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May 2018

Preparing for an ASC Accreditation Survey

Preparing for an ASC Accreditation Survey

By ASC Development, ASC Management No Comments

They walk in the door without an appointment. Staff immediately know they are not patients or family members. Within minutes, word has spread throughout your facility – your center is about to undergo an ASC accreditation survey.

Surveys are a fact of life in the ASC industry. Whether they are performed by surveyors from the Centers for Medicare and Medicaid Services (CMS), your state’s department of health, or an accreditation organization, doing well on surveys is critical to your ASC’s success. Poor survey performance can jeopardize your licensure, Medicare certification, and/or accreditation. Lose any of these and you are looking at a loss of insurance contracts and patients.

More importantly, poor survey results may indicate shortcomings that have the potential to jeopardize patient and staff safety. ASC accreditation survey requirements, while they may feel cumbersome, are designed to help support the delivery of safe, high-quality care. By meeting them, you demonstrate a commitment to the wellbeing of everyone served by your ASC.

While your ASC should always strive to meet requirements (more on this later), survey preparation is a worthwhile exercise. Preparation can help shore up deficiencies and ultimately improve survey performance – a win-win combination.

ASC Accreditation Survey Areas of Focus

Here are some areas to focus on prior to an ASC accreditation survey to help improve your likelihood of success.

Policies and procedures. Carefully review your ASC’s policies and procedures. Make sure staff are adhering to them as written. If any policies are outdated, update them. If you have added new policies and/or procedures but lack written documentation, create it.

Physician credentialing. Ensure your physicians are credentialed and their files include all required – and current – documentation. Each physician has numerous documents with expiration dates that differ from physician to physician and document to document. Without careful monitoring, it’s likely one or more of these documents will expire. Expect a surveyor will catch any such lapse.

Personnel records. Keep employee files current and complete. Documents in these files should include job description, competency assessments, training records, performance evaluations and I-9s (used to verify identity and employment authorization).

Decontamination area. Surveyors are paying greater attention to compliance with rules governing sterile processing areas. Under scrutiny is cleaning, disinfection and sterilization of scopes, and separation of clean and sterile processes. Make sure staff follow your policies and procedures and can explain how they adhere to guidelines and manufacturers’ instructions.

Infection prevention. While infection prevention has always been an area of focus for surveyors, it’s receiving even more attention these days. Work with your infection preventionist to ensure staff understand and are following proper processes. For example, if your procedure manual indicates “bonnets over the ears,” then make sure everyone has bonnets over their ears.

Emergency preparedness. Another area likely to face increased surveyor scrutiny during your ASC accreditation survey is emergency preparedness. This issue is in the spotlight thanks, in part, to the CMS Emergency Preparedness requirements that took effect in November 2016. Ensure your ASC has performed its required fire and other emergency/disaster drills and completed the appropriate accompanying documentation.

The basics. Regularly walk around your ASC and look for anything that seems out of place or could jeopardize compliance. Perhaps there’s a cart in the hallway when it should be in a closet. Maybe someone borrowed a policy and procedure binder and did not put it back. Identifying who made the mistake and using the experience as a teaching opportunity helps prevent recurrence of errors.

Perform a visual inspection of your restricted areas, checking for cleanliness. Conduct a “white glove test” on doors, screens, and operating room lights.

Staff preparation. Surveyors will inevitably ask your staff questions during their visit. Prepare your staff for this experience. Ask them questions you think a surveyor might ask. These questions can cover topics such as job responsibilities, policies and procedures, location of equipment, and emergency response.

While staff should be able to answer many such questions, they may not know all the answers. And that’s okay. Rather than make up a response that may be incorrect, instruct staff that it’s acceptable to say they do not know an answer but know where they can find it.

Maintain an ASC Accreditation Survey Mentality

Surveys tend to be infrequent events. This is no excuse for allowing compliance to falter in between surveys. Your staff should approach every day as if an ASC survey may take place.

Here are some quick tips to achieve this mentality:

  • Quiz staff. Keep staff on their toes by asking them surveyor-type questions. If someone doesn’t know an answer, you may have identified an area for additional education and/or training.
  • Conduct mock surveys. Periodically conduct mock ASC accreditation surveys. A member of your leadership team can fill the role of a surveyor, walking around the ASC and assessing performance. You can also bring in an outside, trained consultant to simulate the survey experience and identify compliance gaps.
  • Engage staff. Encourage staff to speak up when they identify potential compliance concerns. Treat these moments as learning opportunities rather than punitive incidents.
  • Don’t wait to educate. If you change a process, educate staff on the revision as soon as possible. Remember to update affected policies and procedures as well.

Working to keep compliance on the front of staff’s minds can help your ASC better meet requirements and ensure a consistently high level of care.

Kirk Lagonegro, Director of Operations

Choosing the Right Lender for Your De Novo ASC

Choosing the Right Lender for Your De Novo ASC

By ASC Development No Comments

Banking relationships are crucial to any successful business venture. Choosing the right lending partner for your de novo ASC development project is integral to the longevity of your financial asset. There will be times when you need an ally to watch your back financially. A lender who knows your business and is willing to be your partner throughout the process is essential. So, how do you select the right lender?

Submitting an RFP

During the feasibility phase of development after you have run your financial pro forma, send out a request for proposal (RFP) to at least three banking entities. Ensure you include one financial institution from the local market where the de novo ASC will be established. Banks in the local market are often more attuned to market conditions and may be willing to extend better rates or lower fees to win your business. Decide early on what type of services and resources you will need. Send your RFP to banking entities you’ve identified as strong providers of these services and resources. Make sure you give yourself enough lead time – at least 90 days – before needing any funds for the project.

A typical finance package will include:

  • Tenant improvements (TI) – if a separate real estate entity and core/shell will not be a part of your anticipated debt,
  • Equipment loan, and
  • Working capital via a line of credit (LOC)

Based on the credit history of the ASC partners, you should be able to obtain 70-80 percent loan to value on the TI. Investor contributions will be required to make up the remaining TI balance of 20-30 percent. Higher loan to value percentages (90-100 percent) are often available for equipment. The LOC will initially be revolving but, once your center is more established, the credit line is often rolled up into a fully amortized note.

Comparing Lender Options

After you receive the proposals, carefully evaluate the terms. There can be many variations in these proposals. Try to create a solid apples-to-apples comparison. Some variables to compare include rates, fees, maturity dates, early pay-off terms, corporate guarantees, and personal guarantees. Most of the language in loan agreements is derived from a standard template. You may want to have your attorney review these agreements, however, to ensure there are no hidden issues or concerns.

Although selecting the lender with the best terms may seem logical, make sure you factor into your decision your view of them as a long-term partner. Consider the banker’s accessibility, promptness, and flexibility. You may want to consider the location of the bank and how often you will need to physically visit it, if at all. Is the lender equipped to meet all your service needs, including digital services?

Ask questions such as:

  • How many ASCs do you currently work with/have worked with?
  • Who will be our direct contact should we have any questions or concerns?
  • What happens if additional funds are needed in the future or a re-amortization needs to occur?

A good lender will be straightforward and honest in his/her responses. Their focus should be on building a lasting relationship. If the bank doesn’t feel like a good fit for your business or service needs, it makes sense to look elsewhere. It’s important to find a lender who fits your business needs and feels like a good fit for you and/or your partners.

The Right Banking Partner

Selecting the right banking partner is an important early step in ensuring the success of your de novo ASC development project. Look for someone who is knowledgeable about your industry, your business needs, and the financial factors for success. The right lender will help transitions occur smoothly throughout the process. Knowing you have a financial expert who can help in times of need is reassuring and will let you focus on other matters that will make your de novo ASC an overall success!

Richard DeHart, Principal Partner

Effective Health Care Marketing Goes Beyond Driving Business

Effective Health Care Marketing Goes Beyond Driving Business

By ASC Management No Comments

Health care regulations and policies are constantly changing, which makes health care marketing dynamic and challenging. Most marketing focuses heavily on targeting the right audience and delivering a tailored message to that audience. If the message is successfully transmitted, it drives demand for the health care service and consequently increases business and revenue. However, more nuanced effort is required to effectively market your surgery center and drive revenue growth.

Although patients may arrive at the specialist’s or ASC’s doorsteps through effective advertisements or physician referrals, there is no guarantee patients will stay to receive treatment for the same reasons.

For effective long-term business growth and retention, patients need to view your ASC as a reliable, trustworthy, and competent place to receive care. This is not fulfilled through marketing alone; it requires commitment from your entire organization.

Building Trust with Patients

Health care fits into the service industry category, where trust is translated into currency. Patients seeking care are already experiencing some vulnerability and stress related to their health. From the moment your patients walk through the door, and even before this point, they are assessing how your ASC responds to their needs and the quality of service they can expect to receive. In other words, can they expect your ASC to live up to the expectations set forth by your marketing campaign?

Long gone are the days when companies were able to unilaterally control their marketing message. Nowadays, patients are doing the marketing for providers, whether the providers agree or not. Technology has provided a platform for consumers to express their feelings and experiences online about the businesses with which they interact.

One study by the Local Consumer Review has indicated positive online reviews make 73% of consumers trust a local business more.[1] It is crucial to understand how patient experience and brand reputation go hand-in-hand in an increasingly digital world.

Focusing on Patient Experience

Strong marketing strategies focus on optimizing patient engagement to enhance positive brand reputation. That engagement starts with the initial marketing, but it solidifies through the patient’s experience at the ASC.

Here are some ways to improve patient experience:

  1. Set expectations through patient education.

Offer patient education through different platforms to establish patients’ expectations for their care. Patients get frustrated when there is a lack of information about their procedure, which sets the stage for unintended miscommunication. By being proactive in creating simple, relevant guides, you will contribute to your patients’ overall perception and experience.

  1. Invest in customer service education for your staff.

Your staff is the “face” of your organization. Patients tend to care more about how they are treated than the facility’s appearance. Educate your staff on how to engage with patients in positive ways, and how to ask patients to provide feedback about their experience. You may also consider giving staff a simple flyer or cut sheet to hand to patients which outlines how to leave an online review for your ASC. Evidence shows that 70% of consumers will leave a review for your business when asked.[1]

  1. Invest time in communicating with your customers.

Technology has changed consumers’ expectations about how businesses communicate with them. Be aware of what patients are saying about your organization and be proactive in responding to what they are relaying. Let your patients know you are open to feedback, whether it’s good or bad.

Also, it is important to understand where to communicate with your patients. Although a recent study shows Yelp & Facebook are local consumers’ most trusted review sites,[1] other platforms are being used for consumer reviews. One of the services Pinnacle III provides to its facilities is managing each ASC’s online reputation. We foresee demand for patient interaction expanding, not decreasing.

  1. Have a service recovery plan.

This applies to both patients and referring physicians. As a physician, you value your relationship with your patient. As a surgeon, you value the trust other physicians place in you when they refer their patients to you. What if a mishap occurs that could potentially tarnish those sacred relationships?

It is wise to prepare your staff members to handle an unhappy patient or referring physician partner. By focusing on customer loyalty versus attempting to gain new ones, you may realize more positive benefits in the long run. Frederick Reichheld, author of the Loyalty Effect, stated that a five-percentage point increase in customer retention increases profits by more than 25 percent.[2]

Better Business at Your ASC

Targeting potential consumers with tailored marketing messages can help lead patients to your health care door, but their arrival is only half the battle. Comprehensive and results-driven health care marketing also incorporates the patient experience when they seek treatment at your physician office and/or ASC. Stay in-touch with the ever-changing health care market to make sure you are providing the best possible service for your patients’ needs. Seek to build trust with patients and you will be rewarded for your efforts. Recognizing and prioritizing each patient’s overall experience ensures health care marketing results in long-lasting, loyal relationships.

Alice Beech, Physician Liaison


[2] Reichheld, Frederick F., and Thomas Teal. The loyalty effect: the hidden force behind growth, profits, and lasting value. Harvard Business School Press, 2008.


Revenue Cycle Management Processes: Establishing a Status Quo and Incorporating Input from New Employees

Revenue Cycle Management Processes: Establishing a Status Quo and Incorporating Input from New Employees

By ASC Management, Revenue Cycle Management No Comments

It’s Monday morning and one of your billing office employees walks in with a bizarre patient statement. To make matters even worse, your employee’s work on the statement does not reflect your office’s revenue cycle management processes. Where did this statement come from? How long have your employees employed this process? Where did the communication go wrong?

Perhaps your organization is in growth mode and new staff began implementing experiences and practices from their previous employers. Their understanding of the best way to proceed may not align with your company’s established revenue cycle management processes. Additional education or retraining is necessary.

Perhaps it’s time to re-evaluate your processes to assess if they still meet your business needs. If you’re not auditing your current protocols, how do you really know they are effective?

Consider the following practices to ensure successful communication is being delivered to your billing office employees. These suggestions will also ensure your processes remain relevant and effective.

  • Create, implement, and adhere to a robust onboarding process. This helps managers and trainers provide each new employee with the same foundation. A key onboarding element is spending time in other departments to gain an understanding of how each department contributes to the process. If you don’t have a well-defined new employee onboarding process, you need one. The orientation period is the most important opportunity to position new employees for success.
  • Hold educational boot camps when issues arise. It may be much easier to hold short 15-minute topic-specific meetings to address identified issues, than a 30 minute or an hour-long meeting designed to cover multiple topics. This tactic will allow you to be very detailed in reviewing and educating your team about the specific processes or issues in question. Addressing one topic per meeting leads to a greater chance your team will adopt your revenue cycle management processes. Addressing multiple topics in the same meeting may cause the team to become overwhelmed and lose direction, not knowing what to tackle first.
  • Review your policy and procedure manual. Engage your team members in revamping or creating revenue cycle management processes. Allow them to review existing policies to determine if they are still relevant. Retraining and education naturally occur through this type of employee engagement — a win-win for your team.
  • Allow employees to cross-train or shadow in different departments. Confusion often occurs when multiple departments are part of a process. Allowing employees to cross-train or shadow in departments other than their own will help them understand the process in its entirety. Once they have a clear understanding of the entire process, they are better equipped to problem-solve in areas they can control to help their colleagues. Time spent cross-training or shadowing also allows employees to establish relationships and team build with one another.
  • Audit, and then audit some more. Audits don’t have to be cumbersome. A high-level review can reveal where you need to focus your attention. The issues you discover may apply to only one employee and may not be departmental problems.

Bottom line: don’t bury your head in the sand and hope for the best. When adding new team members, training, education, and communication are your best shots for success to ensure their understanding and continuous use of current, relevant revenue cycle management processes. Allowing new team members to suggest alternate ways of proceeding is a bonus for the organization. Their fresh perspective may lead to improvement of established or outdated processes.

Carol Ciluffo, VP of Revenue Cycle Management