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June 2018

Developing a Successful ASC Staff Onboarding Program

Developing a Successful ASC Staff Onboarding Program

By ASC Management, Leadership No Comments

Onboarding plays a vital role in the success of new hires. An effective ASC staff onboarding program helps new employees acclimate to their role and environment while learning rules and responsibilities. Effective onboarding is also critical to employee retention. Staff are more likely to be satisfied, productive team members when they are provided with the knowledge and training needed to thrive in their positions. Some estimates put the cost of replacing an employee as high as 150 percent of their annual salary.[1] Retaining staff has a direct, positive impact on your bottom line.

ASC Onboarding Best Practices

To help improve the success of your ASC onboarding program, consider these recommendations.

Choose your HR representative carefully. The individual overseeing your human resources (HR) responsibilities is likely the first person new hires will meet on their first day of employment. This meeting sets the tone for the entire ASC onboarding experience. It’s your ASC’s opportunity to make a positive first impression and establish the standard for your positive culture. Your HR representative should be warm and approachable. New employees should come away from their time spent with HR feeling welcomed and valued. They should also understand your ASC’s plan and commitment to helping ensure they excel in their position.

Don’t move too fast. While you may be tempted to put new hires to work right away, refrain from extending too much responsibility too early. Improve the likelihood of job success by allocating appropriate time to cover essential rules and processes. This can include mandatory training, use of your ASC’s patient accounting system, emergency preparedness, and departmental policies and procedures. For new clinical staff members, complete this education and associated paperwork before they begin providing patient care. For new business office staff members, do so before they tackle any business tasks, especially those requiring compliance with HIPAA.

Be consistent. If multiple team members educate new staff, try to ensure training is consistent. Doing so will help you measure training results and efficiently address areas for improvement.

For example, many ASCs assign preceptors to new clinical staff. Each preceptor should know what they need to review to deliver complete, effective training. If you identify shortcomings, it will be easier to train all preceptors on the new information. This will provide confidence that new staff receive this revised education regardless of who fills the preceptor role.

Measure competency progress. As new hires move through your ASC onboarding process, measure their competency progress. One mechanism to consider using is a checklist. As new staff demonstrate proficiency in critical areas, the individuals tasked with overseeing training can indicate on the checklist that competency has been achieved. The checklist can also remind trainers to provide more focus on areas of competency deficits identified during the ASC onboarding process.

Check in periodically. Managers should periodically check in with new staff members throughout their training. While you can make this a formal process, such as scheduling time to speak after 30 and/or 60 days, informal discussions can be beneficial as well. Pull new hires aside at appropriate times to ask about the ASC onboarding process thus far. Are they receiving the training they need? Are questions being answered? How are they getting along with their trainers? Have they encountered any problems?

By asking these types of questions, you may discover opportunities to improve the ASC onboarding experience. After all, you want to make training as successful as possible. Everyone benefits if you can identify worthwhile changes earlier in the process.

Perform formal evaluation. At the end of the onboarding process, schedule a formal evaluation of new hires. Gather notes from trainers and any tools used to measure competency. Ask new hires specific questions about their role and responsibilities. Review competencies, verifying that new hires are adequately prepared to provide services without constant oversight.

If trainers have noted competencies in need of improvement, use this meeting to discuss how to address any limitations. Some areas may simply require reviewing educational materials at the meeting. If that will not suffice, you may need to extend training, focusing on competencies still requiring attention.

Hire Smart to Boost ASC Onboarding Success

The key to a successful ASC onboarding process is a successful hiring process. The onboarding process uses precious time and resources, including the skills and energy of multiple employees. You don’t want to waste these efforts on people who aren’t a good fit and do not remain with your ASC for long.

Here are some quick tips to help improve your hiring process:

  • Don’t hire too quickly. Unfilled job openings may require current staff to work overtime or your ASC to use part-time help. These options are better than rushing to hire people who might lack the qualifications to effectively fill positions.
  • Hire to fit your current culture. It’s important that new hires have the professional skills to fill your job openings. You also need individuals who possess strong interpersonal skills. New hires should contribute to your positive culture and encourage other team members to strive to succeed. Remember, one negative person can seriously damage your facility’s culture.
  • Look for shared vision. The people you hire should possess a vision for the ASC that aligns with that of your facility. For example, if you value compassion and productivity, look for those qualities in candidates.
  • Conduct initial interviews over the phone. Resumes, cover letters, and references only tell part of potential candidates’ stories. Before proceeding with face-to-face interviews, schedule telephone interviews. Go through a set list of questions to help determine whether candidates seem professionally and personally qualified for your openings. If you sense a good potential fit, proceed with in-person interviews. You’ll already have a feel for each candidate’s personality before they arrive, which should help interviews progress efficiently and effectively.

A careful, thoughtful hiring process is more likely to identify candidates who are likely to be successful in your environment. Once they arrive, an onboarding program focused on productivity and satisfaction will increase the likelihood new employees remain with your ASC for many years to come.

Jennifer Arellano, Director of Operations


Avoiding the Cost of a Bad Hire through Strategic Interviews

Avoiding the Cost of a Bad Hire through Strategic Interviews

By ASC Management, Leadership No Comments

It is undeniable hiring personnel is tough. In the fast-paced, dynamic ASC industry, there is little room, if any, to proactively hire candidates. OR nurses and surgical technicians are scarce with ASCs facing significant competition for those resources with other health care organizations. With these factors at play, we often rush to fill open positions. Current staff may be overextended sapping them of energy required to participate effectively in the hiring process. When everyone is anxious to fill the void or expand the team, we overlook flaws in candidates. We end up hiring people who don’t really meet our job-related needs and end up costing the company more in the long run.

Recognize the True Costs of a Bad Hire

The expenses associated with recruitment and new employee onboarding are more significant than most of us realize. Consider the following:

If you are using a free job posting platform, you may think you aren’t incurring any recruitment fees. However, if you and your staff are preparing and placing open positions on these platforms, that takes time – one of your most precious resources. Screening applicants, conducting strategic interviews, preparing offer letters, and negotiating employment terms all come with a time and energy price tag. Tack on the fees associated with background checks, drug screens, pre-employment physicals, and/or relocation packages and you have a good idea of what it costs to secure the services of a new team member. If you use the services of a professional recruiter, the costs associated with new hire recruitment can increase exponentially.

But it doesn’t stop there. Factor in the costs of onboarding which may include the following:

  • Time spent preparing and processing new hire paperwork
  • Time spent explaining benefit offerings and processing new hire enrollment elections
  • Time spent conducting organizational and departmental orientation
  • Costs associated with compliance training platforms
  • Time spent training and mentoring new team members
  • Time spent conducting competency assessments

And onboarding isn’t a one day, one week, or even one-month process. Onboarding should last for months with scheduled check-ins at one week, 30 days, 60 days, and 90 days. If you and your new team member have chosen well, the costs associated with recruitment and onboarding result in a return on your investment over the course of the employee’s tenure with your organization.

However, if your new employee doesn’t work out, the costs escalate. To calculate the cost of a “bad” hire – we are not passing judgments on people, we’re referring to a poor fit – add these potential outlays to the loss of everything spent on your new hire thus far:

  • Additional recruitment fees and staff time spent securing a replacement
  • Relocation and training for a replacement
  • Negative impact on team performance
  • Disruption to workflow
  • Potential for lost customers
  • Weakened employer brand
  • Job separation and/or litigation fees

To obtain the right person for the job, you need to know what you’re looking for, ask the right questions, and accurately discern candidate responses. This “simple” formula requires forethought, planning, communication, staff training, and a commitment to press on until you identify an “ideal” candidate.

Conduct Strategic Interviews

If your organization doesn’t have a standardized strategic interviewing process, create one. You’ll reduce the odds of making poor selection decisions when your hiring managers are provided with tools to formulate good questions and effectively evaluate candidates.

Standardized interviews ensure the process is consistent for all candidates. Strategic interviews for each vacancy should be conducted by the same set of interviewers for all candidates. Similarly, strategic interview questions should not vary from one candidate to the next. This allows for a better apples-to-apples comparison during your hiring team’s debriefing sessions.

Development of interview questions should be thoughtful, focusing on the competencies – knowledge, skills, and abilities (KSAs) – required to be successful in the job as well as the attributes required to be effective in the position, department, and organization. Well-formulated job descriptions will help you identify the critical success factors for each position. It may also help to consider the attributes of your top-performing personnel.

Here are some KSAs to consider:

  • Time management
  • Communication
  • Problem solving and decision making
  • Strategic thinking
  • Ethical practice
  • Reliability
  • Initiative
  • Credibility and personal effectiveness
  • Collaboration and teamwork orientation
  • Interpersonal skills
  • Customer/client focus
  • Leadership

Strategic interview questions can fit into various categories – general, behavioral, situational, and technical. An often-used general question posed at the outset of many interviews is, “Tell me about yourself.” Behavioral questions focus on the candidate’s past experience as a means of predicting future behavior and performance. An example is, “What was one of the toughest problems you ever solved? What process did you go through to solve it?” Situational questions provide the candidate with a hypothetical scenario and ask how they would respond given the situation described. For example, “You complete a task early. What do you do with your extra time?” Technical questions tend to be specific to a role. You might ask an infection preventionist, “How do you keep employees abreast of the latest developments in infection control? What types of surveillance techniques do you find most effective?” Develop a healthy mix of these types of questions based on KSAs identified as critical success factors for each position. Focusing solely on skills and experience can lead to overlooking an applicant’s true potential or minimize behaviors that are inconsistent with company values.

Strategic interviews aren’t merely about employers posing questions and soliciting information from interviewees. They provide your applicants with an opportunity to get to know you and your organization. Ensure you allot time for candidates to ask you and your team questions. Strive to properly convey your brand and culture to applicants.

Finally, ensure everyone involved in the strategic interviewing process has the tools they need to avoid asking inappropriate questions. Provide them with a list of illegal questions and alternate phrasing to obtain the answers they need. Here are a few examples:

  • Instead of asking “Can you get a babysitter on short notice for overtime or travel?” ask “You’ll be asked to work overtime or travel on short notice. Will this be a problem for you?”
  • Instead of asking “Is English your first language?” or “What is your native tongue?” ask “What languages can you read, write, or speak fluently?”
  • Instead of asking “How old are you?” ask “Are you over the age of 18?”

It’s easy for inexperienced hiring personnel to unwittingly phrase a question inappropriately. Set your team up for success by preparing them ahead of time. Ask them to stick to the script. They can convey their engagement to candidates via a friendly handshake, smile, and thanking them for their time or candor.


A well-formed talent recruitment strategy in the ASC industry is crucial to running a successful organization. Strategic interviews minimize the risk of a bad hire by ensuring you perform due diligence in vetting potential employees’ skills, experiences, capabilities, and cultural fit for your organization. Taking the time to create a strategic interview process positions your interviewing team to ask the right questions. When you gain a deeper understanding of potential new hires, you save time and money in the long run.

Kim Woodruff, VP of Human Resources & Compliance

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.


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

Securing Payer Contracts for Your De Novo ASC – It’s About Time!

Securing Payer Contracts for Your De Novo ASC – It’s About Time!

By ASC Development, Payor Contracting No Comments

Does anything matter more to your de novo ASC’s long term operational success than reimbursement rates and volume? Yes! While both reimbursement and volume are important, buying yourself the time required to secure credentialing, carefully negotiate reimbursement rates, and execute contracts with your key commercial payers is integral to your new facility’s success. They say, “Time is money.” In this scenario, that translates into securing adequate capital to cover operating costs while you accomplish crucial contracting tasks on behalf of your ASC.

Assessing Your Needs

Consider the following when assessing the cash reserves, line of credit, and time your de novo ASC will need during the payer contracting ramp-up stage of your development project.

Payer Credentialing

Credentialing for the newly developed ASC will take time. Credentialing requirements vary by payer. Some payers may require your new facility to receive approval from Medicare of its enrollment application prior to accepting your ASC’s credentialing application. To complete Medicare’s enrollment application, your ASC must perform several “test” cases. The current requirement is 10 cases. These cases will involve coverage from insurers other than Medicare. It not only takes time to perform these cases, it also takes time to select them from your surgeons’ patient pool of cash pay, workers’ compensation, auto, or charity cases that are readily available for surgical care shortly after your ASC opens. Completing this portion of the process can take several days to several weeks.

Some payers may require your ASC to be certified by Medicare and/or accredited by one of the CMS-approved accreditation organizations prior to completing credentialing. Once your new ASC’s Medicare enrollment application is approved, your facility will be placed on Medicare’s unannounced survey calendar. This means a surveyor may show-up anytime in a 90-day window for the on-site certification survey. Then, once the certification survey is finished, it may take several more weeks for the parties to exchange and/or process documentation before Medicare issues your certification letter. The certification letter provides your ASC with its Medicare number and Provider Transaction Access Number (PTAN). This portion of the process can take several months and must be accounted for in your project timeline.

Finally, once your ASC meets all the credentialing documentation requirements mandated by payers, it may take several more weeks for their credentialing committees to review and approve your credentialing application. Even if all goes well with credentialing, contracts cannot be executed before reimbursement is negotiated and each payer loads each agreement into its claims processing system.

Reimbursement Negotiations

Negotiating reimbursement rates take time. It will take time to obtain optimal reimbursement – or rates that are close to what you need – because payers often attempt to pay new ASCs lower than existing ASCs. This may be because payers view new ASCs as low hanging fruit on the cost-savings tree. Payers see an opportunity to save money by proposing lower reimbursement which, unfortunately, is quickly accepted by some new cash hungry ASCs.

From a short-term perspective, it may appear to make sense for a new ASC to accept the proposed low rates to secure payer contracts which then allows them to quickly start seeing commercial patients. However, in the grand scheme of things, the ASC is not solving a problem – it’s just delaying a problem. Such a situation gives rise to artificially setting market rates which takes additional time and effort to resolve during subsequent renegotiations.

It takes time and effort to secure reasonable reimbursement. It may take your new ASC a few to several months to negotiate agreeable reimbursement and contract terms with all its major payers. While some negotiation efforts can begin before the facility opens, most payers will not take new ASCs seriously until they open their doors. Maybe that’s because, until your doors are open, an opportunity cost to the payer and its members does not exist.

Executing Contracts

Waiting for payers to load the contracts you negotiate takes time. It generally takes 30-45 days, depending on the payer and the time of year, but occasionally it can take well over two-months. Oftentimes, the only thing your ASC can do during this stage is hurry up and wait. Therefore, the time spent in this portion of the process must be accounted for as well.

Gathering Resources

Having access to adequate capital to meet your ASC’s operating costs for 6-12 months after you open may be necessary to buy the time you need to secure your payer contracts. This is an important consideration when selecting a lender and applying for a line of credit for your de novo ASC.

No one can say exactly how long it will take. However, you should be financially prepared to spend a significant amount of time in the payer contracting ramp-up period. There is no way to get around this often-lengthy time investment, but laying the proper reimbursement foundation is a key component of your de novo ASC’s long-term success.

Dan Connolly, VP of Payer Relations & Contracting