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ASC Management

When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

By ASC Management, Uncategorized No Comments

A patient comes into your ASC and undergoes a screening colonoscopy. Polyps are found during the procedure and are removed. Considering the circumstances, this sounds like good news. The screening served its purpose. You detected and removed cancer precursor lesions, hopefully helping to prevent the disease.

There’s just one problem: The patient is angry. Not about the successful removal of the polyps, but about how a change in type of procedure also changed the patient’s financial responsibility. A scheduled screening colonoscopy has become a diagnostic colonoscopy. Rather than being a preventative service provided at no cost to the patient after their insurance has processed the claim, the patient now owes a payment – possibly one considered quite significant.

Guidance for Screening Colonoscopy Education

By taking a proactive approach to colonoscopy education, your ASC can help reduce its number of upset patients. You may even improve their satisfaction in the process. Here are some recommendations on how to help patients understand their potential financial responsibilities before undergoing a colonoscopy.

Develop Documentation

Alleviate some of the confusion about colonoscopies by providing patients with documentation explaining possible outcomes of their screening colonoscopy. Share background on preventative services, noting limitations on this provision. Explain how the definition of a preventative service is adjusted due to changing (and strict) insurance guidelines. Elaborate on how this may affect patients scheduled for a screening colonoscopy and their financial responsibility. Define the categories of colonoscopies: screening/preventative, diagnostic/therapeutic, and surveillance/high-risk.

This background information will hopefully help patients gain a better understanding of colonoscopies. Then summarize what can happen when patients receive a screening colonoscopy referral. Describe how categorization can change based on information captured during the scheduling and pre-procedure processes. Consider addressing some frequently asked questions, such as whether physicians can change a diagnosis so a procedure can qualify as screening and why insurance companies may seem to indicate that your ASC can alter a CPT or diagnosis code.

Share Benefits Information

Along with this documentation, provide patients with information about their colonoscopy benefits. Give your benefits coordinator a form to fill out when they review coverage information online and/or contact patients’ insurance carriers. This form would include details on patients’ covered benefits concerning screening and diagnostic colonoscopies. It would also state patients’ financial responsibilities (or potential responsibilities), broken down by co-pay and deductible.

You may want to include details about payment plans your ASC offers on this form. This can help patients start planning how they will pay for their care if the colonoscopy categorization changes. Include this form with the background documentation.

Speak Directly With Patients

While these documents should better prepare patients for their colonoscopy and possible financial outcomes, calls to patients are also worthwhile. Use this opportunity to review the information in the documentation and form. Ensure individuals at your ASC who speak with patients can explain the difference between screening and diagnostic colonoscopies. Staff should receive training to help them effectively communicate with patients and accurately answer questions.

Quick Tips for Dealing With Upset Patients

Despite your best educational efforts, you may still receive phone calls from upset patients following their colonoscopy. Consider following these steps to help address their concerns:

  • Let them vent. If patients sound animated, give them time to share their thoughts and feelings. Avoid interrupting and try to respond only when asked a question. Giving patients this opportunity to vent can help them calm down and become more focused on the discussion to follow.
  • Remain polite. Throughout your conversation, strive to remain polite, listen carefully and remain calm. If patients believe you are becoming frustrated, not listening closely, or failing to take their concerns seriously, they are likely to become angry.
  • Review case history. Help patients feel like you take their concerns seriously by discussing the details of their situation. Pull up their chart and bill. Talk through the procedure: what was scheduled and found, and how that affected information submitted to their insurance carrier. Verify that your ASC properly coded and billed the procedure.
  • Explain insurance rules. After discussing the case history, patients may still question what they owe. Describe health insurance rules and how they dictate changes in colonoscopy categorization. Provide education on diagnosis codes and your ASC’s requirements to code based on the procedures performed, not scheduled. Discuss the claims submission process and how that triggers the health insurance reimbursement process. Note: If patients spoke with their insurance before you, they may have been told that had you coded the procedure as a screening colonoscopy, it would have been covered. Be prepared to explain the potential fraud implications of improper coding and billing.

Going through these steps can provide comfort to patients and help them better appreciate your ASC’s responsibilities. Once you address any outstanding questions, move to the discussion about how patients will cover what they owe. Be cognizant that patients may be in a delicate state as they come to accept their financial responsibility. Help relieve some stress by informing them of payment options that can spread their financial responsibility over time. While patients may express displeasure with what they’re hearing, patience and compassion can move the situation toward a positive resolution.

Catherine Sayers, Director of Operations

Launching an ASC Staff Certification Program

Launching an ASC Staff Certification Program

By ASC Management, Leadership No Comments

When members of your staff indicate they want to get better at their jobs, your response is probably enthusiastic support. After all, a more competent, skilled staff is better prepared to achieve improved clinical and financial results and higher patient and surgeon satisfaction. These are some of the reasons ASCs allocate time and resources to staff training and in-service education. They are also compelling reasons for developing a program that supports ASC staff certification.

ASC Staff Certification Program Components

Here are some of the essential components to address when developing your ASC staff certification program guidelines.


Determine certification program eligibility. Is the program limited to full-time employees or are part-time employees also eligible to participate? Are staff required to work at your ASC for a specific amount of time (e.g., one year) before they are eligible for the program? Will you restrict participation to employees in good-standing?

Acceptable Certifications

Specify which certifications your program will cover – preferably, those that are essential to your facility’s success. Examples of certifications you may want to include:

  • Certified Perioperative Nurse (CNOR)
  • Certified Post Anesthesia Nurse (CPAN)
  • Certified Ambulatory PeriAnesthesia Nurse (CAPA)
  • Certified Surgical Tech (CST)
  • Certified Gastroenterology Registered Nurse (CGRN)

It’s important to permit staff to propose certifications not included in your program. You can weigh the merits and applicability of each proposal. While you may add to your original program list, consider including only those certifications awarded by nationally recognized professional organizations.

Covered Expenses

Identify which expenses are eligible for reimbursement upon successful completion of the ASC staff certification. You will likely want to cover the certification exam fee. You may want to reimburse certification renewal fees. Other expenses to consider:

  • Educational resources to support exam preparation (e.g., books, webinars, conferences)
  • Practice exams
  • Transportation to and from an exam center
  • Continuing education required to maintain the certification

Include a qualifier noting that reimbursement only applies to the portion of eligible expenses not already covered by other payment sources, such as scholarships. Put a cap on the amount of reimbursement available for a single certification and/or timeframe (e.g., annually).


Require documentation at the beginning and end of the program. Employees seeking certification assistance should submit their application/request in writing. Following certification program completion, ensure employees provide documentation demonstrating they earned the certification. If you are covering other expenses, request itemized receipts.

Secure a Return on Your Investment

An ASC staff certification program is one way for your ASC to invest in staff. Help protect your investment by including a reimbursement qualifier in your guidelines. State how long employees are expected to remain with your surgery center following completion of, and reimbursement for, the certification program. Clearly outline the financial penalty for failing to reach this mark.

For example, you might require employees to repay 70% of their assistance if they do not stay with your ASC for one year after achieving certification. While you cannot require employees to remain at your center, financial penalties encourage them to thoughtfully consider the impact leaving prior to completion of the qualifying term will have on them and your ASC. Financial qualifiers also deter individuals not fully committed to staying with your ASC from applying to the program.

ASC Staff Certification Program Expansion

If you launch a program that is successful, consider additional ways to encourage staff members to participate. One way is to add certifications to your list. Ask staff for their recommendations. Monitor the development of new certifications, such as the recently launched Certified Ambulatory Infection Preventionist (CAIP).

Another way to expand the program is to go beyond certifications. Include courses provided through an accredited educational institution of higher learning (e.g. college, university, trade or vocational school). These offerings may attract individuals already holding certification(s) or those not interested in certification.

Here are some additional considerations if you are going to offer reimbursement for course tuition:

  • Require the primary business of the institution attended is education. Academic or college credit hours should be earned upon successful completion of the class.
  • Ensure course work is applicable to the employee’s current position or tied to a degree related to an employee’s career path with your ASC.
  • Require proof of completion, such as a transcript or grade report.
  • Determine whether to reimburse for books and other supplies mandated for course participation.

Offering reimbursement for certifications and courses is a potentially low-cost, high-reward method to improve staff performance and productivity. This investment can encourage greater staff loyalty and appreciation of leadership support. An ASC staff certification and educational course program promotes an ASC’s mission of providing compassionate, high-quality care. That’s a proposition easy to endorse!

Michaela Halcomb, Director of Operations

Quick Tips for Managing a Rural ASC

Quick Tips for Managing a Rural ASC

By ASC Management, Leadership No Comments

Managing a rural ambulatory surgery center (ASC) presents unique challenges. In a limited demographic region, staffing, physician recruitment, and patient access can be problematic, especially if a well-formed strategy isn’t in place.

Here are several tips to help manage a rural ASC.


In a remote (non-urban) region, there are typically a limited number of skilled professionals available to staff your rural ASC. While professionals in the area may possess the necessary medical credentials, they may not be equipped with firsthand ASC experience. If you require ASC experience as a minimum qualification, you will further limit your applicant pool. Therefore, it’s best to shift your focus to hiring qualified, motivated individuals who are willing to put in the time and effort necessary to achieve competency in the surgery center arena. Be prepared to spend adequate time onboarding and introducing new employees to the ASC model. It differs significantly from the hospital model where available staff may have gained much of their previous experience. A challenge faced by employees new to the ASC model is learning to perform multiple duties they were not likely required to complete in the hospital setting. Patience, consistent check-ins, and open communication with the preceptor are key in getting them up to speed.

Physician Recruitment

Physician recruitment can also be challenging for a rural ASC. Typically, there is only one hospital which employs physicians in the area. The ASC will either need to have a transfer agreement with that hospital or the physicians providing surgical and procedural services will need to have privileges at the local hospital.

If the hospital is not inclined to provide a transfer agreement to the ASC, physicians who only perform outreach medical services in the area may find obtaining medical staff privileges at the hospital burdensome. Because these physicians are not providing services to the rural community daily, they may be unable to meet the hospital’s case threshold requirements.

Take time to understand physicians’ relationships with the hospital prior to onboarding them to your ASC. In turn, ensure physicians you are recruiting to the ASC understand the steps they may have to take to secure the necessary relationship with the local hospital.


Patient access is limited in a rural area. Some patients may travel for an hour or more to receive medical services. Robust patient scheduling, admission, and discharge criteria are necessary to ensure optimal patient experience. Train your staff to ask your patients the right questions. Nursing staff need to supply patients with detailed post-operative instructions, as well as travel instructions to make sure patients are comfortable on their trip home.

Some patients may require longer recovery times to adequately prepare them for their extended post-op travel. Understanding these needs up front, will save your staff, physicians, and patients valuable time post-surgery. Provide patient satisfaction surveys, monitor the responses, and implement operational changes to enhance customer service.

The challenges encountered in running a rural ASC are different than those you may face in a surgery center located in a metropolitan area. Devise a strategy that considers staff, patients, and physicians. Focus on building and maintaining a high functioning ASC team. Create relationships that extend beyond the rural community. Focusing on these efforts will help you run a more successful rural ASC with the limited market and resources available.

Kelli McMahan, Regional VP of Operations

ASCs: Marketing for Your Small Businesses

ASCs: Marketing for Your Small Business

By ASC Management, Leadership No Comments

Most businesses understand some type of marketing is imperative to compete in today’s economy. Some businesses, especially small businesses like ambulatory surgery centers (ASCs), shy away from venturing into new digital platforms due to lack of time, financial resources, or both. However, there are strategic steps small businesses can take to engage in time- and cost-effective digital marketing initiatives.

First, identify your target audience. Begin by collecting appropriate and available customer data, such as age, gender, household income, etc. Ensure the data collected adheres to guidelines established under the Health Insurance Portability and Accountability Act (HIPAA).

Next, identify your marketing goal – the ultimate action you want your customers to take. Because surgery centers do not sell products online, an example of a marketing goal might be to increase the ASC’s web page views.

Now, identify the best platform to engage your patients. Then track the results. This is typically where small businesses need guidance. Although most platforms mentioned below are “free,” they will cost you hours in content creation and maintenance. And, if not managed properly, your customer engagement initiative could fail.[1] However, our goal is to provide tips that boost your confidence, not instill fear!

Let’s start with the basics: managing your ASC’s online profiles (e.g., Google, Yelp, Healthgrades). A 2017 consumer report indicated 97% of consumers use the internet to find a local business and 85% of these consumers trust an online review as much as personal recommendations.[2] The expectation for business to consumer interaction is also high, with nearly 52% of customers expecting a response in seven days or less, especially if the review is negative.[3] Therefore, proactively managing patient reviews and capitalizing on positive patient experience is vital. Checking on these platforms at least once a week will help you stay on top of reviews and show your customers you are listening.

Once your profiles are properly created and managed, look at other free social platforms with a creative eye. Because social media is very interactive, it takes time and dedication to maintain. YouTube can be a great platform to showcase your brand by posting “how-to” videos that display industry expertise. Healthcare entities have used this platform to provide pre/post-operative educational videos for patients, eliminating webinars or in-person classes. Small businesses can also collaborate with their partners. For example, consider working with a device company to produce medical equipment demonstrations or provide patient education with affiliated hospitals.

Most people research medical information online before consulting with a provider. This could be a path that leads information seekers to your service. Instagram is the third largest social media platform. It is estimated to have 700 million active users each month.[4] The age group utilizing it is also diverse, with 18% of users in the 50-64 age group.[5] However, the best way to engage with your audience is to have them do the marketing for you. Social media reviews are the digital equivalent to the good old word-of-mouth. Obtaining referrals from a trusted source goes a long way.

If you are inspired to explore the possibilities of a social media business account, ensure you have proper disclaimers and/or permissions to post customer reviews. The last thing your ASC needs is a lawsuit triggered by a poorly managed marketing initiative.[6]

Marketing automation tools such as GetResponse, Emma, and Marketo are great ways to follow up on successful patient engagement. Not all marketing automation tools are free, but they can help small businesses know when a lead lands on their website, requests information, and participates in other engagement behaviors. The data provided can be used for strategic follow-up through email, short messaging service (SMS), or direct mailers.

Marketing automation may not be for you just yet, but that doesn’t mean your business can’t gather data on marketing efforts. Ensure all marketing campaigns have a call to action that is trackable. Although this is simple advice, many small businesses forget about post-impression behavior tracking. This is voluntary forfeiture of customer data that could benefit your future marketing efforts. The adage, “if it can’t be measured, it can’t be improved,” is applicable here.

In summary, marketing should not be a shot in the dark. Increase your chances of hitting your target by incorporating marketing into your business’s strategic plan. In today’s fast-paced, noisy, and competitive market, small businesses do not have the luxury of bypassing customer engagement and loyalty. Customer engagement should be focused, analyzed, and personalized for the best long-term results.

Alice Beech, Physician Liaison







ASC Policies, Procedures, and Protocols, Oh My!

ASC Policies, Procedures, and Protocols, Oh My!

By ASC Governance, ASC Management, Leadership No Comments

Policies, procedures, and protocols are the lifeblood of an ASC’s operations. These critical guidelines should be clear, concise, and readily accessible to members of the workforce. Sometimes, despite the importance of these standards, locating a comprehensive listing of policies, procedures, and protocols is not easy. When staff members are unable to easily locate a policy for the guidance they need to complete their job duties, they are hampered in their mission to provide efficient and effective service to patients. Frustration arises when time is wasted working through inefficient processes. And, in a surgery center’s fast-paced environment, timeliness is critical to efficiency.

Policies and procedures are written to provide clear and concise context, which in turn promotes consistent performance across teams. Written policies are the guideposts which represent evidence-based practices to be applied in daily functions. When team members cannot locate a policy, mistakes can happen, and clinical care can falter.

The best policies and procedures are well-researched, carefully crafted documents that contain pertinent references. They should also be stripped of bulky words, keeping content current, consistent, and concise. No matter how well written the policy, it is meaningless if it is never read and applied to practice.

How do you know if your staff is knowledgeable of your surgery center’s policies and procedures?

If your staff asks questions which are addressed in the policies and procedures manual, that can be an indicator that they are unfamiliar with your ASC policies and procedures. For example, do they ask, “What policy addresses cleaning point of care devices between patient use?” or “How often must relative humidity be monitored?” These questions indicate your staff either do not know best practices, or your ASC process, or they are unsure where to locate the information.

To address a lack of awareness of policies and procedures, begin by creating open dialogue with your staff. During this process, you may uncover a need for retraining or identify areas in your onboarding process that are insufficient. On the other hand, if your staff reveals competency in the areas where there were questions and they are solely looking for your center’s specific policy, take a step back to review the accessibility of your policies and procedures and determine if they are user friendly. There may be many reasons why staff members do not establish and maintain policy knowledge with ease; communicate with them to find out why.

Are Policies, Procedures, and Protocols Accessible?

Let’s explore the accessibility factor by looking at the history of policies and procedures. In the past, policies and procedures were paper based – typically housed in several large three ring binders. Often, these policy notebooks were strategically placed in the confines of a manager’s office – the person most often responsible for upkeep of written policies. In this model, the binders are not immediately available to the bedside nurse who may benefit greatly if they were in a more convenient, accessible location.

The communication breakdown here can be explained by competing priorities. A manager of a busy ASC is often overwhelmed by the demands of the day. The ongoing task of refreshing policies quickly can easily slip to a lower priority.

A practicing nurse knows to wipe down the gurney and put clean sheets on the bed before the next patient uses it. He or she did not need to read a policy to know this. However, does this same nurse know why only FDA approved disinfectant is used? How much dwell time is needed to kill microorganisms? Which point of care devices need to be cleaned? The answers to these infection prevention practices are critical to current infection control standards and are addressed in written policy. When the policy is read and executed, best practice is displayed by the entire team.

Poor practice, ineffective communication, and inadequate onboarding occur when the cleaning process is vocalized but not provided in written form during the orientation of a new hire. The orientee does their best to repeat what is heard and observed – but a breakdown in the consistency of the function can easily occur. If the employee does not receive enough guidance or resources, he or she may resort to performing the task in the way he or she knows how, relying on previous experience or observations of others. That performance might not adhere to the latest best practices. Alternatively, proper infection control processes are easily achieved as a repeatable task with initial and continuous education resources available.

Sustainable solutions to sharing protocols, policies, and procedures

As ASC leaders, our responsibilities include consistent, reliable management of information. Effective policies contain information that can be easily shared with members of the workforce. Leaders need sustainable solutions that improve how we share policies with staff members.

Here are four goals to consider:

  • Policies are readily available to end users.
  • Policies are accurate and current.
  • Policies are protected from erroneous editing.
  • Policy updates are communicated clearly and in a timely manner to appropriate personnel.

To select a communication platform designed to achieve these goals and secure utilization among all team members, consider the following questions:

  • Does the platform address your identified goals?
  • Can the facility afford the platform?
  • What training is required to launch and implement the platform?
  • What will be gained from using this platform?
  • How will leadership appropriately administer change management?

Not every ASC will be able to adopt the same method, hence the importance of identifying your own goals. Once goals are established, develop leading questions to identify the best tool or process for your surgery center presently and in the foreseeable future.

Is there a better way?

Pinnacle III’s managed facilities recently adopted a technology-based policy management system. This strategic move allows our ASCs to immediately gain access to our surgery center policy library. Placing a clickable icon on every workstation provides employees immediate access to policies. System administration ensures accurate and current content material, maintaining intellectual ownership. To protect policies from incidental tampering, all editing occurs via permissions and a prescribed work flow process.

To facilitate the change management process, staff training was provided upon implementation. Periodic in-services were scheduled following initial implementation. To progress staff adoption, a series of quizzes were prepared for personnel affording them opportunities to practice locating and reading various policies on the platform.

Implementation of this software has decreased employee frustration with inability to locate policies. The software provides a more efficient way to maintain and update policies. Our leadership team is more confident members of the workforce are following policies. This has enhanced the workforce’s ability to achieve compliance to practice standards and defined business operations. The leadership team’s repetitive message, “Let’s view the policy!” and “Did you read the policy?” makes consistency probable.

A technology-based platform may not be the answer for your ASC. However, it is important to understand the pain points and efficiency issues that occur in your center. These critical components are directly tied to patient care. No matter what your solution, make sure you are addressing your policy, procedure, and protocol goals. After all, the best policy ever written is the policy which is accessed, read, and applied to daily practice!

Jean Day, Director, Clinical Education

6 Strategies for Optimizing Patient Satisfaction at Your ASC

6 Strategies for Optimizing Patient Satisfaction at Your ASC

By 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.

  1. 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.
  1. 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).
  1. 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.
  1. 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.
  1. 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.
  1. 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

ASC Marketing and Sales: Keeping Up in an Evolving Industry

ASC Marketing and Sales: Keeping Up in an Evolving Industry

By 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.

  1. “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?”
  2. “What are your current patient demographics? Are there any additional cases or services you would like to start performing?”
  3. “Are there any special equipment needs for your surgical cases?”
  4. “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:

  1. Is your pre-registration pamphlet easy for patients to read and understand?
  2. 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?
  3. Do patients receive any form of communication prior to their procedure to ensure they are ready?
  4. Do front desk personnel warmly greet patients and/or friends and family when they arrive?
  5. 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

Welcome Aboard: Â Great Reasons to Become an ASC Nurse

Welcome Aboard: Great Reasons to Become an ASC Nurse

By 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.
  2. 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


Opening a New Surgery Center: A Roadmap for Success

Opening a New Surgery Center: A Roadmap for Success

By 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

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