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Catherine Sayers Archives - Pinnacle III

Sep 28
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When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

By ASC Management, Uncategorized No Comments

A patient comes into your ASC and undergoes a screening colonoscopy. Polyps are found during the procedure and are removed. Considering the circumstances, this sounds like good news. The screening served its purpose. You detected and removed cancer precursor lesions, hopefully helping to prevent the disease.

There’s just one problem: The patient is angry. Not about the successful removal of the polyps, but about how a change in type of procedure also changed the patient’s financial responsibility. A scheduled screening colonoscopy has become a diagnostic colonoscopy. Rather than being a preventative service provided at no cost to the patient after their insurance has processed the claim, the patient now owes a payment – possibly one considered quite significant.

Guidance for Screening Colonoscopy Education

By taking a proactive approach to colonoscopy education, your ASC can help reduce its number of upset patients. You may even improve their satisfaction in the process. Here are some recommendations on how to help patients understand their potential financial responsibilities before undergoing a colonoscopy.

Develop Documentation

Alleviate some of the confusion about colonoscopies by providing patients with documentation explaining possible outcomes of their screening colonoscopy. Share background on preventative services, noting limitations on this provision. Explain how the definition of a preventative service is adjusted due to changing (and strict) insurance guidelines. Elaborate on how this may affect patients scheduled for a screening colonoscopy and their financial responsibility. Define the categories of colonoscopies: screening/preventative, diagnostic/therapeutic, and surveillance/high-risk.

This background information will hopefully help patients gain a better understanding of colonoscopies. Then summarize what can happen when patients receive a screening colonoscopy referral. Describe how categorization can change based on information captured during the scheduling and pre-procedure processes. Consider addressing some frequently asked questions, such as whether physicians can change a diagnosis so a procedure can qualify as screening and why insurance companies may seem to indicate that your ASC can alter a CPT or diagnosis code.

Share Benefits Information

Along with this documentation, provide patients with information about their colonoscopy benefits. Give your benefits coordinator a form to fill out when they review coverage information online and/or contact patients’ insurance carriers. This form would include details on patients’ covered benefits concerning screening and diagnostic colonoscopies. It would also state patients’ financial responsibilities (or potential responsibilities), broken down by co-pay and deductible.

You may want to include details about payment plans your ASC offers on this form. This can help patients start planning how they will pay for their care if the colonoscopy categorization changes. Include this form with the background documentation.

Speak Directly With Patients

While these documents should better prepare patients for their colonoscopy and possible financial outcomes, calls to patients are also worthwhile. Use this opportunity to review the information in the documentation and form. Ensure individuals at your ASC who speak with patients can explain the difference between screening and diagnostic colonoscopies. Staff should receive training to help them effectively communicate with patients and accurately answer questions.

Quick Tips for Dealing With Upset Patients

Despite your best educational efforts, you may still receive phone calls from upset patients following their colonoscopy. Consider following these steps to help address their concerns:

  • Let them vent. If patients sound animated, give them time to share their thoughts and feelings. Avoid interrupting and try to respond only when asked a question. Giving patients this opportunity to vent can help them calm down and become more focused on the discussion to follow.
  • Remain polite. Throughout your conversation, strive to remain polite, listen carefully and remain calm. If patients believe you are becoming frustrated, not listening closely, or failing to take their concerns seriously, they are likely to become angry.
  • Review case history. Help patients feel like you take their concerns seriously by discussing the details of their situation. Pull up their chart and bill. Talk through the procedure: what was scheduled and found, and how that affected information submitted to their insurance carrier. Verify that your ASC properly coded and billed the procedure.
  • Explain insurance rules. After discussing the case history, patients may still question what they owe. Describe health insurance rules and how they dictate changes in colonoscopy categorization. Provide education on diagnosis codes and your ASC’s requirements to code based on the procedures performed, not scheduled. Discuss the claims submission process and how that triggers the health insurance reimbursement process. Note: If patients spoke with their insurance before you, they may have been told that had you coded the procedure as a screening colonoscopy, it would have been covered. Be prepared to explain the potential fraud implications of improper coding and billing.

Going through these steps can provide comfort to patients and help them better appreciate your ASC’s responsibilities. Once you address any outstanding questions, move to the discussion about how patients will cover what they owe. Be cognizant that patients may be in a delicate state as they come to accept their financial responsibility. Help relieve some stress by informing them of payment options that can spread their financial responsibility over time. While patients may express displeasure with what they’re hearing, patience and compassion can move the situation toward a positive resolution.

Catherine Sayers, Director of Operations

Jun 13
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Strengthening ASC Communications with Physician Practices

Strengthening ASC Communications with Physician Practices

By ASC Management, Leadership No Comments

Physician practices hold a key role in determining the success of an ASC. Because a primary ASC business driver is the center’s partnered physician practices, prioritizing good ASC communications with physician practices is a must. Making it easy for practices to schedule cases at your ASC will increase the likelihood of capturing volume. Critical to achieving this with ease: strong ASC communications with affiliated practices.

When your surgery center develops effective communications with physician practices and their staff, the benefits are typically widespread. Scheduling is streamlined. Information sharing becomes more seamless. Questions – from patients as well as ASC and practice personnel – receive prompt answers. Surgeon satisfaction increases.

These factors contribute to the likelihood that practices will schedule cases at your ASC. They also help support the delivery of exceptional care and a great patient experience at the ASC and practice.

Guidance to Boost ASC Communications

Follow these tips to improve your ASC communications with practice personnel.

Develop strong administrative relationships. When the administrative leaders of ASCs and practices work well together, this creates a foundation for a successful partnership. Whoever manages the daily operations of your ASC should get to know the practice manager(s). Schedule a time to meet, perhaps over lunch, to discuss ways in which the organizations can work more effectively together.

Don’t just make the meeting about work. Sharing and learning some personal information can help create stronger bonds and even friendships.

Schedule social outings for front office staffs. Practice schedulers often have significant control over where their surgeons perform procedures. When schedulers think favorably about a facility, they may be more inclined to direct cases to that organization rather than a competing facility.

Consider arranging a meal or happy hour for practice schedulers and your ASC’s front office personnel. This is an opportunity for individuals working together virtually to learn about each other and put faces to names.

Hold periodic front office staff meetings. While social engagements can help bring different office staffs together, they’re typically not ideal for addressing areas for improvement. Notice a decline in scheduled cases tied to a specific practice or physician? Unsure why cases appropriate for your ASC are scheduled elsewhere? Try to arrange a meeting between the front office staff in your ASC and the practice’s front office employees. This creates an opportunity to discuss what’s working and what isn’t. Ask what you can do to improve your ASC communications and help the practice. Use the meeting to brainstorm ways to resolve problems and create better efficiencies.

Celebrate together. If your ASC hosts a summer picnic or an annual holiday party, consider extending an invitation to the staff of your affiliated practices. The first time you try this, the results might look like a junior high dance: ASC staff with ASC staff, practice staff with practice staff. Over time, however, the groups are more likely to mingle and bond.

Note: Social gatherings that combine ASC and practice staff will be easier to organize if your center is only affiliated with a few practices. If your ASC has many affiliated practices, you may need to weigh the practicality of a single, large event or more frequent, smaller get-togethers.

Provide resources. Many ASCs provide their affiliated practices with information about the ASC that is intended for patients. There’s also value in supplying practices with ASC information designed for the practice itself. Consider developing a brochure or pamphlet that includes the following:

  • an overview of your ASC, its services and typical hours of operation;
  • preferred methods of communication (e.g., phone, email, website form, portal);
  • scheduling process;
  • names and contact information of managers; and
  • communication process in the event of a problem/emergency.

You may also want to consider developing a “cheat sheet” for practice schedulers. Include step-by-step scheduling process instructions and contact information if a scheduler has a question. This resource may help existing schedulers book cases at your ASC and should prove useful when the practice hires new schedulers.

Breaking the Ice: Starting Your ASC Communications Outreach

The tips provided above can further strengthen communications with existing affiliated practices. You will also want a strategy in place for initial outreach to new affiliated practices.

This outreach should include a visit to the practice. Identify individuals who will interact most with the practice (e.g., administrator, clinical manager, scheduler) and can represent your ASC well. Dispatch them to the practice, bearing welcome gifts, such as bagels or donuts. Find a time – sooner than later – during which you can present your ASC, highlighting why your facility should be the site of choice for procedures. Even a 30-minute initial meeting can help open the lines of ASC communications with a practice and start the new partnership on a path to success.

Conclusion

Continuity of care and patient experience are improved when ASC and affiliated physician practices prioritize communication. Use a multi-faceted approach when establishing an open line of communication with physician practices. The benefits experienced by your ASC, affiliated physician practices, and patients will be equally multi-faceted.

Catherine Sayers, Director of Operations

Mar 15
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Hiring an ASC Clinical Director

Hiring an ASC Clinical Director

By ASC Development, ASC Management, Leadership No Comments

Recently I took some time to reflect on what I’m grateful for. The long list I came up with included my ASC clinical director.

Our clinical director does a lot for our center. She certainly makes my job as administrator easier. Concerns have never been raised about her work ethic and performance. I wouldn’t think twice about leaving the ASC under her command for an extended period of time. I know that, if an issue arises, she can effectively address it or find the resources to do so. You can’t put a price tag on that peace of mind.

An ASC clinical director is a highly important function within the facility. Finding the right person for this role can be difficult. The clinical director must possess a variety of qualifications related to both clinical and business operations. To find the optimal clinical director for your ASC, I have listed characteristics to hone in on during your search.

Clinical Director Characteristics

Several characteristics clinical directors should possess to help them succeed in their role are outlined below.

Relevant clinical background. The clinical director should have a solid understanding of their center’s specialty(ies). For example, at an endoscopy center such as ours, our clinical director’s gastroenterology background is valuable. If you work in a multi-specialty center, the clinical director should possess a broad surgical and PACU background.

The appropriate clinical background allows the clinical director to:

  • Understand the roles and responsibilities of their staff;
  • Fill in for clinical staff members if someone calls in sick or needs to take a break;
  • Understand how to meet the needs and requirements of physicians in their respective specialties;
  • Earn respect from staff and physicians because of a demonstrated knowledge and experience with the specialty(ies);
  • Support the delivery of high-quality care; and
  • Help the center meet accreditation and regulatory requirements.

Eagerness to learn. ASC clinical directors typically work their way into the position by ascending the ranks of the clinical staff. Clinical directors often do not possess a strong business background as they move into this leadership position. To perform successfully as a clinical director, though, one must understand the business side of running an ASC. This includes budgeting, expense monitoring, and third-party payer contracting and reimbursement.

A clinical director must embrace learning. Your ASC will benefit as your clinical director learns the ASC business and incorporates new knowledge into his or her approach to clinical responsibilities. A clinical director who is motivated to go outside of his or her comfort zone in the learning process contributes to the ASC’s success and is worth his or her weight in gold.

Responsiveness. ASC clinical directors should be responsive to their physicians and staff. They must know how to recognize when issues are developing, such as a dissatisfied physician or poorly performing staff member. They must also know how to deal with these issues in a timely fashion to avoid them becoming more significant problems.

For example, a clinical director should recognize when a physician is becoming busier and adding cases. Such a development touches on many aspects of an ASC’s operations. It may require hiring more staff, allocating more block time, and/or purchasing more supplies. The clinical director is not expected to address these potential developments independently. Rather, they may research the development and speak with other members of the ASC team about actions to effectively accommodate the growth.

Proactiveness. Strong clinical directors can foresee future challenges and know how to act in advance. When a clinical director is new to the position, these challenges may primarily be clinical in nature. The longer the clinical director is in the position, the more he or she should consider business and operational issues as well.

Effective communicator. Clinical directors should be strong communicators, an important ability for effective leaders. They must know how to engage in clear communication with everyone in the center, including physicians, staff, vendors, patients and their families.

Remember, effective communication is a two-way street. A clinical director should feel comfortable approaching others and promote an environment where others feel comfortable approaching the clinical director.

Giving Thanks for My Clinical Director

Our center recently went through an unannounced CMS survey. We were understandably stressed when it occurred, but no one panicked. The staff performed their job duties and provided the high-quality care that they do every day of the year. The physicians expressed complete confidence in the performance of the staff and the leadership of the clinical director. We passed the survey with no deficiencies.

This experience demonstrates how well our clinical director performs. ASCs typically have a small group of physician owners. The physician owners are likely to be critical of the clinical director because it is a clinical role. A successful ASC needs its physician owners to be confident in the clinical director’s leadership and ability to help run the center. If staff members feel the same way, employee turnover rates tend to be low. When staff members like their leaders and work environment, they’re not going to leave.

Patients notice this dynamic. They often comment, “You all seem to like your jobs and have fun here.” That speaks to how the center is managed and how ASC staff members feel about their culture and work environment. Much of this hinges on the presence of a strong clinical director.

Catherine Sayers, Director of Operations