Monthly Archives

June 2017

Taking Care of Your “Second Victims” After an ASC Adverse Event

Taking Care of Your “Second Victims” After an ASC Adverse Event

By | ASC Management, Leadership | No Comments

Life is full of unexpected events. Despite our best efforts, bad things happen. If you work in clinical settings like ASCs long enough, it is likely you will encounter an unexpected event where the outcome is not optimal. Hopefully the resultant harm is minimal, but sometimes it’s not. Adverse events can lead to painful infections, injuries that require surgery, permanent damage, and death. Research shows medical errors are the number three cause of death in the United States.

When an adverse event occurs in a surgery center, the primary concern is the well-being of the patient and their family. With patient needs tended to, leadership works to prevent the mistake from occurring again.

While all of this is happening, potentially overlooked or underappreciated are the needs of your staff. Most ASC physicians and clinical staff pursue a career in medicine because they enjoy taking care of people. Many will establish emotional connections to patients. Surgery center caregivers often use possessive phrases – “these are my patients.” With such strong connections formed, caregivers may suffer significant distress if an adverse event results in patient harm. Given the nature of care provided in ASCs, staff rarely deal with emergencies or surprises. This can magnify the shocking effects of an adverse event.

The term “second victims” describes health care providers involved in an adverse event and traumatized by the incident. They often feel responsible for the outcome. The weight of the experience can have short- and long-term effects. These can include:

  • feelings of guilt, sadness, and shame,
  • distraction, both at and outside of work,
  • second-guessing of knowledge and skills, and
  • personal harm, even suicide.

Here are some recommendations that may help provide support to caregiver “second victims” following an adverse event.

1. Determine affected staff and evaluate.

Identify who served on the clinical team caring for the harmed patient. Clinical ASC supervisors and the administrator should then work to evaluate the impact of the event on involved staff. The administrator and medical director should evaluate the impact on physicians. These evaluations can include one-on-one conversations with team members about their response to the incident. They can help determine if staff are experiencing any emotional trauma.

Do your best to make staff feel comfortable about sharing their thoughts and feelings. While some team members may not open up to you, simply reaching out can help. Doing so conveys you are genuinely concerned about staff well-being and not just determining the cause of the incident.

2. Address patient ratios.

It is difficult to predict how team members will cope with an adverse event, even one that inflicts minimal harm. From a staffing perspective, it may behoove you to assume the worst. Expect involved caregivers to require time to process the situation — time that may keep them out of the ASC or lead to reduced shifts. Immediately address patient ratios and redistribute patient loads to allow for coping and account for reduced staff. You do not want someone treating patients not emotionally or physically prepared to deliver quality care.

3. Provide support.

Offer your support to those team members who indicate some form of trauma. Discuss how they are feeling. Ask if there is anything the surgery center can do for them. This may include providing longer breaks or shorter shifts (if possible). Let them know they can speak to leadership at any time if they find themselves distracted or struggling with emotions.

Note: Not everyone on your team will feel comfortable sharing their emotions or requesting assistance. Keep an eye on team members for signs of struggling. If your gut tells you someone is having a difficult time or you notice changes in behavior (e.g., crying), speak with this team member. Work to obtain an honest answer on their state of mind; it can impact your risk management.

4. Offer professional counseling.

As helpful as it can be for ASC leadership to provide support, some caregivers may require or want outside professional counseling. Have the ability to offer such counseling, even if no one takes advantage of it. Some caregivers may initially dismiss the offer only to take advantage of it later. What’s important is to have counseling available and for caregivers to know how to secure an appointment.

Preparation is Critical

An adverse event can occur at any time. When it does, what matters most is how you respond. Ensure your response plan takes into consideration potential second victims. When caregivers do not receive the necessary attention and support following an adverse event, the likelihood of another incident occurring increases. While you can’t undo a mistake, you can work diligently to prevent another one from happening.


Jebby Mathew – Regional Director of Operations

Your Surgery Center Safety Tools May Not Be Enough for Patient Safety

Your Surgery Center Safety Tools May Not Be Enough for Patient Safety

By | ASC Management | No Comments

ASCs use a myriad of safety tools – hand off protocols, checklists, computerized order entry systems, automated medication dispensing systems, and other similar solutions – to prevent unintentional slips and errors. These protocols are essential. But what happens when a clinician does not speak up when a safety tool identifies a risk?

When a clinician knows of a risk and does not speak up, the communication break-down can appear intentional. Someone knows, or strongly suspects, something is wrong, but chooses to ignore or avoid it. They may attempt to speak up, but back down when faced with resistance. This is not a slip or an error. This is a calculated decision to not engage in a conversation that may be uncomfortable, elicit a negative response, or result in no response at all.

The American Association of Critical-Care Nurses and VitaSmarts documented in their research, Silence Kills: The Seven Crucial Conversations for Healthcare (Maxfield D, 2005), clinicians identify three concerns which are often left undiscussed because they are emotionally and politically risky topics. These topics are dangerous shortcuts, incompetence, and disrespect.

The data from this study presents a convincing case:

1. More than one half of the clinicians who participated in the study reported shortcuts led to near misses or patient harm;
2. More than one third said incompetence led to near misses or harm to a patient; and,
3. More than half indicated disrespect (not listening to their ideas or valuing their professional opinion) experienced in previous scenarios prevented them from speaking up.

The data also shows clinicians are more likely to take their concerns to managers rather than speak to the person they are concerned about. Since organizations often assume working through the hierarchy is the correct way to address a problem, it is important to examine if this system actually works.

A better solution may be to tackle these issues using a multifaceted approach to create a culture where people feel safe to speak up when they have concerns. Try the following:

Establish a Team.

Start by assembling a small team made up of leaders, including physicians. Work to identify crucial moments and vital behaviors in the center or department.

Identify Crucial Moments.

There is a handful of “perfect storm moments” when circumstances, people, and activities combine to make safety tools ineffective. The team needs to identify these moments so people recognize when they occur. One example is when the facility pushes the surgery schedule into the evening and people are in a rush to get home.

Define Vital Behaviors.

When clinicians are in a crucial moment they need to know what to do or say. This is where vital behaviors come in. Here are two examples:

1. Encourage 200 percent accountability. Each staff member is 100 percent accountable for following safe practices and 100 percent accountable for making sure others follow safe practices.
2. Create the “thank you” program. Establish a safe and respectful environment where staff members can hold each other accountable. When someone reminds them of safety practices, they thank the other person and redouble their efforts to keep patients safe.

Develop a Playbook.

Create a list of situations (crucial moments) and plans (vital behaviors) staff can refer to. They may modify these and invent new strategies on their own. You can use this as a training tool and assist in performance improvement.

Most safety tools work by warning a clinician of potential problems. However, warnings only create safety when clinicians can speak up and get others to act.


Jovanna Grissom – Director of Operations

Dos and Don’ts When Developing a Surgery Center Project Budget

Dos and Don’ts When Developing a Surgery Center Project Budget

By | ASC Management | No Comments

“The best-laid plans of mice and men often go awry.” This quote is an adaptation of a line from the Robert Burns poem, “To a Mouse.” It essentially means, no matter how carefully one plans, something may still go wrong.

This can be true when developing a budget for an ASC project. The smallest of oversights can derail budget accuracy. I’ve seen it happen and witnessed the ramifications. Suffice it to say, when the cost of a surgery center project exceeds its budget, management is usually displeased. And justifiably so. Unexpected expenses can place financial strain on owners who may be forced to make up the difference on short notice.

Here are some dos and don’ts that can help you develop a more accurate project budget.

Do use a work breakdown structure (WBS)

A WBS identifies the individual tasks necessary to complete the project. The tool is typically arranged in a hierarchy. It is intended for practical groupings, such as by activities or deliverables.

When assembled correctly, a WBS provides a comprehensive list of tasks needed to complete the project. With this information, you can better determine:

  • what personnel you will need to complete each activity,
  • what types of vendors/service providers are necessary,
  • what materials are necessary,
  • what approvals (e.g., city, state, fire, accreditation, Medicare, etc.) are necessary,
  • how long completion of each activity is likely to take, and
  • potential risks to take into account (more on this later).

You will want to carefully consider these factors when determining the cost of each activity. Your final budget reflects the sum of the costs of all activities.
Without the use of such a planning tool, you are more likely to omit important financial considerations.

Don’t guess

Resist the temptation to guess about any element of your ASC project and its budget. Doing so can create a harmful ripple effect.

Let’s say your project requires a service such as painting. If you required painting services last year, you may feel confident about guessing the cost. However, many factors could cause your guess to come in low. The painting company you used last year may no longer be in business or available for your project. You may need a more expensive paint. The ASC space you need to paint this year may be larger than last year’s space.

Perhaps a manager asks how long a project will take and you guess a month. The manager may use this information to make plans for a new project after the month has passed. If your project takes longer than a month, you now have two projects overlapping. If these projects require use of the same space and/or personnel, there may be delays in completion of one or start of the other, potentially resulting in increased expenses.

Take the time to conduct the due diligence necessary to secure accurate estimates. Avoid succumbing to pressure to begin a project or provide on-the-spot answers. Maintain the integrity of the project by refusing to cut corners on research. The potential negative effects of guessing on your ASC project components and its budget likely outweigh any potential positives.

Do budget for risk

No matter how great you are at surgery center project planning, try to budget for the unexpected. Most projects inevitably experience unexpected and uncontrollable hiccups that will increase costs.

For example, if a project involves new construction, you may learn of surprises underground or during visits by inspectors. If a project involves an existing space, there may be pipe or wiring surprises behind the walls. Other causes of unexpected challenges can include weather interruptions, personnel sickness, subcontractor delays, and shipping/supply delays.

As the size, scope, and timeline for an ASC project grows, so do the risk considerations. It’s better to come in under-budget than need to request additional funding once the project is underway.

Don’t overextend personnel

When assembling a team to work on a project, take staff members’ skill sets into careful consideration. An effective manager of a department may not necessarily serve as an equally effective project manager. While some responsibilities may be similar, differences in the roles, including management of an extended timeline, could lead to costly problems and delays. Ensure skill sets align with the tasks you need accomplished.

Take personnel availability into consideration. If a project requires staff to take time out of their normal job schedule, who will fill these open hours? Does it make sense to pay overtime or bring in PRN (as needed) staff to complete a project faster? Should you spread out hours over a longer period of time to avoid extra staffing expenses?

Do the best you can

Surgery center project budgeting is not a perfect science. You can put together what you believe is an accurate budget that accounts for risk and still exceed established parameters. If you encounter obstacles likely to cause you to go over budget or allotted timeframe, be transparent. Inform leadership as soon as possible so they can make plans to account for the change.

What’s most important is to be diligent in your planning. Try to limit surprises and ultimately come as close to your budget as possible. If you accomplish these objectives, consider your project budget planning a success!


Jebby Mathew – Regional Director of Operations

Running a Successful Endoscopy Center is all about Patient Access

Running a Successful Endoscopy Center is all about Patient Access

By | ASC Management | No Comments

In ASCs, where surgical procedures are performed, volume is typically driven by surgeons. ASC leadership is responsible for making it easy for physicians/surgeons to bring their procedures to the facility.

Most adults need to undergo a routine colonoscopy when they turn 50. In an endoscopy center, the volume is driven by patients or their referring primary care physicians (PCPs). Therefore, an endoscopy center’s leadership must make it easy for patients to come to the center for their procedures. Without ease of access, patients are likely to look elsewhere for care and PCPs are likely to refer elsewhere.

Eight steps endoscopy centers can take to improve patient access and grow their volume in the process follow.

1. Be easy to find.

Make sure patients and PCPs can find your center without much effort. These days, that means developing and maintaining a strong internet presence. Keep your website current. Make sure it’s mobile friendly by incorporating a responsive design. When patients search for a place to receive a colonoscopy, you want your center showing up on the first page of results and as close to the top of that page as possible.

2. Provide direct access.

Give patients the ability to call and schedule their procedure directly with you. Make this as simple a process as possible – you don’t want to give patients a reason to hang up.

3. Conduct community outreach.

The internet is a valuable tool to connect with patients but don’t underestimate the power of human contact. Participate in outreach programs. Encourage your physicians to give talks at community centers. Attend senior expos and other events that are likely to attract your target demographics.

4. Streamline the referral process.

Provide local PCPs with packets of information about your endoscopy center and colonoscopy scheduling process. These packets should include everything a patient needs – health history form, consent form, preparatory instructions, directions to your facility, contact information, etc. PCPs will appreciate your efforts to help their patients receive care. This is an effective way to directly market to patients and PCPs.

5. Network with PCPs.

Focus on building strong relationships with PCPs and their offices to encourage referrals. Schedule lunch meetings where you can talk about your center and the services you offer. Discuss any barriers to access and what you can do to help remove them. Whenever possible, involve your physicians in these efforts which will help develop peer-to-peer connections with PCPs.

6. Analyze referral patterns.

Keep a close watch on your referring physicians’ case volumes. If you witness a noticeable decline, determine the cause and try to fix it. If volume is flat, find out if there is anything else you can do to encourage more referrals. When volume increases, express appreciation and make sure you maintain a high quality of service.

7. Monitor physician activity.

Make sure you are on top of the movement of physicians in your market, especially those who are high referral sources. When a referring physician changes practices, make sure the new practice receives your patient packets. Schedule time to meet with this physician to reestablish your connection, if necessary. You can also use this as an opportunity to speak with this physician’s new partners about becoming referral sources. If a new PCP comes into the market, be the first one to welcome him or her. Reach out and schedule a meeting. A positive first impression can go a long way toward securing referrals.

8. Stay current.

Be on the lookout for new gastroenterology and endoscopy procedures and technology. For example, new means for treating fecal incontinence are gaining greater acceptance. As word spreads about such advancements, you may want to offer these services. Doing so can add case volume while elevating your center’s profile, bringing attention to the other services your endoscopy center provides. Keep an open mind to what you can do in your center. Developments coming down the pipeline may be worth considering.

Remain Proactive

There’s a lot of competition for patients and referrals. To maintain ease of patient access and remain a primary referral destination, vigilance is required. Establish processes for monitoring your internet presence. Ensure continuous communication with your referral sources. Do whatever is necessary to establish your endoscopy center as the provider of choice for patients and PCPs – then don’t let up! The moment you take your ease of patient access and referral sources for granted, another facility may seize the opening.


Catherine Sayers – Director of Operations

outpatient total joint replacement program

Starting an Outpatient Total Joint Replacement Program at Your ASC: 5 Key Questions

By | ASC Development, ASC Governance, ASC Management | No Comments

Advances to minimally invasive surgical techniques, blood loss management, and anesthetics have led to a rise in total joint arthroplasties (TJA) being performed at ambulatory surgery centers (ASCs). Orthopaedic specialists and patients nationwide are increasingly well-served with the same-day model, in which patients receive their total joint replacement and return home for recovery within 24 hours, typically on the same day as surgery. Many orthopaedic-focused and multidisciplinary ASCs are preparing to offer a same-day TJA program, if they do not already. For ASCs working to initiate a credible total joint program, there are key clinical, business, and marketing elements of a well-developed program to consider.

Five questions ASC board members and investors will want to ask before approving a TJA program follow.

1. How does the ASC determine TJA patient selection criteria?

Well-formed patient selection criteria are important components of a successful TJA program. Key stakeholders will likely query, is there a national standard for outpatient TJA patient selection criteria? Unfortunately, the current answer is no. Outpatient total joints do not have as much history as that of outpatient surgery in general. And few professional societies have yet to publish specific criteria for outpatient total joint replacements. However, publications from institutions doing TJA successfully on an outpatient basis are available.

To form a TJA patient selection criteria that is safe for your patients, lean on your clinical leaders. This includes your clinical nurse manager and head anesthesiologist. Begin with your center’s current patient selection criteria for all patients. Then, consider American College of Surgeons National Surgical Quality Improvement Program (NSQIP) standards and American Society of Anesthesiologists (ASA) standards. Do this before reviewing accepted standards from peer-reviewed publications and other ASCs with successful TJA programs.

2. What is the ASC’s clinical plan for performing total joints?

A thorough clinical plan includes patient selection criteria, pre-operative screening protocols, anesthesia plans (pre-operative, intra-operative, and post-operative), clinical guidelines, discharge guidelines/criteria, and follow-up guidelines. Once again, rely on your clinical leaders to formulate the guidelines. If you are having trouble determining some of the clinical plan components, contact a qualified total joint program consultant and/or your ASC association. You can also perform an internet search to look at what other ASCs are doing. Finally, the clinical plan should also incorporate physical therapy, which many ASCs are arranging for patients to complete at the ASC both pre-operatively and post-operatively on the day of surgery.

3. Is the ASC’s nursing staff prepared for the first TJA case?

The beauty of working with skilled nurses in an ASC is their wide-ranging experience. Their experience often includes total and partial joint surgeries at hospitals and other surgery centers. Still, you will want to work with your Clinical Nurse Manager to prepare your ASC’s nursing staff for the TJA program. Identify individuals on your team with the most experience in orthopaedic surgery and in performing total joint surgeries. If you are lucky, you may even have nurses on staff who have worked on TJA cases with the physicians who will be performing them at your center. Rely on these individuals to serve as your skilled TJA nurses and teachers for the other nurses.

In advance of your first patients, prepare your operating room nurses. Arrange for a TJA walk-through with your device representatives. Prepare your pre-op/PACU recovery nurses by arranging for a lesson with a physical therapist who can teach them safe post-surgery movement and ambulation techniques that will prepare TJA patients for discharge. If overnight patient stays are part of your clinical plan, ensure nursing staff members understand patient care expectations during this extended recovery time.

4. What will be the fiscal impact on the ASC?

If you are projecting a certain number of total joint cases in your first year, identify the market and physicians who you expect will deliver these cases. For example, is there a patient population you are not treating because an outpatient total joint program isn’t currently in place? Or, will your physicians be moving a sector of their current patient population to your ASC? Is there another way to capture market share? Combine projected case counts with information on reimbursements and costs to identify the potential fiscal impact on your ASC.

5. What is the marketing strategy and plan for your TJA program?

To answer this question, one must first gain direction from the ASC’s governing body. Determine their interest in working collaboratively with key stakeholders such as the hospital partner to market a comprehensive total joint program. In some cases, collaborative marketing may be a strong desire of your board. Regardless, it will behoove you to create a marketing plan that divides marketing efforts into consecutive stages.

For example, the initial stage might aim to maintain the current customer base. This can include efforts like marketing to referral sources and direct-to-consumers through patient education, media/public relations, and website enhancements. The next stage could then focus on expanding the customer base by exploring new market areas and referral sources. At each stage, marketing efforts and metrics should be evaluated to determine if program goals are being met. This analysis will help determine future growth opportunities and identify further initiatives for enhancing the TJA program.

One of the key components of a successful outpatient total joint replacement program is early preparation. Completing a clear and concise clinical, business, and marketing plan will not only demonstrate to surgery center board members the ASC is ready for total joint approval, it will also deliver a safe environment for total joint replacements performed in your facility.


Jack Mast – Physician Liaison

ASC's 10-year anniversary

Turn Your ASC’s 10-Year Anniversary into an Improvement Opportunity

By | ASC Management, Leadership | No Comments

Your ASC has reached its 10-year anniversary.  Congratulations!  Reaching this milestone is no small feat.  Take stock of all you have accomplished, reflect on the adversity you have overcome, and then celebrate with your team.  You’ve earned it!

When your surgery center hits a significant milestone such as a 10-year anniversary, it’s important to recognize the achievement.  A celebration is a great opportunity to boost staff satisfaction.  Announcing an anniversary to your community is an effective way to market your ASC to patients and physicians.  People are naturally drawn to and have confidence in organizations with a successful track record.

A noteworthy anniversary is also an opportune time to perform a complete assessment of your surgery center and its operations.  Your ASC has likely undergone significant internal changes during the past decade.  An assessment can help ensure your ASC stays on a path toward celebration in another 10 years.

Include the following areas in your assessment:

ASC Aesthetics

  • Determine if places in your facility need remodeling to ensure it does not look outdated.
  • Examine wall coverings, furniture, fixtures, flooring, and carpet.

ASC Workflow

  • Determine if process and efficiency changes occurring over the past 10 years will benefit from physical or operational improvements. For example, if case volume increased, would adding a patient registration check-in station help handle the growth and improve efficiency?
  • Walk through your ASC with a critical eye on space utilization. As a surgery center “grows out of its space,” optimization of space helps keep areas organized, uncluttered, and efficient.  Consider inventory management, for example.  Could consolidating manufacturers reduce par levels of supplies in some categories?

ASC Information Technology (IT)

  • Work with your in-house IT specialist(s) and IT vendors to determine the age of all your technology. Assess whether any equipment needs replacing. This is especially important for servers that manage your programs and battery backup systems that provide supplemental power.
  • Make sure IT security, such as a firewall, is current and performing adequately.
  • As with any technology, computer workstations gradually slow down and become susceptible to problems that can affect functionality. If you do not already have a schedule to replace your workstations, put one together. Plan your budget to spread the expense out if you want to avoid the financial hit all at once.

ASC Medical Equipment

  • Determine which equipment may be nearing the end of its lifecycle. Many items are not designed to function properly for more than 10 years.
  • Assess the following high-expense items – some of which can exceed $100,000 in cost – and develop a plan for repairs or replacement:
  • Main sterilizer in sterile processing
  • Washer/disinfector in sterile processing
  • Smaller sterilizer units in sub-sterile rooms
  • Scope processors
  • C-arms (x-ray tube and image intensifier usually last 7-10 years)
  • Power equipment (e.g., drills, saws, reamers)
  • Surgical and procedure room tables
  • Ultrasound and transducer for anesthesia pain blocks
  • Patient monitors
  • Defibrillator
  • Anesthesia machines and gas modules
  • Video towers for endoscopy (e.g., video equipment, including cameras, monitors, and shaver boxes)
  • If you purchased any refurbished equipment, keep in mind that its lifespan is likely shorter than new units.

ASC Equipment

  • Ask your maintenance/service vendors to assess facility/plant-related equipment for estimated end of life. If these machines fail, the surgery center will likely need to shut down until completion of repairs or replacement.  Examples include:
  • Generator/transfer switches
  • Boiler and steam system, steam traps, and valves
  • HVAC system/rooftop units
  • Electrical isolation monitors/panels in ORs and procedure rooms
  • A completed assessment should include vendor predictions of how much longer equipment will last. Obtain price quotes and estimates to budget for replacements accordingly.
  • Even if replacements are not needed or recommended for another several years, plan to increase your budget for maintenance and repairs. Expenses will increase with the aging of the units.

Ongoing Exercise

While a 10-year anniversary marks a fitting time in your ASC’s history to perform these evaluations, a mature ASC is best served by performing routine assessments.  More frequent assessments will help minimize surprises and provide ample time to develop plans to address anticipated issues.  If substantial improvements are needed, provide your governing board with project details and solicit their feedback.  Then, appropriately budget for the work.

Your 20-year anniversary may not be right around the corner, but there is plenty of work you can do now to position your ASC for continued prosperity.


Diane Lampron – Director of Operations

ASC scheduling efficiencies

How ASC Scheduling Efficiencies Impact Your Facility’s Revenue

By | ASC Management, Leadership, Revenue Cycle Management | No Comments

Efficiencies in scheduling can be crucial to positively impacting revenue at your ambulatory surgery center.  Maximizing scheduling efficiency creates room for more procedures.  Even if you gain only one or two procedures each day, these marginal gains can easily increase your bottom line.  Therefore, taking steps to cultivate efficiency is an essential strategic initiative. 

Here are seven ways to create efficiency in your ASC’s scheduling process.

1.  Encourage your physicians’ offices to schedule cases as far in advance as possible.  Cases scheduled well in advance of surgery dates allow surgery           center personnel adequate time to prepare for patients.  Obtaining pre-authorizations from some insurance companies can take several days to complete.  Surgery center staff must call patients in advance of their procedure to review their medical history and discuss financial obligations.  Managers staff the center based on the number and types of cases on the schedule.  At times, center personnel need to pre-order special equipment, medical supplies, or patient-specific implants.  If your physicians’ offices encounter changes in their surgeons’ schedules – cancellations, add-ons, time changes, or order changes, for example – encourage them to communicate those changes to you as quickly as possible.  Discuss ahead of time the preferred form of communication for your center – phone, email, fax – to create efficiencies for their team and yours.

2. Establish a strong working relationship with your physicians’ offices to obtain accurate information. Coordinating patient care requires teamwork.  When your ASC serves as an extension of each physician’s practice, the care continuum is virtually seamless.  It is crucial to obtain scheduling forms from your physicians’ offices with comprehensive patient information and up-to-date copies of both sides of the patients’ insurance cards.  This information assists in determining if patients are viable candidates for surgery at your facility from both a clinical and third-party payor coverage standpoint.  If the surgery or procedure falls under workers’ compensation, ask your physicians’ offices to include adjustors’ names and phone numbers.

3. Schedule patients with special needs and your more extensive/high acuity cases at the beginning of the day. Include small children and patients with chronic illnesses, such as diabetes and sleep apnea, in this classification. Scheduling these cases first allows lengthier recovery times to be more easily accommodated.  Additionally, caring for these patients during usual working hours prevents staff from having to stay late or accumulate costly overtime hours.

4. Schedule specialties in the same room whenever possible. This prevents staff from spending valuable time moving equipment from room to room, leading to shorter turnover times. 

5. Schedule similar surgical sites consecutively (i.e., right vs. left, shoulder vs. knee). As an example, for orthopaedic arthroscopy cases, you may prefer to keep all the shoulder cases in line and then move to knee arthroscopies.   This will reduce the need to change positioning devices and room set up between cases.   Speeding up room turnover, anesthesia set up, and the overall flow of surgery, typically yields happier surgeons!  

6. Know what you have to work with. Larger facilities may have the ability to set up rooms by specialty.  Smaller facilities will need to focus on how to best move and position equipment. Train your staff to think strategically about these types of things based on your center’s unique characteristics.

7. Communicate your ASC’s patient criteria to your surgeons and their staff. Patient safety is a priority.  When your physicians and their office staff understand the contraindications and anesthesia requirements at your center, they can schedule their patients at the appropriate facility.   

After you determine the best efficiency workflow processes for booking procedures at your facility, educate physicians, their scheduling staff, and your facility personnel on how they work and why they are set up that way.  Scheduling efficiencies go a long way toward creating higher satisfaction for your team and physicians.  More importantly, scheduling efficiencies create opportunities to add more cases and increase your ASC’s revenue.


Kelli McMahan – VP of Operations

asc political landscape

Preparing Your ASC for Political Battle

By | ASC Governance, Leadership | No Comments

There’s an old saying, “Laws are like sausages, no one wants to see them being made.”  When I was younger, I was fully on board with that analogy.  The last thing I wanted to do was participate in the political process.  Then, about 15 years ago, I was thrust into a position that forced me to get directly involved.

Within the same year, pieces of legislation were introduced in Colorado and Minnesota that would have severely negatively impacted the ambulatory surgery center (ASC) industries in those states.  Neither state had an active or robust state association.

Consequently, neither state was prepared to deal with the threat.  Through a herculean effort, disaster was averted in both instances.   Those of us involved in those fights learned a valuable lesson – the best time to prepare for a disaster is before it occurs.

Fast forward to 2017.  The landscape has changed in many ways.   After a five-year battle, the Wisconsin state association, WISCA, under the leadership of Eric Osterman and the association’s board, narrowly missed getting the state’s gross receipts ASC tax rescinded.  In Oregon, the state association recently pushed forward House Bill 2664, allowing 16 ASCs to introduce an “extended stay” license to committee.  In Colorado, CASCA is fervently addressing yet another attempt to negatively impact our state’s convalescent center license for ASCs.

At the federal level, the Ambulatory Surgery Center Association (ASCA) supported the Ambulatory Surgical Center Quality and Access Act of 2017. This act addresses a flaw in current law that allows the Centers for Medicare & Medicaid Services (CMS) to use different measures of inflation for ASCs and hospital outpatient departments (HOPDs) when setting reimbursement rates.

As demonstrated by that short list of activities in 2017, the ASC industry, both on the state and federal level, is far more equipped to deal with threats.  It is also more proactive than ever before.  That by no measure means every state or individual center should sit back and consider the battle won.  Rather, continual preparation and reform is necessary to avert the next crisis.

Some problems that still exist and are keeping ASCs from being formidable political players include:

  • Lack of organized state response to business threats
  • Embryonic, unsophisticated, or paralyzed state organizations
  • Unaware, unable, unwilling, or disinterested physicians
  • Insufficient funding
  • Nonexistent, minimal, or inconsistent education of key elected officials
  • Failure to engage ASCA on a state level
  • Lack of experience, robust understanding, or discomfort with politics, government, and public policy on the part of surgeons, administrators, and staff
  • Ineffective recruitment of hospital support by ASCs and physicians in joint venture arrangements

To set up your ASC for political survival:

  • Join or work to revitalize your state association.
  • Contribute to political fundraising at the state level.
  • Solicit contributions from facility investors for political fundraising.
  • Encourage key stakeholders in your ASC to join a committee in your state association.
  • Involve your physician investors, leadership team, and staff members in state association activities.
  • Engage ASC hospital partners as an ally with your state association.
  • Utilize the ASC’s staff or investors’ political connections.
  • Access key political players on federal and state levels.
  • Engage ASCA on a state level.
  • Contribute, and secure contributions from key stakeholders, to ASCAPAC.
  • Have key ASC personnel and physicians participate in the ASCA Washington DC Fly In.

The above suggestions are some ways every ASC can improve their own political standing along with the political standing of the industry.

To summarize, let me leave you with three quotes to consider when preparing for your ASC’s political survival.

“All politics is local.” – Tip O’Neil

“Never let a third party define your issues or your identity.” – Steven Covey

“It’s not the size of the dog in the fight that counts, it’s the size of the fight in the dog.” – Dwight D. Eisenhower


Robert Carrera – President/CEO

Claims Issue Log

The Claims Issue Log – Not Just Another Spreadsheet

By | Revenue Cycle Management | No Comments

Claims issues arise daily in the health care billing and collections arena.  If your accounts receivable personnel are repeatedly relaying the same issue, refrain from merely commiserating and determine the scope of the problem.  Is that recurrent theme of inaccurate payments, for example, affecting two or twenty claims?

I’ve found the most effective way to identify trends is to create a claims issue log.

I know what you’re thinking – “I don’t have time for another spreadsheet.”  When used effectively, this spreadsheet can create efficient communication with your payor.  Ultimately, it can lead to timely resolution of issues and correct payment of claims.

What is a claims issue log? 

A claims issues log is a tool that identifies specific details of claims impacted by the same issue with a given payor.  Items on the log may include, but are not limited to:

  • Patient account number
  • Patient and/or subscriber ID
  • Claim number
  • Date of service
  • Network/Plan
  • Total billed
  • Reimbursement due
  • Amount paid
  • Balance due
  • Date billed
  • Billing comments
  • Payor comments

So, you have all this data – now what? 

  • Review your data for accuracy. The first, and most crucial step is to confirm the accuracy of your data.  Another pair of eyes, perhaps those of a manager, is essential at this point.
  • Once you confirm the accuracy of the data, notify your contracting department.  Alert them to the issue.
  • Forward the claims issue log to your provider representative with a clear explanation of the issue. Set expectations.  Outline what steps are required to resolve the problem.  Underscore payment of the balance due must occur as well.
  • Set meetings with all involved parties to track progress. Items to cover may include:
  • Does the payor have a specific format for this process? If so, obtain and use their form.
  • Why is the issue happening?
  • What is the plan to resolve the issue?
  • What is the timeframe for issue resolution?
  • When can you expect to receive correct reimbursement?
  • Will the payor use the claims issue log to reprocess all affected claims?
  • How often will updates be provided on all the above?

Bottom line

A pattern or trend of inaccurate reimbursement is the last thing you want to discover when working claims.  Unfortunately, it happens often.  Prepare for this inevitability by having a process that organizes, tracks, and resolves claims issues with maximum efficiency.  It’s never too early to identify a trend.  Hop on it as quickly as it rears its ugly head.  You don’t want to lose out on revenue because you failed to connect the dots.


Carol Ciluffo – Vice President of Revenue Cycle Management