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Mar 28
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ASC Materials Coordinator

Your ASC Materials Coordinator May Be Your Greatest Asset in Controlling Medical Supply Expenses

By ASC Management No Comments

Medical supplies are one of the most significant expenses incurred by an ambulatory surgery center (ASC).  In fact, they may run as high as 10 to 20% of your net revenue.  Your ASC materials coordinator is on the front line when it comes to controlling medical supply expenses.  The more knowledge the person who fulfills this role has regarding business operations and budget expectations, the better equipped they are to serve your facility well.

Here are seven ways to actively engage your materials coordinator:

1. Include your materials coordinator in the budget process.

Their assistance can provide you with valuable insights about what to anticipate for the coming year – annual increase expectations from vendors and potential cost savings measures, for example.  Involving them in the process early affords them an opportunity to embrace your expectations, then operate within the guidelines of the budget.

2. Ensure material coordinators maintain an up-to-date item master.

Updating your item master is an ongoing process.  When new supplies are added, ask your materials coordinator to ensure they aren’t duplicating previous entries.  Have them compare the item pricing with the order confirmation and/or invoice to verify the most current price is loaded in your inventory system.  Set an expectation for consistency in nomenclature to assist with item searches and reporting.  Provide a big picture perspective – a clean, up-to-date item master provides accurate case costing reports necessary to make sound business decisions.

3. Utilize just-in-time inventory.

Ask your materials coordinator to limit stock items on your storage shelves to basics and items that can only be ordered as a case unit.  Have them check with your distributor to determine which items are sold individually.  To effectively handle order or delivery delays, plan on keeping several days of inventory for fast-moving items on hand.  Order enough supplies to cover procedures until the next delivery date but avoid overstocking your shelves.  While overstocking may meet a materials coordinator’s desire to reduce time spent placing and receiving orders, it creates an unnecessary increase in expenses that doesn’t directly correlate to case volumes.  Again, providing the big picture perspective to your materials coordinator can create buy-in to just-in time inventory methods.

4. Involve material coordinators in your preference card process.

Consider allowing them full access to physicians’ preference cards including permission to change items reflected there.  If you are uncomfortable with this, ensure they have access to a clinician authorized to make those changes on the material coordinator’s behalf.  This access ensures preference cards are updated when ‘old’ items are replaced with ‘new’ items.  Up-to-date preference cards assist your clinical team to efficiently pick supplies for the facility’s cases.

5. Provide education to your materials coordinator on payer contracts, especially those that reimburse for implants separately.

Because materials coordinators are responsible for ordering implants, they need to understand when implants are included in your facility’s procedure reimbursement and when they are reimbursed separately.  Creating a ‘cheat’ sheet of payers with implant reimbursement information can help guide them in their purchasing process.  Armed with this information, your materials coordinator can assist with surgeon education on the cost of implants and payer reimbursement.

6. Ensure your materials coordinator has a refined process for receiving and invoicing supplies.

Having the following process for your materials coordinator will provide inventory control and accurate financials –

  • Enter receipt of supplies from packing slip into inventory module.
  • Review the invoice against the purchase order (PO) and packing slip to confirm receipt of invoiced products.
  • Compare invoice pricing to the facility’s inventory item master.
  • Code the invoice for accounting.
  • Input the invoice number into the inventory or patient accounting system.
  • Close the PO once all items are received and invoiced.
  • If your facility prepares financial statements based on accrual accounting, provide an open PO accrual log report to your accountant at the end of each month. Doing so will ensure the current month’s supply costs are accrued for with the current month’s revenue and expenses.  This also helps your materials coordinator stay on top of open invoices.  Having this list provides your materials coordinator an opportunity to call vendors to request delayed invoices thereby avoiding late payment fees or account holds. 

7. Have your materials coordinator perform an annual physical count at year-end.

If inventory has been managed properly during the year, and there have been no significant changes in your business, the inventory adjustment from the previous year should be minimal.  If specialties were added, there may be an increase in on-hand inventory to cover supplies purchased for the new specialty.

Involving your materials coordinator in the ASC’s business operations and budgeting processes could contribute significantly to your center’s bottom line. The key is to provide them with clear expectations and explain how their daily activities impact your vision for the upcoming year.  Then, empower them to make decisions that positively impact your surgery center’s finances.  

Kelli McMahan – Vice President of Operations

Mar 20
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Changing Banks

Time for Your ASC to Consider Changing Banks? What You Need to Know

By ASC Governance, ASC Management No Comments

The threat of rising interest rates in the banking industry came to fruition in November 2016.  If your ASC has not taken advantage of refinancing its debt at a lower rate, your days to do so may be numbered.  Unfortunately, if the refinancing of your outstanding notes also includes a change in bank relationships, significant forethought is required to ensure the process does not negatively impact your business operations.

It is best to use a team approach to manage this process.  Team members could include administration, revenue cycle management, managed care, accounting, accounts payable, materials management, and human resources.  The process may take several months to manage safely and effectively, so plan accordingly.

First, have your team identify all aspects of your business that changing banks will impact.  Here are some areas to consider:

Accounting, Accounts Payable, & Materials Management

  • Transfer of deposits between accounts and/or lockbox
  • Current bank credit card
  • New bank credit card
  • Automatic lease payments
  • Online banking fees
  • Automatic vendor payments

Human Resources

  • Payroll
  • 401(k) withdrawals
  • HSA withdrawals
  • Automatic employee benefit provider payments

Revenue Cycle & Managed Care

  • Electronic fund transfer (EFT) payments
  • Lockbox
  • Online bill pay
  • Merchant services accounts

Next, delegate responsibilities to team members for each aspect of your business.  Responsibility and delineation of duties may look something like this:

Administration

Administration may be the best department in your organization to oversee the process.  Arrange bi-weekly calls with all stakeholders to enhance communication.  Have an agenda with specific items to accomplish before the next meeting to maintain project organization and oversight.  Prepare owners for potential disruption in cash flow. Discuss precautions, such as keeping extra cash on hand, to proactively manage worst case scenarios. 

Managed Care

Coordinate a strategy with revenue cycle management to communicate with payers about the change in payment remittance.  It may not be in your best interest to notify all payers at once that you have changed banks.  Stagger payer notifications.  When funds begin to flow through the new account from a given payer, proceed with notifying the next payer.

In advance of changing banks, and based on the schedule developed in conjunction with revenue cycle management, begin notifying key commercial payers via email the ASC’s plan to change the lockbox or EFT address.  Provide the following information based on the contract requirements:

  • The old remittance address
  • The new remittance address
  • The effective date of change – build in a 10-14 day delay between the notice and effective date
  • An updated W-9
  • Submit all information on your ASC’s letterhead as an attachment to your email notification

After you have received confirmation from each commercial payer that the new lockbox or EFT address has been loaded into their system, ask your revenue cycle management team to recommence billing.  At that time, you can begin dropping claims reflecting the new remittance address.

Revenue Cycle Management

Work with your managed care representative to develop a schedule for notifying payers of the change in bank.  Once you gain user access to the new bank account, confirm it meets your needs to perform associated collections activities.

If using a lockbox, determine the size required.  Obtain the new lockbox address.  Complete the lockbox application form, selecting documentation delivery and storage options that meet your needs.  Then, complete the automated clearing house (ACH) transfer form with your facility’s online payment vendor.

 Once you receive the new lockbox address:

  • Update the lockbox address in your patient accounting system.
  • Change the lockbox address on your electronic and/or paper statements.
  • Complete a forwarding order with the US Postal Service to the new lockbox address.
  • Obtain a copy of a voided check required to complete many EFT change forms.
  • Review current EFT payers and timing (effective date) of EFT changes.
  • Complete third-party payer applications online and via paper.
  • Monitor both accounts to confirm when EFT changes become active in the new account.
  • For payers who are not delivering payments via EFT direct deposit, complete a W-9 form and send to them with a request to correct your remittance address in their system.
  • Monitor both accounts to confirm EFTs, credit card deposits, and all other payments are moving from the old account into the new account.
  • Ensure lockbox activity at the previous bank ceases.
  • Apply for a merchant account with your new bank. Review your merchant account contract to determine how to terminate merchant services at your old bank.  Then, terminate services with the old bank to ensure credit card payments are deposited in your new account.

Human Resources

Have human resources determine which employee benefits are directly linked to your current bank account.  Armed with this information, schedule transfer of funds to your new account.  The list may include, but not be limited to, payroll disbursements, 401(k) contributions, medical/dental/vision insurance premiums, health savings and flexible spending account transactions.

Accounting, Accounts Payable & Materials Management

Accounts payable and materials management must collaborate with accounting and administration to verify bills are paid from the proper account and the account has sufficient funds.  Ensure autopay accounts are updated to reflect the new bank account information.  If a bank credit card is in use at the facility, coordinate a schedule for terminating the old card and activating the new card. 

Keep in mind your old bank account will likely remain open for six months or longer while all required transfers take place.  Bank fees will continue to be charged until the account is closed. However, following the process outlined above will assist you in timely closure of the old account and reduction in associated bank fees.

There are many reasons your ASC may find itself in a position to change bank accounts.  Managing the process for your center with forethought will not only reduce disruption to stakeholders but ensure the advantages of doing so are clear to everyone.

Pinnacle III Leadership Team

Mar 16
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Convalescent Care Center

Value Proposition: Adding a Convalescent Care Center to Your ASC

By ASC Development, ASC Governance, ASC Management, Leadership 2 Comments

If your ASC operates in a state that allows convalescent care centers, there are numerous benefits of adding one to your existing continuum of care.  We outline some of those benefits in this value proposition.  

Convalescent Center Value Proposition

In some states, an ASC may maintain a separately licensed convalescent care center as part of its service offering.  This separate licensure provides an ASC with the opportunity to keep most commercial patients beyond the standard 23-hour stay of a regularly licensed ASC.  The extended stay is granted for observation and pain control for more extensive outpatient procedures.  

The ASC is generally directly compensated for the additional recovery time in the convalescent center.  Compensation occurs in a variety of ways including hourly rates, per day rates, or increased consideration in global or bundled fee arrangements.  In addition, the ASC may be indirectly compensated by securing greater reimbursement from commercial payers on lower acuity cases.  This is because payors recognize cost savings occur when higher acuity cases safely move from a hospital to an ASC with extended stay capability.  

The primary advantage for an ASC with a licensed convalescent center is the potential to provide services to higher acuity surgical patients.  Orthopaedics and neurosurgery specialties benefit most from this advantage, specifically in total joint replacement and spinal surgery.

The types of orthopaedic cases requiring extended stay that are well-suited for an ASC connected to a convalescent care center are: 

  • Patella femoral arthroplasty
  • Total hip arthroplasty
  • Total knee arthroplasty
  • Total shoulder arthroplasty
  • Total ankle arthroplasty

These cases traditionally restricted both physicians and patients to an inpatient setting.  Although moving them to an outpatient setting represents significant savings for insurance carriers and patients alike, these higher acuity cases can provide a net revenue per case increase of 300-400% over traditional ASC orthopaedic cases.

Other types of extended stay cases well-suited for this arrangement are orthopaedic-spine and neuro-spine.  Specifically, the following:

  • Single and multi-level anterior and/or posterior cervical and lumbar fusions
  • Cervical and lumbar disc arthroplasty

Again, these spine cases may have traditionally restricted physicians and patients to inpatient settings.   Cost-savings for both insurance carriers and patients also occur when these cases move to ASCs with separately licensed convalescent centers.  The result for ASCs can be a net revenue per case increase of 600-700% over traditional orthopaedic cases and 250% above traditional spine cases.

Another advantage of these separately licensed facilities over inpatient hospitals and orthopaedic specialty hospitals occurs in payor contracting.  The value proposition for commercial payors, workers’ compensation, auto insurers, and the general public is significant.  A contracting advantage for surgeons in terms of future health care reimbursement may also be realized.  Future reimbursement will likely include, but not be limited to:  bundled payments, pay-for-performance, at risk contracting, clinically integrated networks, consumer-driven care, and price transparency.

Finally, having the capacity to accommodate higher acuity and higher paying surgical cases enhances surgeon and partner recruitment. With the saturation of “commodity” ASCs, an ASC with an adjoining convalescent care center offers the benefits of a mini-hospital. This is attractive to surgeons who may not otherwise be interested in using your facility, much less investing in it. 

What Value Does a Convalescent Center Represent for You?

Investigating convalescent care center licensure requirements in your state is a worthwhile endeavor if your facility is interested in performing higher acuity cases.  If your state allows these types of centers, conduct a thorough cost-benefit analysis to determine the feasibility of establishing one in conjunction with your ASC. 

If your state does not currently afford ASCs the opportunity to establish an adjoining convalescent center, consider these benefits, network with other facilities, then work together to rally legislative support for them in your locale.

Pinnacle III Leadership Team

Mar 10
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ASC Trends

New White Paper! Looking Ahead: 10 ASC Trends and Developments to Watch in 2017

By ASC Development, ASC Governance, ASC Management, Leadership, Payor Contracting, Revenue Cycle Management No Comments

We are excited to release our latest white paper – 10 ASC Trends and Developments to Watch in 2017.

We are still in the early months of 2017, but it is already shaping up to be an interesting year in health care — one that is likely to be a mix of uncertainties, challenges, and opportunities.

Fortunately for ASCs, they are well-positioned to thrive in the rapidly changing and evolving marketplace.  They may even be able to improve their position by planning for and effectively responding to trends and developments.

The 2017 trends and developments for ASCs identified by our leadership team include a forecast for strong industry growth, interest in adding new specialties, and continued migration of higher acuity cases to ASCs.

Changes in the relationship between ASCs and payors are impacting reimbursement especially in facilities who do not have strong revenue cycle management solutions.  Bundled payment programs and the growing number of self-insured employers continue to create marketing opportunities.

Unfortunately, the continued escalation of the financial responsibility borne by patients present revenue challenges.  And, a rise in cyberattacks has disrupted health care, bringing cybersecurity to the provider forefront.

Finally, educating patients, physicians, health systems, and payors on the value of ASCs remains a top priority. Raising this awareness is crucial to fuel the growth the ASC industry is primed to experience in 2017.

In summarizing what’s ahead in 2017 for ASCs, Trista Sandoval, our Director of Business Development & Physician Relations, said:

“One of our main strategies is to continue to focus on raising awareness of ASCs as a high-quality, low-cost option for care, and doing what we can to drive applicable outpatient cases to our ASCs. That may take the form of helping hospital systems build their own ASCs, educating patients through direct consumer marketing, or reaching out to physicians to build awareness of the ASC setting as a viable option for their procedures.”

Through such efforts, Pinnacle III’s leadership team believe ASCs will thrive in 2017.

To read the full report, download the white paper here: https://www.pinnacleiii.com/white-papers/ 

The Pinnacle III Marketing Team

Mar 06
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ASC Medical Equipment

Purchasing ASC Medical Equipment Doesn’t Have to Be a Pain

By ASC Development, ASC Management 2 Comments

Purchasing medical equipment for a new surgery center or adding new equipment to your existing ASC can be daunting.  With forethought, however, the task is manageable and can be downright rewarding.  Here are some important considerations to keep in mind.

1. Buy only what you need.

How do you know you what you need?  Communication with your surgeons is key.  Review their preference cards.  Understand the kinds of cases they perform.  Discuss their equipment model and vendor preferences.  This information will arm you to shop wisely and negotiate well. 

If you’re in an existing center and a physician requests new equipment, identify what prompted the request.  Gather information on how the equipment will improve patient care.  Determine if new volume will be generated and understand what types of cases will be served by the equipment.   Calculate the anticipated return on investment.  If you need the equipment for rarely performed cases and it will take five years to recoup the investment, it may make sense to defer the purchase until the situation changes.

2. Negotiate.

It may not be in your ASC’s best interest to accept the first price a vendor provides.   Determine if you have opportunities for discounts based on aggregated purchases.  Is GPO pricing available?  Are there demo models on hand to purchase?  Is there package pricing based on the number of disposables you purchase from the vendor? 

Don’t be afraid to shop around to see if other vendors offer better pricing.  While your surgeon may be partial to a specific vendor, they may be willing to switch to an alternate vendor if cost savings can be realized.   

Be willing to look at refurbished equipment, especially for your workhorse items.  Once refurbished, these items can last another ten years.  Work with reputable refurbishment vendors when considering this option. 

You can also check for used equipment online.  Craigslist and eBay often have great pieces of equipment available.  Sometimes, the price you pay may be worth the additional risk you assume by shopping for these items online.

3. Trial new equipment.

There is an abundance of new technology on the market right now.  Ask your vendors to bring in new equipment for a trial period.  This will allow surgeons to test the equipment to determine if it meets their needs and provides the highest quality of care to their patients. 

It’s important to have facility staff involved in setting up the equipment.  This allows them to familiarize themselves with the equipment prior to its purchase. During the equipment trial, ask the following questions.  What effect does the equipment have on turnover times?  Does it provide any efficiencies?  The answers will aid in your purchasing decision.

4. Review warranty and service contracts.

If the equipment breaks, is it fully replaceable?  Does the vendor provide loaners to meet the facility’s needs while the equipment is out for service?  Does the warranty cover the first year of service?  Does receiving service from an outside vendor void the warranty?  These are all important questions to consider prior to the purchase.

5. Lease, finance, or pay cash?

When considering how to pay for your equipment, determine the life of the equipment.  What is your cash on hand? How much interest will you pay for the lease or loan?  What are the buyout terms at the end of the lease?  Consider both the short- and long-term impact of the purchase.

6. Delivery and installation.

Often, little thought is given to the delivery and installation of the equipment.  The size of your capital purchase dictates how and where delivery occurs.  If you have a loading dock at your center, indicate that on the purchase order.  If you don’t have a loading dock, ensure you specify the need for a liftgate.  You may think whoever is delivering your equipment will bring it inside and place it where you like.  This is not always the case.  If you need inside delivery and placement of your equipment, indicate this on your purchase order so the vendor can provide this information to the delivery company. 

Another consideration is the unpacking and disposal of delivery pallets.  Sometimes the equipment is delivered encased in pallets.  If you require disposal of this material, let the vendor know.  It is often necessary or helpful to ask your vendor to unpack the equipment for you.  This helps prevent any damage to the equipment and identify issues that may have occurred during transit.

7. User Competency.

To ensure employee competency with new equipment, schedule an in-service demo for your staff with the vendor representative.  Develop a competency document that employees sign-off on indicating they understand the correct use and function of the equipment.  Retain these documents in employees’ personnel files.

Making capital purchases is a vital step in your surgery center’s development. Optimize this process to address the ongoing maintenance and long-term sustainability of your facility.  Once you understand the nuances and address the considerations noted above, the process is easier to navigate successfully.

Lisa Austin – Vice President of Facility Development

Mar 02
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CMS Emergency Preparedness Rule

What the CMS Emergency Preparedness Rule Means for ASCs

By ASC Management No Comments

The Final Rule outlining Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers became effective November 15, 2016.  Ambulatory surgery centers (ASCs) are one of 17 providers and supplier types that must comply with and implement all regulations by November 15, 2017.  The purpose of the 186 page rule is to institute national emergency preparedness requirements and increase patient safety during emergencies.  It also establishes a more coordinated response to natural, technological, and human-caused disasters.

ASCs are required to meet the following four core elements for conditions of participation.  There is a fifth element applicable for integrated ASC health systems who elect to participate in a coordinated emergency management program.

Establishing and maintaining an emergency preparedness program that meets the requirements outlined in the rule, include but are not limited to, the following elements:

1. Develop and maintain an Emergency Management/Operations Plan. Review and update annually. The plan must:

a. Be based on and include a documented facility and community-based risk assessment using an all hazards approach.

b. Include strategies for addressing emergency events identified by the risk assessment.

c. Address patient populations served by the plan. This includes, but is not limited to, the type of services the ASC can provide in an emergency and continuity of operations such as delegation of authority and succession plans.

d. Include a process for cooperation and collaboration with local, tribal, regional, state and federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster/emergency. Integration includes documentation of the ASC’s efforts to contact such officials and its participation in collaborative planning efforts.

2. Establish corresponding policies and procedures.

a. Must be based on the emergency plan, risk assessment, and communication plan.

b. Must be reviewed and updated at least annually.

c. Must minimally address the following elements: tracking sheltered or relocated patients and on-duty staff during an emergency, evacuation from the ASC, a means for sheltering in place, a system of medical documentation, the use of volunteers and other staffing strategies, and the role of the ASC in the provision of care and treatment as an alternate care site.

d. Additional specific requirements pertaining to policies and procedures are available in the Federal Register, Vol. 81, No. 180.[1]

3. Communications Plan

a. Must comply with federal and state laws. It needs to be reviewed and updated at least annually and include the seven elements outlined in the rule.  For more information on the seven elements, refer to page 165 via the hyperlink referenced below.

4. Training and Exercise Program

a. Develop a training program based on the emergency plan, risk assessment, policies and procedures, and communication plan. This should include initial and ongoing training on policies and procedures. Your training program should be reviewed and updated at least annually.

b. Maintain documentation of all emergency preparedness training and demonstrate staff knowledge of emergency procedures.

c. Conduct at least two exercises annually. One should be a community-based full scale exercise if possible. The other should be a facility-based full scale or table top exercise.

d. Develop a documented after action report and improvement plan. Implement improvement items identified and maintain documentation of same.

5. Integrated Health Care Systems

a. ASCs in a system containing multiple separately certified health care facilities that elect to have a unified and integrated emergency preparedness program must meet the five elements outlined in the Integrated Health Care Systems section of the rule.

Accreditation Status:

A facility’s accreditation status is a significant factor in determining the burden to an ASC in terms of both the workload and the associated costs required to meet the new CMS requirements.  The final rule calculates anticipated burden hours and cost estimates for each of the four core elements based on accreditation status.  ASCs accredited by the American Osteopathic Association/Healthcare Facilities Accreditation Program (AOA/HFAP) and American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) currently have minimal emergency preparedness requirements. Therefore, their anticipated burden is higher.  The Joint Commission (TJC) and the Accreditation Association for Ambulatory Health Care (AAAHC) accreditation standards contain more extensive emergency preparedness requirements. Although ASCs with TJC or AAAHC accreditation will likely incur some work to meet the requirements, their anticipated burden is lower than AOR/HFAP and AAAASF accredited facilities.

What are the next steps for your ASC?

  1. Review the section of the Final Rule that pertains to ASCs on pages 77-82 by clicking on the following link: https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf
  2. Schedule an initial meeting to start work on performing a thorough risk assessment (also known as a Hazard Vulnerability Analysis or HVA).
  3. Complete a gap analysis by cross-walking your existing Emergency Management Program with the final CMS rule to identify areas that do not meet the requirements. Your existing Emergency Management Program should include your Emergency Management/Operations Plan, response plans, policies and procedures, as well as your training and exercise program.
  4. Develop relationships with other ASCs and share your work with one another.
  5. Find local and national resources for the Final Rule at cms.gov.
  6. Take advantage of technical resources which can be found at https://asprtracie.hhs.gov/technical-resources. Click on “CMS Emergency Preparedness Rule: Resources at Your Fingertips” and refer to pages 15-16 for plans, tools, templates, and links to other resources.     
  7. Develop a relationship with your local hospital(s), public health agency, and the Office of Emergency Management. This may be accomplished directly and/or through your regional Health Care Coalition.
  8. Health Care Coalitions are currently evolving in Colorado. Contact your local Hospital Emergency Preparedness Coordinator, Local Public Health Agency, or Office of Emergency Management to determine how to get involved in your designated coalition.[2]

Julie Zangari – Emergency Preparedness Coordinator of Peak One Surgery Center

Michaela Halcomb – Administrator of Peak One Surgery Center 

[1] https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[2] A Health Care Coalition resource specific to Colorado is:  https://www.colorado.gov/pacific/cdphe/health-care-coalitions

Feb 28
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ASC Front Office

Creating Financial Accountability with Your ASC Front Office Personnel

By ASC Management No Comments

One of the most challenging aspects of running a surgery center is eliminating claims processing errors and denials.  These issues lead to delays in reimbursement and decreased revenue.  When it comes to claims processing errors and denials, there are several items your front office can control.  ASC administrators can prevent many of these errors by establishing financial benchmarks that track front office performance.  Implementing these benchmarks will demonstrate to your staff how these controllable factors go a long way toward maintaining healthy reimbursement for your ASC.

To accomplish this, ask yourself the following questions:

Are you tracking registration data entry errors that cause claim denials?

An incorrect insurance address, inaccurate insurance provider, forgetting to include the subscriber date of birth (if subscriber is not the patient), and entering the wrong patient ID number create claim denials.

Review data entry errors with personnel responsible for patient registration.  Most patient accounting systems contain audit mechanisms that allow you to track field updates by user. Encouraging staff to methodically enter data, then double-check their work typically improves accuracy.

Are you tracking denials based on no pre-authorization?

Many payers have pre-authorization requirements for various procedures.  If pre-authorizations are completed prior to the date of service, payers will deny the claims.  

Review denials that occur for this reason with your front office staff.  Ask them to determine why pre-authorizations were not obtained to identify process issues.  Most insurance providers outline pre-authorization requirements on their websites.  Ask your staff to access these websites to review pre-authorization requirements.  They can print this information and place it in a resource binder for future reference.  Consider having your team develop a flow sheet identifying your facility’s top CPT codes, top insurance providers, and corresponding pre-authorization requirements.  These tools will be an invaluable resource.

Are you tracking time of service collection of co-pays and deductibles? Have you outlined expected time of service collection goals?

It is now standard practice for ASC front office personnel to collect co-pays and deductibles at the time of service. 

Set goals for upfront collections and track progress towards those goals.  Share monthly reports with your front office to review any co-pays or deductibles that were not collected.  Determine what types of actions, if any, can be implemented to increase time of service collections.  

Are you tracking whether supporting documents needed for claims processing are provided in a timely manner?

Set benchmark due dates on documents such as operative notes, implant invoices (when applicable), and pathology reports.  Track monthly documents that are not available on the due date. 

Work with your staff to determine why set goals are not met and identify how they can reduce the frequency of late documents.

Is your front office routinely receiving updates on insurance changes such as new contracts and sample cards?

When evaluating trends, you may discover failure to achieve established benchmarks ties back to outdated information.

Many payers have comprehensive information on their websites regarding benefits.  They often display sample insurance cards to assist providers with proper identification of patient plans.  Best practice is for your front office to maintain up-to-date payer information in a resource binder (paper or electronic, whichever works best).  If you maintain sample insurance cards on patients you’ve treated in your ASC, be sure to redact patient-specific information to remain HIPAA compliant. 

Set benchmark goals to track the above-mentioned items, then meet monthly with your front office staff to review these measures.  Identify trends. Encourage open discussion regarding benchmarks, errors, and denials, to help your staff understand how their role affects the health of your ASC.  Provide additional training when warranted to create a work environment where your staff can succeed.  Keep them engaged by asking for suggestions on best practices to optimize their efforts.  Celebrate their successes and enjoy watching your ASC thrive!

Kelli McMahan – Vice President of Operations

Feb 14
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surgeon recruiting

Become A Surgeon Recruiting Master for Your ASC with these Sales Tips

By ASC Management, Leadership No Comments

The recruitment of new physicians to an existing ASC is an essential component of surgery center management. Most ASC administrators are not trained sales/marketing professionals, nor are they supported by a sales force. Here are some tips I have found helpful as I’ve become self-trained in this area over the years.

Identifying potential new surgeons

  • Determine if they meet the criteria your board of managers has established for physicians in your center. Please see my previous blog post for a list of criteria to consider in vetting new surgeons.
  • Be aware of new surgeons moving to your area. Ask your current physicians and the manufacturer representatives who frequently visit your facility to alert you when new doctors enter your market.  Periodically review the list of newly licensed physicians who have recently moved to your area.
  • If your ASC is in a joint venture relationship with a hospital or health care system, work closely with their business development, marketing, or physician liaison team to identify prospects.
  • Target physicians who are unhappy at their current center. Disgruntled physicians oftentimes express their dissatisfaction in their current center’s ORs, hospital ORs, or hospital locker rooms.  You can often garner this information from the representatives mentioned previously, your existing surgeons, or your anesthesiologists who encounter them in these environments.

Setting yourself up for success

Once you have identified a single physician or a group of physicians as prospects, it’s time for the sale. Don’t be afraid of that word.   We’ve all engaged in sales.  At the very least, you sold yourself to your employer to secure your job.  Selling your facility is not that different.  Forge ahead – call the physician’s office and arrange a time to meet with them.

  • Determine what your objective is for the meeting. Is it getting the physician to the ASC for a tour?  Or securing the physician’s agreement to complete a credentialing packet?
  • Research your prospect to learn anything you can about them. Where did they go to school? Where did they train?  What procedures do they perform?  Do they have any dislikes?  If so, what are they?
  • Identify your needs and anticipate their wants. For example, you know you want them at your center, but can you accommodate their preferred day and time.  Determine how to deal with these kinds of scenarios ahead of time and be prepared to present options.
  • Determine what information you need to bring to the meeting. If you have specific information regarding a program you offer, bring that with you to present if afforded the opportunity.  When you have someone on your team who knows a lot about the surgeon’s specialty and will assist in closing the deal, bring them with you.
  • Know your competition. What will other centers be able to offer them?  What were they unhappy about elsewhere?  Prepare to address these topics in a subtle way.
  • Be aware of any previous history between this physician and your facility, or any stakeholders in your facility. Prepare to address these issues.
  • Think win-win. You must bring value to your facility, the physician, and the physician’s scheduler(s).  A one-sided relationship will never work.

Delivering what you promised

Let’s say you’ve identified your prospective surgeon(s) and had a successful meeting with them.  You were so successful, in fact, they are now scheduling cases at your center.  Now you need to ensure your team delivers what you promised.

  • Educate and empower your staff. Brief your staff on the physician’s expectations and what you promised.  Perform a dry run of the surgeon’s cases if you think it will assist the staff provide outstanding customer service.
  • Ensure the physician’s preference cards are correct and everything needed is present, including properly sized scrubs and gloves.
  • Make sure you are in the facility as the physician arrives for their first day. Welcome them, thank them for being there, and follow up with them at the end of the day. These are best practices to maintain for all your doctors every single day.
  • Attempt to schedule them with a consistent team.
  • Communicate, communicate, communicate!

Winning over the schedulers

Lastly, when recruiting new surgeons to your ASC, avoid underestimating the power of their scheduler(s).  I’ve been in many surgeon’s offices where the scheduler determines where their surgeon will perform a case.  I’ve spoken with numerous surgeons who’ve told me they go where their scheduler tells them to go. You must win their schedulers over!

What do schedulers want?

  • The path of least resistance. A full offering of managed care plans allows them to readily determine what procedures and/or surgeries can be performed at the center. And, if the physician has a set block time available, it’s easier for the scheduler to offer specific days to their patients.
  • We all want to do business with people we trust and like. Schedulers are no different.  They like people with “can do” attitudes.
  • They want to schedule at the time they call. Oftentimes the patient is standing there when they are making appointments.
  • They do not want to be put on hold. If this is unavoidable, ensure the hold time is short.
  • Little to no paperwork. We need information from the physician’s office but the process for exchanging information should be streamlined.

The best advice in recruiting new surgeons is to maintain open lines of communication among all parties.  This allows you to capture wants, needs, and dislikes.  Once you have this information, you can work toward creating a situation that satisfies everyone’s needs.  Your surgery center will be the preferred place of choice and you’ll be happy you created this environment from day one.

Robert Carrera – President/CEO

Feb 07
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Celebrating Milestones

Celebrating Milestones at Your Aging ASC

By ASC Management, Leadership No Comments

Most ambulatory surgery center (ASC) owners and investors desire longevity for their facility. When your facility reaches important milestones, it’s important to capitalize on them.    

An important anniversary is an excellent opportunity to host an event or execute other marketing initiatives that demonstrate appreciation for investors, foster relationships, build community interest, and educate providers and consumers about the services you provide.  Here are some tips on promoting and/or celebrating your ASC’s stability in the market and thoughts about what you will likely gain in return for your efforts.

Opportunities and Gains

Not celebrating a milestone your ASC has reached is one of the greatest missed opportunities in facility management.  An official celebratory event can seem like a daunting project.  However, the return on investment can be quite rewarding when accomplished strategically and executed appropriately. 

The Surgery Center at Lutheran in Wheat Ridge, Colorado, decided it was best to hold two separate events to celebrate their ten-year anniversary.  The first, a celebration dinner held at a local restaurant, honored the surgery center’s physicians and staff for their long-time dedication to the center and patients in their local community.   Showing appreciation and gratitude for those who have stuck with you throughout the years strengthens employee engagement, creates social and prosocial interactions, and enhances productivity.

The second event, a cocktail hour open house held at the ASC, allowed the surgery center to invite everyone in its extended network.  It created a platform and opportunity for people from all levels of health care to gather in the same room.  Beyond networking, individuals had the opportunity to discuss issues they face every day.  Because those issues resonated with their colleagues, their conversations afforded them time to view them from alternate perspectives and discuss solutions beneficial to all parties.

An ASC open house creates an opportunity to increase business.  Prospective surgeons can tour your facility and meet your team.  This may help them make the decision to credential at your facility and begin performing cases.  Inviting referring providers gives them the opportunity to meet with specialists and strengthen the referral relationship. 

In today’s health care delivery model, primary care physicians (PCPs) rarely, if ever, take call at the hospital.  As a result, PCPs have minimal opportunities to connect with specialists in the hospital setting.  By touring your ASC during an open house, primary care providers can talk with their patients about the facility they are sending them to for surgery based on firsthand knowledge. This increases everyone’s comfort level and enhances the physician-patient relationship.  

Extending open house invitations to third-party payor representatives allows them a chance to view the inclusive services you offer.  Many payor contracting representatives, although familiar with the ASC model, rarely have opportunities to interact with your facility’s surgeons and staff in the actual location where their insureds are receiving care.  

Inviting local news sources will create an occasion for them to document a great story that demonstrates your ASC’s stability to community members.

Best Practices for Execution

Collaboration

If you are going to celebrate an important milestone with an event at your facility, the first step is collaboration.  Make sure to reach out to your physician practices to see if they are interested in collaborating on the celebration.  Give them the chance to joint-market at your event to boost their business.

Fine tune your invite list

Consider who to send invitations to and why.  Send invitations to individuals in your ASC’s network whom you feel have had the greatest impact on your past success and could impact your continued success.  Have good representation from your own facility to serve as the face of your center during the event.  Invitees to consider include your staff, your physicians, your physicians’ practice staff, your board members, members of the hospital administration, bank representatives, device company representatives, third-party payor representatives, referring providers, employees of the ASC’s management firm, employees of the billing office (if outsourced), local legislators, and local news publications. 

Work with your affiliated physician practices to determine which referring providers to add to your invitation list.  Important local legislators to consider are the mayor, city council, county commissioners, the governor, US senators and representatives, state senators and representatives, leadership in the local government’s business development/economic development department(s), and leadership in the local government’s health and human services department.  Consider inviting members of your state and national ASC associations.

Showing off your business

Some of the preparations for your event will include coordinating with your administrator and clinical staff to lead facility tours.  A facility tour is one of the most enriching experiences for facility guests.  Whether it is during an important celebratory event or during a regular business meeting, taking a guest on a tour of your facility allows them to see all the impressive components of your business model.  It allows you to highlight your successes and the ways in which your ASC is changing and/or leading the health care industry.

Involving key leaders

As you approach the event date, consider asking one of your leaders (i.e. board president, medical director, and/or other board members) to offer a toast.  By allowing your leader(s) to speak about why the ASC is important to them, guests will receive a more complete picture of your ASC and how they may impact its success going forward.

Tying up loose ends that you may not have considered

When following-up with your ASC board members after the event, make sure to highlight key attendees, such as local legislators, or prospective physicians who have interest in joining your medical staff.  These key attendees will demonstrate the value added from a celebratory event. 

Other follow-up includes communicating with local news sources.  Provide an update for news publications that attended as well as those who did not attend.  Being featured in the media is the ultimate cap off to a successful milestone celebratory event!

Conclusion

Any milestone reached in serving the community is an important accomplishment for an ASC.  When your ASC reaches five years, or ten years, or even twenty years, don’t let the opportunities pass you by.  Not only is this a great time for “spring cleaning,” it’s a chance to make the most of your ASC’s long-term success.  Recognition does not have to begin or end with a celebratory event.  Capitalize on your ASC’s accomplishments throughout the year. 

Jack Mast – Physician Liaison

Feb 01
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2016 ASC Industry Year in Review

New White Paper! 2016 ASC Industry Year in Review: 10 Key Takeaways

By ASC Development, ASC Governance, ASC Management, Leadership No Comments

We are excited to release our latest white paper – 2016 ASC Industry Year in Review: 10 Key Takeaways.

As we start the new year, it is worthwhile to examine trends and developments that helped shape the ASC industry in 2016.  These trends and developments will most likely set the tone for 2017 and beyond.

Key industry takeaways identified by our leadership include renewed focus on the migration of inpatient surgical care to outpatient settings and a surprising abundance of de novo development.

While momentum for alternative payment models stalled, the impact of implant reimbursement and increased patient financial responsibility dominated operational discussions.  Challenges presented by nursing shortages, increased regulatory compliance, and the demand for more data continued to be hot topics.

Garnering insights from these areas of focus is important given the prominent role ASCs perform in the delivery of affordable quality care.

In summarizing 2016, our Principal Partner, Rick DeHart, stated:

“From my perspective, 2016 was a transitional year for ASCs.  A significant amount of time was spent focusing on the election and anticipating its impact on the future. Everyone was waiting for much of that activity to finish . . . We may see even more activity in the industry in 2017.  Surgery centers are certainly well-positioned to be the low-cost, high-quality provider of choice for an increasing number of patients.”

To read the full report, download the white paper here: https://www.pinnacleiii.com/white-papers/

-The Pinnacle III Marketing Team