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July 2017

ASC Infection Control Program

How to Develop an ASC Infection Control Program

By ASC Management No Comments

Surveillance, prevention, and control of infection in ambulatory surgery centers is a frequent deficiency cited in state, Medicare, and accreditation surveys. ASCs are required to have an infection control program that outlines purpose, goals, specific risks, methods of data collection, and strategies used. The program also must identify how and when the infection control program is evaluated. Because most centers do not have a full-time infection control nurse or officer solely dedicated to this role, this requirement can seem daunting. With some luck, the Infection Control Officer (ICO) might get to a meeting once a year and complete the training required to hold this position.

The purpose of infection prevention is to protect the patient, health care workers, visitors, and others in the health care environment. In an ASC especially, it needs to do so in a cost-effective manner. How can you effectively and efficiently ensure infection prevention in your setting?

1. Start by setting infection control program goals.

  • Identify and reduce the risk of endemic and epidemic facility-associated infections.
  • Report appropriate information to internal surgery center leadership and public health authorities.
  • Develop communication linkage between professional and health care workers, patients, families, public health professionals, and the community.
  • Create plans to respond to emerging infections and bioterrorism.
  • Promote a zero tolerance of hospital acquired infections (HAIs).

2. Explain how infection control is embedded in your organization. Spell out how the ICO integrates with committees, the reporting structure, and the sources utilized for evidence-based practices. For example:

  • The ICO is part of the Continuous Assurance Committee and oversees the infection control program.
  • Under the direction of the Medical Director, the ICO investigates all suspected outbreaks. This occurs in collaboration with the appropriate medical and administrative staff.
  • Using the most correct and useful statistical process, data is collected, analyzed, and reported.
  • The ICO has access to comparable community data to determine if rates within the center are above or below those in the community.
  • The ICO develops this plan using data from CDC/NHSN/NNIS.
  • The board of managers approves the infection control program, types and scopes of activities, and training materials. They review this plan at least annually to evaluate its effectiveness in the center.

3. Create a prioritized risk assessment. The risk assessment should focus on internal and external factors. This helps form a complete picture of the risks that exist. Prioritize the identified risks based on the potential impact, probability, and the organization’s preparedness. This is your base for determining what activities you should perform and at what intervals.

  • External: Consider patient populations and cultural reactions to health care. Examples are community issues, such as high rates of TB. These factors are not fixed. As situations arise in the community, a new risk assessment may be necessary.
  • Internal: Focus on your high volume/high acuity cases. Think about instrumentation and the associated cleaning problems (i.e., long, luminated). Consider the physical plant in which you provide care. Are there risks? Do you have a water feature in your lobby?

4. Identify and summarize your activities.

  • Remember to take credit for activities you already perform. This can include monthly and 90-day SSI surveillance, prophylactic ABO administration tracking, and bloodborne pathogen exposure monitoring/reporting and outcomes.
  • Based on your risk assessment, you may track things like monthly monitoring of SPD logs, environment of care items, and hand hygiene. Ensure each one of these activities has a summary explaining the process, frequency of tasks, and documentation undertaken.

5. Spend time discussing and documenting the strategies you will use.

  • A good general statement is “TJC, AAAHC, OSHA and pertinent federal, state, and local regulations pertaining to infection control are being implemented and followed.”
  • Include items such as staff training on PPE, TB, hand hygiene, and cleaning. In addition, list the local, state, and federal contacts and reporting requirements, as well as communication with other health care facilities and providers in your community.

It is important to formally evaluate and revise your goals and program, or portions of the program, at least annually and whenever risks significantly change. Make sure your evaluation addresses the assessment of the success or failure of interventions for preventing and controlling infections and responds to concerns raised by leadership or others. The evaluation should always address how relevant infection prevention and control guidelines are based on evidence and have evolved. In the absence of evidence, cite expert consensus.

Oftentimes, daunting tasks are made less so when you have a framework to follow. Once you get the ball rolling, you are more likely to find an internal champion to serve in the ICO role. Ensure you support your ICO as they tackle program specifics by allocating the funds necessary to secure appropriate training and advance program goals. Before you know it, you’ll have a thriving program and your ASC will significantly reduce the likelihood of being cited for an infection control related deficiency.

Jovanna Grissom, VP of Operations

Everyone Sells

Everyone Sells

By ASC Management, Leadership No Comments

I have been in sales nearly my whole life. As a kid during the summer, my friends and I sold lemonade, snow cones, or our old toys from a stand in the neighborhood. From the ages of twelve to fifteen, I rented a table at comic book conventions to buy and sell to other collectors. At the age of sixteen, I had to sell myself in a job interview. When I graduated from college with a degree in physical therapy, I “sold” patients on my ability to assist them in recovering from a variety of physical ailments. To ensure the most optimal outcome, I needed them to “buy” into how important it was for them to be actively involved in their own recovery process. As I moved into formal management and leadership positions, my sales challenge progressed. I was charged with getting my teams or clients to buy into the vision or direction I was “selling.” And, as a business owner, I’ve sold my company’s services to prospects.

Yes, I’ve been selling a long time. That’s what got me excited about a recent Harvard Business Review article by Rebecca Knight titled “How to Improve Your Sales Skills, Even If You’re Not a Salesperson.”1 In it, she quotes Thomas Steenburgh, professor at the University of Virginia Darden School of Business, who states, “Selling is moving somebody else to action.” As managers and leaders, that’s what we do every day. Ms. Knight then proceeds to provide fantastic advice regarding how to think about sales and make oneself more comfortable with the thought of selling.

Although Ms. Knight’s article was focused on actual sales, I viewed it from the aspect of managing and leading people. The principles are the same. Effectively selling your team or clients on your vision and implementation strategy requires the same four tools Ms. Knight identifies as those required to effectively sell products or services.

Reflect.  Look back on the great leaders you’ve worked with in your career. How did they inspire you or your team to achieve more? I always say, management is getting people to do what they are supposed to do, but leadership is helping them achieve more than they thought they could. I had a boss who was great at providing what I needed. He broke down bureaucratic obstacles in the organization that kept me from being successful. Once he paved a path for me, I understood he expected me to deliver results. I’ve tried to adopt a similar leadership style.

On the flip side, reflecting back to poor leaders allows us to learn what not to do as well as what types of behaviors to avoid. I had another boss who was ruthless. She actively sought out weaknesses. The more vulnerable the victim the better, especially if that person reported directly to one of her subordinates. My takeaway from that experience was to make sure my team members were always prepared. Furthermore, I made it clear I would always stand with them.

Put yourself in your counterpart’s shoes. I appreciate the old saying, “To truly know someone, you need to walk a mile in their shoes.” Empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings and thoughts of another. A leader may be able to fake empathy once or twice. However, the people you are leading will quickly identify whether you are truly empathetic or just paying them lip service.

Understand what motivates your group. Tie the motivations of individuals to your vision to accomplish your goals. I once worked for a senior VP who desperately wanted to expand his territory. He asked what my goals were. I told him I wanted to become an area manager. He replied with, “Then build an area.” He proceeded to provide me the resources, encouragement, and, when necessary, the interference, to build an area. The result was both visions were realized.

Plan, prepare, and practice. You only have one chance to make a first impression. If you’re trying to sell your team on a shared vision for success, obtain buy-in by preparing an initial “pitch” to get them on board. Not being successful the first time doesn’t doom the plan or idea for the future. However, being ill-prepared during the initial roll-out seriously reduces the chance of success going forward.

  • Plan: Identify objections you may encounter ahead of time. Know the people you are preparing to lead or motivate.
  • Prepare: Know your facts. Understand your data. Do your research.
  • Practice: Find a friend or family member with whom to practice your presentation. Or, at the very least, pitch it to yourself in front of a mirror.

Stay calm and don’t brag. Staying calm is especially important if you don’t receive the response you expected. If there is resistance to your plan when initially presenting it to your team, keep your wits about you. You may find additional research is required. Sometimes, you need to work through the plan with your team gradually. Generally speaking, losing your temper or panicking will make things worse.

Bragging or making the project or vision about you is a sure path to difficulty. I have seen managers try to motivate staff or physicians to get behind a vision but these individuals were so ego-centric it was clear to their audience the plan was really about the manager, not the team. Generally, “me” based managers fail.

Again Ms. Knight quotes Thomas Steenburgh, “Very few parents say they want their kids to grow up to be a salesperson.” If these parents truly understood the versatility of the sales skill set, they would appreciate that a sales career can prepare their kids for a life of leadership.

Robert Carrera, President/CEO

insurance claim

An Insurance Claim is Like Baking a Cake – Here’s the Perfect Recipe

By Revenue Cycle Management No Comments

I enjoy cooking and baking. Spending time in the kitchen is my happy place. And I’ve been involved in revenue cycle management for many years. But I bet you’re wondering what baking and insurance claims have in common. Please allow me to explain.

Certain ingredients are required to bake a cake. When you follow a recipe, paying attention to every detail along the way, you’re likely to get it right. Voila! You end up with the perfect dessert.

Submitting a clean claim is no different. Taking the right steps (ingredients) and following the right process (recipe) will result in a clean claim (cake). A clean claim increases the chance of being paid correctly in a timely manner (icing).

Here’s a clean claim recipe:

  • Ingredient #1: Demographic information
    • Schedule patient.
    • Register patient and insurance demographic information into patient accounting system.
    • Verify patient’s benefits and eligibility with the payor.
    • Submit prior authorization request, if required.
    • Prepare estimate of payor and patient responsibility for services being rendered.
    • Discuss estimate with patient.
    • Collect copay and/or outstanding deductible from patient prior to service.
  • Ingredient #2: Charge capture and coding
    • Assign ICD-10/CPT codes from the operative note.
    • Enter charges into the patient accounting system.
    • Review and address EDI claims edits and rejections.
  • Ingredient #3: Claims submission
    • Follow payor guidelines for paper or electronic claims submission.
    • Verify receipt of the claim by the payor.
    • Manage denials received.
  • Ingredient #4: Claims adjudication and collections
    • Post payor reimbursement timely.
      • Transfer responsibility to secondary payor or patient.
      • Forward underpaid or incorrectly paid claim to accounts receivable for appeal and resolution.
    • Transmit statement to patient.
    • Utilize outside collection agency when necessary (not the icing on the cake).

According to Revenue Cycle Intelligence, research from the Government Accountability Office found up to one-quarter of claims are denied.1 Denials can cripple the financial health of your facility. When providers do not follow payor reimbursement guidelines, payors hold claims for review. If the outlined process isn’t strictly adhered to, payors respond with payment denials. That’s like putting a cake in the oven and not being able to finish it for two or three months.

A strong denial management strategy is essential. It allows you to identify denial trends. When trends are identified, it is important to provide additional education to scheduling and registration personnel to address missed steps and minimize repeat mistakes. The result is an enhanced ability to fully capture the revenue that is due to you. Each step is integral to the success of the claim. Taking shortcuts is ill-advised. You end up with a less than optimal outcome.

Accuracy is key. The process doesn’t work if you skip a step or proceed with inaccurate information. It’s akin to forgetting to add baking powder to your cake. You end up with a “hockey puck” that didn’t rise because of the missing ingredient. Ensuring you have a tight claims process will deliver the delicious outcome you desire – hard earned revenue in the bank. Now that is the real icing on the cake!

Carol Ciluffo – Vice President of Revenue Cycle Management

1Revenue Cycle Intelligence article March 10, 2017 Top 4 Claims Denial Management Challenges Impacting Revenue

asc reimbursement

Playing the ASC Reimbursement Shell Game

By Payor Contracting No Comments

When a payer sends you a new ASC fee schedule or other changes to your surgery center’s reimbursement terms, and touts an overall increase, beware! The proposed changes could unfavorably impact your bottom line. For that reason, consider reimbursement revisions with a healthy dose of skepticism.

Surgery center reimbursement changes offered by payers remind me of a sleight of hand shell game. A shell game is a gambling pastime played at carnivals or street fairs. A pea (or similar object) is hidden under one of three nutshells. The shells are quickly shifted around and the spectator is asked to track the location of the pea. Typically, the spectator loses because it’s nearly impossible to follow the pea’s path. The trick itself became so well known, the term “shell game” is now used figuratively to describe measures taken to deceive.

Controlling health care costs has become the great shell game for payers. They establish new rates of payment through sleight of pen, moving reimbursement from one area to another. They may transfer it altogether, shifting the payment responsibility to the patient via higher deductibles, co-payments, and coinsurance. While we may not be able to end the shell game, we can establish a comprehensive method to deal with proposed reimbursement changes that minimizes our losses.

Reductions in reimbursement can come in various forms:

  • changes in the reimbursement by payment category,
  • reassignment of procedures to a different, lower paying category, 
  • assigning previously unassigned (aka unlisted) procedures reimbursed at a percent of billed charge to a payment category, or
  • changes to the payer’s multiple procedure payment logic.

When you receive a payer’s proposed fee schedule or reimbursement changes, the only way to identify what the true effect will be is to pay attention. Keep your eye on the pea! Compare the payer’s proposed reimbursement to your facility’s current reimbursement on all procedures performed for the payer’s members during the last twelve months. Measure the full impact of changes by adjusting your analysis to account for procedure utilization over the same period. An analysis combining both measures will help you “follow the money” to assess the severity and frequency of the changes. Gauging the overall financial impact of the proposed changes will help you determine if you want to accept them.

Changes in fee schedules can only be used to perpetrate deception when you don’t complete a comprehensive analysis. Combat sleight of pen by implementing a thorough process to accurately assess the potential impact of proposed changes. You, and the ASC industry at large, will be glad you did!

Dan Connolly – Vice President of Payer Relations & Contracting

asc leadership

ASC Leadership Comes in All Forms

By Leadership No Comments

I ran across an excellent article, “The Seven Secrets of Great Team Captains” by Sam Walker in the Saturday/Sunday May 13-14, 2017 review section of the Wall Street Journal.

In the article, Mr. Walker identifies seven Olympic and professional athletes whose leadership impacted their teams in a positive way. Some of Mr. Walker’s examples are popular individuals – Boston Celtic great Bill Russell and New York Yankee legend Yogi Berra. However, he also cites more obscure athletes, such as Cuban Olympic volleyballer Mireya Luis and French National Team hand ball player Jerome Fernandez.

The article was a great reminder about how, when, and where leadership manifests itself in an organization. In many of the situations described by Mr. Walker, the individual who stepped up wasn’t the captain of the team, but took action that motivated and inspired others. Sometimes we forget that leadership can originate from any place or position in an organization. And no member of a team should discount how their role can impact results.

Another concept illustrated in the article was that of a leader knowing their team well and understanding when they needed a boost. Leaders should not only understand when a motivational bump will be of assistance, but what type of assistance is needed and when providing that help will be optimal. Executing this well is contingent upon a leader’s emotional intelligence and knowledge of the personalities of each team member. Armed with this information, a leader can adjust the team’s mindset and get them back on track.

I have seen business leaders use admonishment to motivate and re-center a team. And I have observed those same leaders use humor and playful perks (ice cream anyone?) to create the necessary adjustments. The results are always dependent on the leader’s knowledge of the team and what action will best suit the situation. When a leader does not know their team well, the attempt at motivation could very well garner a negative impact.

The article also underscored that it isn’t always the team’s star who emerges as the leader. In many cases, the true leader was a “grinder” – someone who may not have possessed the most innate talent, but still achieved optimal results through hard/smart work. They are usually the individuals who don’t mind performing the mundane or difficult daily tasks with little to no recognition. They complete these tasks simply because they know the work needs to be done. These are the indispensable people on a team. Oftentimes, they are the unofficial leaders. In ASCs, I typically find these people in front office roles. In this environment, the focus is usually on the surgeons, administrator, or nursing staff. However, it is often apparent the unofficial leader is the front office team member who knows every nuance of the facility and is a resource to everyone.

Lastly, the article reminded me how I’ve developed my own leadership style and encouraged others to follow suit. The article cited numerous examples of leadership traits to emulate as well as ones to avoid. New leaders, think back to former teachers, coaches, managers, and your parents to identify leadership traits and qualities to emulate and avoid. The people you meet in life can serve as two things: a shining example or a cautionary tale. Leadership is shaped by knowing who to follow.

Robert Carrera – President/CEO