July 2018

Jul 26

6 Strategies for Optimizing Patient Satisfaction at Your ASC

By pinnacleiii | ASC Management, Leadership | No Comments

When it comes to determining the operational successes of an ASC, patient satisfaction scores provide a resource which highlights areas of success and potential areas for improvement. A robust patient satisfaction survey process contributes to better understanding your ASC’s overall outlook for profitability and sustainability. This is more easily understood if we consider patient satisfaction and operational efficiency as a two-way street. Patient satisfaction scores can reveal the operational needs of an ASC. In turn, operational efficiency can influence the customer experience and patient satisfaction scores. As healthcare shifts from fee-for-service to fee-for-value, initiatives such as the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) gains importance for ASCs.

Here are six strategies to increase patient satisfaction and maximize patient throughput. This can be achieved by focusing on efficient processes that improve patient and operational flow.

Improve efficiency in your scheduling process.
- Encourage physician offices to schedule cases as far in advance as possible.
- Establish strong working relationships with physician offices to obtain accurate information.
- Schedule specialties in the same room, whenever possible.
- Schedule similar surgical sites consecutively.
- Evaluate and communicate patient criteria to surgeons and staff.

Improve operational efficiencies.
- Monitor physician block schedules and utilization.
- Train staff on safety and efficiency.
- Monitor staffing levels.
- Provide pre-op interviews via phone or an online patient portal. Obtaining medical histories prior to date of service decreases time spent on this task on the date of service.
- Monitor OR staff efficiency (e.g., turnover time).

Evaluate your patient satisfaction scores.
- Ensure your surgery center establishes patient satisfaction return rates and score goals.
- Review and update questions regularly to ensure they are current and provide valuable information that addresses specific company metrics.

Assess your patient satisfaction program and complaint resolution process.
- Patient satisfaction is a significant part of an ongoing quality program. Ensure your patient satisfaction information ties into your key performance indicator (KPI) reporting program so you can analyze and develop specific performance improvement initiatives tailored to your ASC. Centers can assess trends allowing them to quickly identify ways to recognize consumer concerns, areas of weakness, and areas of strengths. For example, patient satisfaction scores at an ASC Pinnacle III manages were affected by financial information not getting to patients in a timely manner. The center determined a financial counselor position might be needed to not only enhance consumer satisfaction but increase the center’s time of service collection of patient payments. A financial counselor position was added. The center is now measuring the response to the counselor position with its satisfaction survey scores and time of service collections throughput.
  - Best practice in complaint resolution requires administration to review all patient complaints. The administrator is responsible for the investigation of, and follow-up on, patient complaints. Resolution may take several forms depending on the complaint. The patient may be contacted via phone for further conversation and/or resolution, while other complaints may require a written letter. The administrator should consider the complaint to determine what internal correction of policy or personnel issues need to take place.

Ensure medical staff satisfaction. Medical staff feedback and satisfaction is important to patient satisfaction. Why? Happy physicians mean happy patients. To ensure satisfaction:
- Visit with physicians to obtain direct input on equipment needs, staff performance, operational efficiency expectations, etc. Check-in with your physicians routinely to ensure their needs are being met.
  - Use information gleaned from physicians to improve processes.
  - Gather information from physicians via anonymous physician surveys.

Create a positive customer-focused culture.
- When you create a positive customer-focused culture within your team of physicians and staff, patients will reap the benefits.

It is not difficult to make the connection between the operational efficiency of an ASC and that ASC’s level of patient satisfaction. As we modify and improve our ability to provide quality service to patients, those patients will notice and our ASCs will experience positive results. The first sign that operations are proceeding well is a marked improvement in patient satisfaction scores. Be careful not to let patient satisfaction surveys become a routine process that is not taken seriously. The scores an ASC receives on patient satisfaction surveys will be reflected in customer loyalty, business growth, profitability, and overall reputation. Listen closely to the valuable feedback your customers provide and implement changes that are attentive to those concerns.

Kelli McMahan, VP of Operations

Jul 18

ASC Marketing and Sales: Keeping Up in an Evolving Industry

By pinnacleiii | ASC Development, ASC Management, Leadership | No Comments

Marketing your business isn’t easy. Having a comprehensive marketing strategy is especially important in dynamic markets where change is the norm. In health care, and especially in the ASC industry, effective leaders tend to focus on concrete operational and administrative items that keep the doors open for business. Surgery centers often operate with a precise number of staff designed to support the current client base. An all hands-on deck culture leaves limited time to consider, let alone implement, a robust ASC marketing and sales strategy. Some stakeholders may argue a robust ASC marketing and sales strategy is not vital – after all, physician practices drive business to the site of care. While this is true, environments change. Those who are committed to tactics that have worked well in the past may soon find they have been left behind.

What is an effective way to go about marketing an ASC? Here are some strategies to consider.

Selling – Manipulation v. Persuasion

It is said, “Any successful business sells well.” What does that mean exactly and how does it apply to surgery centers?

As an administrator in a health care entity, it may be difficult to imagine yourself selling as one does, let’s say, in a retail store. When we think of health care in a typical clinical environment, we picture sick patients, caring providers, medical equipment, medicines, and other related items. It can be difficult to imagine selling in the health care arena. In fact, it almost feels wrong – perhaps because most health care isn’t elective. However, I would venture to say this is true only if you consider the old school perception of selling. What do I mean? The old mindset of selling embodies characteristics of manipulation which, by definition, entails, “artful, unfair, or insidious means.” There is a much stronger ethical consideration in health care than in many other industries. Artful, unfair, and insidious means go against the ethics of medical practice.

Shifts towards globalization and mainstream use of technology have allowed for greater sharing of consumer insights. Consumers in turn have become more savvy. Selling now focuses more on persuasion. Persuasion means to move by “argument, entreaty, or expostulation to a belief, position or course of action.” Selling deals with intent, purpose, and an end goal. If the end goal is to rip people off, then, yes, selling feels terrible. That is manipulation. However, health care leaders can expect to feel something different when their selling mindset moves toward persuasion.

The Norwegian word for sell is “selje,” which directly translates to, “to serve.” As a business operator, if you believe you are there to serve the marketplace, customers will find ways to buy your services because you are serving them. With this shift in perspective, selling becomes more palatable for our surgery centers, right?

Understand Your Customer

The best way to attract customers – new patients or physicians – is to understand your prospects. Health care providers ask leading questions to understand the root cause of a health problem. The same practice holds true with your customers.

Let’s say you want to recruit a spine surgeon who just moved into your market. What are your next steps?

How about a visit to the surgeon’s practice, bringing his or her favorite lunch and dessert, to entice the surgeon to stick around while you rave about how great your surgery center is for his/her cases? This represents the old way of selling. And many physician recruiters would feel good about this method because you walked in with intent, purpose, and an end goal. But you would be doing yourself, the physician, and the surgery center a huge disservice if you didn’t take the time to understand the real needs of the physician. The favorite lunch and dessert will only satisfy for a short while. The positive statements in favor of the surgery center will only maintain impact until the physician experiences a negative event that doesn’t measure up to these claims. Even though this sales approach may provide immediate success, it is wiser to invest more effort in understanding the physician’s needs.

Taking time to get to know the physician and asking the right questions will create and sustain a longer-term relationship with them, which should be the real end goal. Another reason to ask the right questions is to assist customers articulate their needs. Your exercise may help get them to a place where they feel better about taking a step forward with you. Conversely, you may encounter a physician who has his or her defenses up because they have run into someone who sold, manipulated, and ripped them off in the past.

How can you engage physician recruitment prospects in deeper conversations about their needs? Here are some examples of focused questions to get you started in better understanding your customer.

“I understand you just moved into the area. Where would you like to see your practice go in the next 3-5-years?” or “What are your goals for you and your practice in the next 3-5 years?”
“What are your current patient demographics? Are there any additional cases or services you would like to start performing?”
“Are there any special equipment needs for your surgical cases?”
“Have you worked in an ASC before?” If yes, “What are some of the best or worst things that have shaped your ASC experiences? What things do you wish you could have changed? What things have you enjoyed?”

To accurately gauge if you are asking the right questions, determine if you are simply selling to your customer or truly servicing them. Servicing your customer entails understanding their needs first, rather than presenting to them what you think they want.

When you ask better questions of your customer, you get better responses about pain points and aspects your customer expects from your service. These answers can help you pinpoint how your ASC stands out from competitors. Sometimes your ASC is a better site of care for a physician; sometimes it’s not. Not being able to serve every client’s needs is okay. Develop your strategy, then focus on servicing your clients if it makes sense for you, your staff, and the business. Avoid being stagnant. Communication about your customers’ needs allows you to uncover hidden opportunities for business growth which can yield untapped profit.

Understand Customers’ Preferred Channels of Communication

Once you obtain the answers you need from your customers, work to understand how your customers want to receive future information and communication. Do they prefer phone calls, texts, emails, or paper communication? Do preferences change depending on the content? Identify when it is appropriate to send out a mass form of communication to all clients and when to communicate with clients on an individual basis. When you communicate with clients one-on-one, tailor your messaging and communication channel to fit their communication preferences. The best way to find out is to ask!

Making Every Sale Count

The last tip in marketing your surgery center is to make every sale count. Air Force veteran and “sales whisperer” Wes Schaeffer claims, “To make any sale, you must make every sale.” He goes on to explain: “Suppose you are going on a date. You would brush your teeth, dress up nice, approach with a smile, and perhaps pay for dinner. All these little gestures are viewed as little sales along the way, contributing to a larger sale.”

The same holds true for your surgery center. Some of the little sales to consider as part of your larger ASC marketing and sales strategy are:

Is your pre-registration pamphlet easy for patients to read and understand?
Can patients easily navigate your website? Is your website enticing to patients? Do they get a good feel for the care they will receive at your facility?
Do patients receive any form of communication prior to their procedure to ensure they are ready?
Do front desk personnel warmly greet patients and/or friends and family when they arrive?
Do your nurses and providers explain all necessary steps and set up expectations throughout each patient’s episode of care?

This is just an example of some of the mini-sales opportunities that occur when providing service to patients. There are many more touch-points in the patient journey. Each of these touch-points allow an opportunity to complete a mini-sale.

What works for your surgery center today, may not work for your surgery center tomorrow. Opportunities to improve customer experience occur with technology updates and patron preferences. The customer experience should be monitored, updated, and modified over time. The best way to identify the quality of your customers’ experiences is through patient satisfaction surveys and online reviews. Identifying how your customers navigate through your supply chain, including all the mini-sales touch-points, lends itself to better customer experiences and opportunities to retain customers long-term.

Effective ASC Marketing and Sales Drives Business

ASC marketing and sales requires an unceasing commitment. Customer needs are your number one priority in providing services, whether that customer is a physician or patient. Ensure you prominently address those needs in your strategic plan.

Effective ASC marketing and sales expresses your story. Never forget, your sales pitch should reveal your passion – to provide the highest quality service to consumers. As every consumer and every industry is different, so too is every business and every sales pitch. When you embrace the unique direction your customer base is encouraging you to move in, customer loyalty and unique service offerings will drive your business growth.

Trista Sandoval, VP of Business Development & Physician Relations

Jul 12

Welcome Aboard: Â Great Reasons to Become an ASC Nurse

Welcome Aboard: Great Reasons to Become an ASC Nurse

By pinnacleiii | ASC Management, Leadership | No Comments

Nursing jobs are aplenty and there are no signs of this changing any time soon. According to data from the U.S. Bureau of Labor Statistics, employment of registered nurses is projected to grow 15% from 2016 to 2026 – much faster than the average for all occupations.[1] Factors contributing to this rosy job outlook include employment growth in the health care sector and the need to replace retiring nurses.

With ample nursing job openings, qualified nurses can be selective about their work environment. A question nurses must answer is: “In what type of care environment do I want to work?” One of the more rewarding and enjoyable opportunities is serving as an ASC nurse.

Advantages of Working as an ASC Nurse

Here are some of the most compelling arguments for why nurses may want to set their sights on landing a position in an ASC.

Better work-life balance. ASC staff do not typically work weekends or holiday hours. Weekday shifts tend to end at a reasonable time – usually, there’s no burning the midnight oil. If you want evenings, weekends, and holidays free, these are typical perks of being an ASC nurse.

There is a trend of ASCs opening on an occasional Saturday to help meet patient scheduling needs. Some ASC nurses jump at the opportunity to work this shift as it often frees up a weekday. An open weekday is a great time to take care of appointments and errands while most people are working. Depending upon your interests, that weekday may be the prime time to pursue recreational activities.

Opportunity for cross-training. Are you interested in expanding your skill set while on the job? The ASC setting is the place for you. ASCs run a lean staff, with team members expected to wear many hats. For an ASC nurse, this may entail assuming roles such as risk manager, quality improvement director, or infection control specialist. Some ASCs ask clinical staff if they are interested in cross-training in what may seem like unusual areas. These can include patient registration, sterile processing, and materials management.

Cross-training affords nurses opportunities to expand their education and skills while still focusing on patient care. Cross-training may also provide an opportunity for nurses to work more hours, if the need arises.

Strong team cohesion. Hospitals, due to their physical and staff sizes, tend to be departmentalized, experience greater staff turnover, and rely upon more temporary staff. ASCs, with their small, cross-trained staff, naturally lend themselves to stronger team cohesiveness and efficiency. It doesn’t take long for a new ASC nurse to meet all coworkers and understand their job roles. By working with the same people day in and out, ASC staff develop powerful, often family-like bonds.

This familiarity helps develop comfort with and confidence in one another. It also improves communication and interaction between team members. The results: greater staff, patient and physician satisfaction; stronger workflow; reduced risks and, typically, better outcomes.

Closer relationships with patients. Patients who seek treatment at an ASC are in generally good health. They lack severe comorbidities. Undergoing surgery in an ASC tends to be less stressful compared to requiring emergent hospital care.

These factors allow ASC nurses to get to know their patients on a more personal level. There’s time for conversations with patients and family members. It’s not unusual for one or more staff members to discover a social connection with patients. As these bonds develop, patients move beyond being a medical record number and diagnosis. It is a rewarding experience to deliver care to someone you know on a more personal level.

Bonus program. In many ASCs, once the facility achieves profitability, leadership will implement a bonus program. This allows staff to take greater ownership of how well the entire business performs. For an ASC nurse, this may include influencing patient satisfaction, room turnover rate, survey performance, and cost containment.
Faster decision-making. In a hospital, change tends to be slow. For example, if clinical staff are unhappy with a type of surgical glove, changing brands usually requires a lengthy approval process. This can include multiple trials and levels of leadership approval, potentially taking many weeks.

In the ASC, the decision-making process is usually linear and quick. Unhappy with a product? It may only take a day or two to switch.

Answer These Questions Before Pursuing an ASC Nurse Job

The pros listed above represent just a portion of the many reasons why serving as an ASC nurse is rewarding. However, working in the ASC environment may not be for everyone. Before you begin applying to ASC job openings, consider these questions:

Do you need a guaranteed shift? ASCs tend to staff for the cases on their schedule. When there is not a full schedule, staff are often sent home. At times, there may be opportunities to fill some open schedule time with special projects. Even then, flexible scheduling tends to be a fact of life for an ASC nurse.
Are you looking for a rush? ASCs perform scheduled, elective procedures. Surprises are unwanted. If they happen, it usually indicates something has gone wrong, potentially jeopardizing safety. Want the adrenaline surge of coming into work not knowing what will happen or what you will need to do? You won’t find that in a well-run ASC.
Do you want to move up the leadership ladder quickly? There are few management roles within an ASC. If your desire is to rapidly advance into a management role, the ASC setting likely won’t lend itself to quick upward mobility. It is important to note, however, if you work in an ASC managed by a larger company, there may be more opportunities for advancement – assuming you’re willing to relocate.
Do you work best independently? ASCs thrive on teamwork. Most projects require it. If you tend to work most effectively on your own, an ASC probably isn’t a good fit.

Still unsure about whether you want to work as an ASC nurse? Consider reaching out to a local ASC and speak with its clinical director or director of nursing. Ask this person to tell you what they love about working in a surgery center. Find out if you can visit, tour the facility, and speak with other members of the nursing staff. There’s a good chance that working as an ASC nurse will check many of the boxes on your desired job qualities list.

Lisa Austin, VP of Facility Development

[1] https://www.bls.gov/ooh/healthcare/registered-nurses.htm

Jul 05

Opening a New Surgery Center: A Roadmap for Success

By pinnacleiii | ASC Development, ASC Management | No Comments

If you’re planning on opening a new surgery center, congratulations! If all goes well, you will soon provide your community with a high-quality, low-cost option for surgical care. But there’s a lot of work to do before you reach that exciting grand opening. It is said that “Rome wasn’t built in a day,” and neither is a successful ASC.

Before you proceed with plans to open a new surgery center, consider the following list of questions. Knowing the answers will help ensure the facility you picture today is what you end up presenting to your community tomorrow.

New Surgery Center Questions to Answer

Are your partners committed?

A new surgery center is destined to fail if you do not have committed partners. That commitment needs to be short and long-term. Commitment can be gauged in several ways – their financial investment, their case volume, and their participation in research and decision-making.

Once partner commitments are confirmed, you will need a well-structured operating agreement. This agreement should account for potential issues that may arise during the ASC’s development and as the business matures. Getting a group of physicians to verbally agree to partner on a project is one thing. It’s another to obtain their signatures on paper and make their vision reality.

Where will financing come from?

Building a new ASC isn’t an inexpensive undertaking. Expenses that will need to be covered before performing the first procedure include:

Construction, either of a new facility or remodeling an existing space
Medical equipment and supplies
Service providers (more on these in the next section)
Computers and software
Furniture and fixtures
Signage
Licenses
Staff salaries and benefits

You will also require working capital to cover expenses as you wait for reimbursement for procedures. Before you break ground, know how you will pay for all these expenses – and some unforeseen ones as well. You’ll probably need a mix of debt financing and cash capital contributions from the owners.

Who is on your team?

You’re going to need a lot of help to bring your plan for a new surgery center to fruition. Carefully consider the selection of individuals and teams with whom you contract to fill project needs. These service providers may include:

Architect
Management firm
Engineer
Attorney
Managed care contract negotiator
Recruiter
Marketer
Website developer

A poor choice of one or more of these service providers may result in serious ramifications. These could include project delays, failed surveys and inspections, poor contracts, and over-staffing.

What is your desired location?

This can be an easy or challenging question to answer, depending upon your circumstances. Do all the new surgery center’s owners practice out of the same building? If so, it may make sense to explore developing the ASC in, or attached to, that building. If that’s not an option, or you’re bringing together owners from multiple practices, you will need to decide whether to build a new facility or move into a remodeled space.

Both options have their pros and cons; weigh them carefully. Do you desire full control over construction of the building and its floor plan? Are you prepared to cover the additional costs (e.g., permits, foundation, connecting water, sewer, and electricity) associated with constructing a building from scratch? Is there an existing space you could remodel and open faster than building a ground-up facility? Will the potential savings of remodeling eventually be offset by building repairs and upgrades? While it may seem counter-intuitive, the cost of remodeling an existing space can surpass that of new construction.

What do you envision for the ASC?

The building of a new surgery center can take many months up to a few years. That’s why planning should consider not only physicians’ current case mix but their future volume projections.

For example, if your ASC will perform orthopedic procedures, are total joints on the horizon? If so, you will need larger operating rooms and additional storage space. If your physicians plan to eventually perform higher acuity cases, will you have the means to accommodate overnight stays (state permitting)? If you anticipate expanding to accommodate future growth, does the location you’re eyeing provide that option?

In the excitement of planning your ASC for today, don’t overlook the potential needs of your ASC for tomorrow. Be careful not to overbuild “just in case.” There’s a fine balance between building for what you need when you open and what you will need to grow.

New Surgery Center Pitfalls to Avoid

We’ve already touched on some of the issues to watch for when planning a new surgery center. Here are a few other pitfalls to avoid:

Don’t make rash decisions. It’s natural to want to break ground as soon as possible to move the project toward completion. But racing to build your new ASC could result in failure to provide appropriate attention to important matters. It’s better for a project to take longer if it means taking time to make educated decisions.

Don’t neglect project management. Building an ASC requires oversight and coordination of numerous moving parts. This adds up to a lot of time and energy. You and your partners may desire significant involvement in managing your new surgery center project. However, juggling it and a busy practice will likely prove quite difficult. Securing adequate, knowledgeable project support will help ensure nothing is overlooked or rushed.

Don’t underestimate the paperwork. You’re going to need to provide documentation to many organizations throughout the development of your ASC. This includes your state’s department of health, the Centers for Medicare and Medicaid Services, and an accreditation organization. The paperwork can be cumbersome and complex, and you will need to appropriately time its submission to keep your project on track.

Don’t wait to begin staff recruitment. Competition for suitable surgery center employees is high across the country. Recruiting and onboarding the staff needed for the first day your ASC is open will take time. Poor management in this area could leave you shorthanded, potentially forcing you to delay opening or slowing case migration.

Final Key Takeaway

One closing thought. I cannot overstate the importance of involving the right people in the building of your new surgery center. Individuals and organizations who are knowledgeable about what makes ASCs successful can help keep your project on schedule and on budget. Choose wisely!

Jebby Mathew, Regional Director of Operations