligence, having the expertise and knowing what to look for, ," says Mr. Carrera. "Cash flow improves drastically when accounts receivable days decrease. From an operations standpoint, that in itself can be the difference between paying out healthy distributions and barely paying the bills." |
| May 9, 2008 |
| 7 Accounting Tips to Help Your Practice Be More Efficient |
| Written by Angela Burger and Sheila Wanjiru
Monday, 28 April 2008 It’s easy to get caught up in focusing on the clinical side of your ASC; after all, bringing in procedures and performing them efficiently and at a high level of quality are the foremost keys to producing revenue. But when the cases are done and the patient files turned over to the business office, what can your back office staff do to ensure they, too, perform efficiently and at a high level of quality to complete the revenue puzzle? Here’s a look at seven best practices offered by our experts. 1. Have internal controls in place to ensure money is handled correctly. It’s something all businesses should have: “I always recommend having a lockbox,” says Kim Woodruff, the vice president of business office operations for Pinnacle III’s Central Billing Office. Lockbox banking is a practice in which you rent a post office box exclusively for receiving payments. Your bank then regularly sends a courier to pick up the box’s contents and process the payments directly into your bank account. “The beauty of that is that you don’t have live checks or money orders that are coming into your facility, which, obviously creates great cash control,” says Ms. Woodruff. Because it cuts out the extra step of someone in your office having to take the payments to the bank, “it’s more efficient.” Lockboxes are not necessarily for everyone, however; some smaller facilities may not find it cost-efficient to pay the fees for a lockbox. In those cases, “it’s always important to make sure that the person who’s opening the mail, the person who’s preparing the deposit, the person who’s taking it to the bank, and the person who’s posting the money into the system are different people,” she says. “You just want to make sure you have good checks and balances in place. And in small facilities, that can be hard, which is part of the reason we recommend that you have a lockbox.” The best way to ensure there are no problems with the handling of the money, Ms. Woodruff continues, is to “think about all the things that could go wrong in terms of the actual handling of the cash,” and come up with preventive solutions to minimize the chance of those problems’ happening. The same is true for money leaving your facility, says David Becker, CPA, the accounting director at MedHQ. “The idea is to have a nice separation of duties,” he says. “Identify different duties that should be performed by different people,” and develop guidelines for the different levels of accounts payable in order to “provide a level of internal control.” 2. Employ accrual-based accounting. “The best way to really see how an entity, ingeneral, is doing is by having accounting records that are accrual-based accounting versus cash,” says Mr. Becker. If a facility were to book the revenue as it collects the payments, it would not give an accurate portrayal because the revenues were billed and earned in prior months. In addition, another characteristic of cash based accounting is to not enter the expenses in accounts payable until they decide to pay them. Conceivably, an ASC could book $300,000 collections as revenue (which was really earned probably two months earlier), not book the $250,000 of expenses (bills received, excluding $50,000 labor) incurred that month until the next month, and show $250,000 net income, when really the ASC really broke even that month. “It’s just not the best way of really telling how a service center is really doing,” he adds. The idea, then, he says is to “get the billing in the proper month and the expenses in the proper month. That will really tell you how a center is doing on a month-to-month basis. Accrual-based accounting, hands down, gives you the best picture of how a center is doing.” 3. Take the time to have detailed data and accurate case-costing. “My philosophy on accounting is you can always summarize detail,” says Jeff Boomershine, CPA, of Somerset CPAs. “But if you don’t keep track of the details, you can’t drill down from high-level summarized numbers. If you only put big, summarized numbers into your accounting system, when it comes time to slice and dice it, and analyze the data, the detail’s just not there; whereas, if you take the time to record information at a detailed level, then it’s there when you need it, and you can always summarize it. “It’s best to capture the detail on a daily or other basis, and summarize it as needed, rather than capturing summary data, and then having to go back and dissect it later.” Ms. Woodruff agrees: “You want to make sure that, on your general ledger, you have specific enough categories set up so that you’re actually able to track where your real expenses are.” For example, she notes that there are some medical supplies that are reimbursable, such as implants. Because implants are outside the classification of general medical supplies, often you can get reimbursed for at least part of their high costs on a carve-out basis. “Accounting-wise, I would want to track my implants separately from my medical supplies because you’re not reimbursed separately for medical supplies,” says Ms. Woodruff. “They’re just a cost of doing business.” Mr. Boomershine points out that “one area that is difficult for a lot of ASCs is accurate case-costing or cost-accounting as it relates to individual cases. We like to see accurate costing, not only by specialty, but by physician.” Ms. Woodruff adds that you “want to be able to see whether or not one physician versus another uses a higher-cost drug or higher-cost implant, creating variances in the overall costs of their cases.” If you can allocate those direct costs not only to the right specialty, but also the right physician, then you can compare case cost averages to reimbursements, says Mr. Boomershine. “Keeping track of your operating statistics in terms of labor hours per case and per OR is also important,” he says. “In addition, track your key operating statistics such as room turnover time from the end of one case to when you’re ready for the next case. If your center is able to produce accurate and timely, detailed and summary financial reporting on a monthly basis, that’s generally a good sign they are being managed well.” 4. Divide expenses between variable and fixed costs. When looking at a facility’s expense history and its costs, it is important to be able to divide these out between variable and fixed costs, says Mr. Becker. For example, labor hours are a variable cost and, “your labor should go down if your case load goes down. Now, we can take a look at answering the question, what is our labor cost per case?” Mr. Becker continues. “If we know what our case count is, and we know what our labor cost is, we can start to take a look at that, and see what we can do about reducing our labor cost per case. Maybe the types of cases we’re doing are high-intensity-labor cases; what can do to fix that? We could try to move into other types of procedures that will allow us to compete better.” 5. Regularly analyze payer contracts Keeping track of how payor contracts are performing and being able to accurately report collections are key to quality accounting. “You definitely want to have an accounting-focused review of your payor contracts and know what your fee schedules are, and whom you’re in- and out-of-network with,” says Mr. Boomershine. “Load the anticipated allowed fee for each payor into your practice management system, so that if the payor changes those fees, the practice management system will automatically flag that below-the-expected-amount payment when it comes in. That way, someone can follow up on that and get it corrected or determine why it has changed.” Such a practice compels you to monitor your contracts daily, which is a goal the experts say you should strive for. The big picture for contracts should also be monitored. Often, when payor contracts come up to expire, they automatically renew, Mr. Becker notes. It is therefore beneficial to have an alert system in place that alerts the management team that a payor contract expiration, and possible renewal, is coming up. This lets you know it’s time to pull out the contract and examine the terms; you might find a renegotiation is in order, and you want to have plenty of time to pursue such an action. Otherwise, you may end up with a contract that doesn’t benefit your ASC. “The idea is to alert the administrator or whoever is on the management team that we have a payer contract coming up,” says Mr. Becker. “It’s very critical for the management team to have something like that in place that will allow the management team to renegotiate, get out of bad contracts, do what they need to do so that the center is operating more efficiently.” 6. Take advantage of patient accounting software “I think it’s really important in ASCs that you have ASC-specific patient accounting software,” says Ms. Woodruff. “Practice management software isn’t set up to capture all the nuances of an ASC. It is one of those sectors of healthcare where it does matter whether or not you have software that is set up to track the details you need to track. You want to be able to determine whether your reimbursement is covering your actual costs, and most practice management software systems are not that intricate.” Mr. Becker agrees: “There is new accounting software that will help separate out and even monitor the expenses more efficiently, monitor revenues more efficiently, put a budget in place, and put a business alert system in place.” Building on his previous comments on tracking and analyzing payor contracts, Mr. Boomershine recommends that you seek out ASC accounting software that lets you load your fee schedules. “Some practice management systems do not load the allowed fee schedule for each payor, so when you get the check from the insurance company and the explanation of benefits that comes with the payment, the person doing the payment posting has no idea if that’s the amount that’s in the contract or not,” he says. “That’s obviously not a good situation.” 7. Look to the experts. If you find your business office simply isn’t equipped to handle the high-level accounting running a facility can require, there’s always the option of hiring an accounting firm or consultant. “You have to know how to navigate the system, which is why a lot of people use our business,” says Ms. Woodruff. “It’s just complicated.” If you do go that route, look for ASC-specific experience. In addition, Mr. Becker notes that that hiring an ASC management company can help put new and better practices in place to guide you out of any rut that you may be in. Contact Angela Burger at ab324305@wcupa.edu.This e-mail address is being protected from spam bots, you need JavaScript enabled to view it |