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ASC Leadership Archives - Page 3 of 4 - Pinnacle III

Jun 07
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asc political landscape

Preparing Your ASC for Political Battle

By ASC Governance, Leadership No Comments

There’s an old saying, “Laws are like sausages, no one wants to see them being made.”  When I was younger, I was fully on board with that analogy.  The last thing I wanted to do was participate in the political process.  Then, about 15 years ago, I was thrust into a position that forced me to get directly involved.

Within the same year, pieces of legislation were introduced in Colorado and Minnesota that would have severely negatively impacted the ambulatory surgery center (ASC) industries in those states.  Neither state had an active or robust state association.

Consequently, neither state was prepared to deal with the threat.  Through a herculean effort, disaster was averted in both instances.   Those of us involved in those fights learned a valuable lesson – the best time to prepare for a disaster is before it occurs.

Fast forward to 2017.  The landscape has changed in many ways.   After a five-year battle, the Wisconsin state association, WISCA, under the leadership of Eric Osterman and the association’s board, narrowly missed getting the state’s gross receipts ASC tax rescinded.  In Oregon, the state association recently pushed forward House Bill 2664, allowing 16 ASCs to introduce an “extended stay” license to committee.  In Colorado, CASCA is fervently addressing yet another attempt to negatively impact our state’s convalescent center license for ASCs.

At the federal level, the Ambulatory Surgery Center Association (ASCA) supported the Ambulatory Surgical Center Quality and Access Act of 2017. This act addresses a flaw in current law that allows the Centers for Medicare & Medicaid Services (CMS) to use different measures of inflation for ASCs and hospital outpatient departments (HOPDs) when setting reimbursement rates.

As demonstrated by that short list of activities in 2017, the ASC industry, both on the state and federal level, is far more equipped to deal with threats.  It is also more proactive than ever before.  That by no measure means every state or individual center should sit back and consider the battle won.  Rather, continual preparation and reform is necessary to avert the next crisis.

Some problems that still exist and are keeping ASCs from being formidable political players include:

  • Lack of organized state response to business threats
  • Embryonic, unsophisticated, or paralyzed state organizations
  • Unaware, unable, unwilling, or disinterested physicians
  • Insufficient funding
  • Nonexistent, minimal, or inconsistent education of key elected officials
  • Failure to engage ASCA on a state level
  • Lack of experience, robust understanding, or discomfort with politics, government, and public policy on the part of surgeons, administrators, and staff
  • Ineffective recruitment of hospital support by ASCs and physicians in joint venture arrangements

To set up your ASC for political survival:

  • Join or work to revitalize your state association.
  • Contribute to political fundraising at the state level.
  • Solicit contributions from facility investors for political fundraising.
  • Encourage key stakeholders in your ASC to join a committee in your state association.
  • Involve your physician investors, leadership team, and staff members in state association activities.
  • Engage ASC hospital partners as an ally with your state association.
  • Utilize the ASC’s staff or investors’ political connections.
  • Access key political players on federal and state levels.
  • Engage ASCA on a state level.
  • Contribute, and secure contributions from key stakeholders, to ASCAPAC.
  • Have key ASC personnel and physicians participate in the ASCA Washington DC Fly In.

The above suggestions are some ways every ASC can improve their own political standing along with the political standing of the industry.

To summarize, let me leave you with three quotes to consider when preparing for your ASC’s political survival.

“All politics is local.” – Tip O’Neil

“Never let a third party define your issues or your identity.” – Steven Covey

“It’s not the size of the dog in the fight that counts, it’s the size of the fight in the dog.” – Dwight D. Eisenhower

Robert Carrera – President/CEO

May 30
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How Marginal Gains are Crucial for Surgery Center Growth

By ASC Governance, ASC Management, Leadership No Comments

Over the course of many years, Pinnacle III has been tasked with the evaluation and turnaround of numerous failing or drastically underperforming surgery centers.  In each situation, it was relatively easy to identify the pain points and devise solutions to create marked improvement in the ASC’s performance.  

There are many centers, however, that already operate at an elevated level.  Their investors often ask us if it is possible for these facilities to improve.  

To answer this question, I am reminded of a story from the 2012 Tour de France and London Olympics. In 2010, Sir Dave Brailsford was tasked with improving the performance of the professional cycling team, Team Sky.  Eventually, he was asked to do the same for the British National Cycling Team.  At that time, Britain hadn’t had a Tour de France champion nor had they performed well in Olympic Cycling. Brailsford realized major gains in the realm of world class athletics were difficult to achieve.  Therefore, he focused on the concept of marginal gains aggregation.  He explained this concept as a one percent margin for improvement in everything.  He believed if you improved every area related to cycling by just one percent, those small gains would add up to remarkable improvement overall.

Initially, Brailsford and his team focused on the obvious – tire weight, seat ergonomics, and athlete nutrition.  Then they turned their focus on the far less obvious.  This included pillow choice and its impact on sleep quality, personal grooming habits and their impact on propensity to develop saddle sores, and hand hygiene to avoid illness.  Essentially, they searched for a one percent improvement in every area where they could create impact.  The results, despite some recent controversies, speak for themselves.  Britain’s Team Sky was victorious in the Tour de France in 2012, 2013, 2015, and 2016.  The British National Cycling Team also won 70% of the gold medals at the 2012 games.

I realize Team Sky is not the first or only organization to espouse the benefits of such an approach.  However, as a cyclist and a geek for human performance improvement, I gravitated to this example to illustrate my point.  Other examples that have paid dividends to the concept of marginal gain include David Cameron’s Behavioral Insight Team which improved the wording of tax demands to increase responsiveness.  Or Google testing 41 shades of blue for its advertising hyperlinks, which they claimed netted an extra $200 million in annual revenue.  The examples are endless.

So, how does a successful ASC ensure continuous growth?  We believe the best get better by consistently reassessing where there are opportunities to aggregate marginal gains.  I have written a great deal about culture.  This is another cultural characteristic which we work to ingrain in our partnered centers.

Every member of an ASC’s team can look for ways to identify marginal gains in their day-to-day activities.  Materials management can move more items to consignment.  Nursing staff can suggest the removal of unneeded items from custom packs.  The revenue cycle management (RCM) team can suggest changes to a dictation template to reduce the need for payors to request additional medical records.  Or, they may suggest implementing online bill pay to create an easier medium for patients to submit payments thereby expediting the receipt of receivables.  These are just a few examples of marginal gains that can be achieved through diligent management.  

It’s also important to keep in mind the reverse can be true as well.  A one percent decline in aggregated overtime can have significant impact on a facility’s operation.  The diagram below, adapted from James Clear, as referenced in “The Slight Edge” by Jeff Olson, effectively illustrates this point.

In closing, it’s easy to get caught up chasing the “large whales” – implementing bundled payments, a total joint program, or a re-syndication – to enhance facility prosperity.  But don’t forget to attend to the “small fish” by creating a culture around aggregating marginal gains.  The valleys in an ASC’s growth can be filled by marginal gains.  Doing so ensures the declines aren’t as sharp which leads to a steadier upward slope.  Overall, marginal gains are crucial to an ASC’s continuous growth.

Robert Carrera – President/CEO

Apr 25
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Management page header image

A Clinical Approach to Healthcare Business Management & Problem Solving

By ASC Governance, ASC Management, Leadership No Comments

I am a physical therapist (PT) by education and training.  I graduated from Wayne State University in Detroit, Michigan with a Bachelor of Science in PT. Go Warriors!

For over ten years, I practiced in a variety of settings, including my time spent as a clinical faculty member at the University.  After that, I moved full time into the world of management.  I like to think I could still earn an honest living as a clinician if I needed to.

As my career moved away from clinical practice, I retained my clinical approach when dealing with issues related to business practices.

The American Physical Therapy Association uses the following statement to describe what a physical therapist does:

“PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.  In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles.”[1]

Essentially, PTs evaluate the situation and assess findings to develop a treatment plan.  Our goal is to return patients to their previous or higher level of function.  In some cases, we develop a plan to prevent or forestall further disability.  Sound familiar?

As is the case with many healthcare disciplines, we learned to evaluate someone and then document our findings in a format called the SOAP note.

Here is what the SOAP note entails:

Subjective – Detailed notes regarding what the patient relays about their status in terms of function, disability, symptoms, and history.

Objective – This is derived from the clinician’s objective observations.  It can include visual observations such as posture and swelling, actual measurements such as range of motion or strength, and hands-on techniques such as palpation.

Assessment – The clinician’s analysis of the various subjective and objective findings yields an assessment.  It explains the reasoning behind the decisions made and clarifies the analytical thinking behind the problem-solving process.

Plan – Conveys how the clinician develops treatment to reach goals or objectives.

As a business leader, I use the clinical approach I learned and practiced to solve management problems.  Here is how:

Subjective – Years ago I read the difference between clinicians heralded at the top of their profession and those considered more average was based on the quality and thoroughness of the clinician’s ability to subjectively capture a patient’s history.  I believe the same is true in business problem solving.

In business, it is important to seek information directly from the source when issues arise.  For instance, I prefer to meet stakeholders in person to obtain the history of the situation and gain an understanding of how it developed.  What areas have been impacted?  What actions have been taken to resolve the issue?  What, if any, impact have those efforts had?  Lastly, I like to ask the stakeholders for their suggestions on resolving the situation.

Objective – When appropriate, I begin the objective portion of my evaluation visually, just like when I treated patients.  This can entail simply walking through the facility or office.  Many times, it involves taking subjective “histories” from stakeholders.  The measurement and hands-on review, in many cases, involves evaluating existing data and reports.  When necessary, and possible, it includes asking for additional information.  This provides me with a complete view of the situation.

Assessment – Again, the assessment is where the expertise and experience of the “clinician” shines through.  Taking all information gleaned from the subjective and objective portions of my evaluation, I can generate a list of problems.  Next, I can prioritize the items on my list.

Plan – Lastly, just as in a clinical setting, I develop a “treatment” plan for the problems in my facility.  The plan addresses not only the symptoms but also their underlying causes.

The business side of healthcare is made up of many clinicians who have transcended their clinical roles into business management and leadership.  I am one of those individuals.  The skills we learned as clinicians allow us to be effective problem solvers in the operational management side of the business as well.

Robert Carrera – President/CEO

[1] http://www.apta.org/PTCareers/RoleofaPT/

Apr 14
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manager rounding

ASC Manager Rounding: Maximizing the Benefits

By ASC Management, Leadership No Comments

Manager rounding is the process of visiting patients and families.  It affords surgery center leadership an opportunity to monitor progress, provide education, and identify areas for improvement.  While rounding benefits an ASC’s leadership team and facility personnel, the most important byproduct is the impact it can have on patients and their families.  There are a number of ways to maximize those benefits and achieve short- and long-term improvements in a surgery center.  Here are some helpful steps to consider.

1. Be consistent.

Perform rounds every day, without fail.  The goal is to round multiple times a day, and do so in a purposeful, productive manner.  This may sound cliché, but it’s the only way to develop an effective process.

Maintaining this consistency requires planning.  Consider in advance how you will perform rounding, when you will do it, and the way you will evaluate the information you pick up along the way.

Be consistent with where you go.  Most rounding occurs in the center’s lobby, but it is worthwhile to add the pre-op area to your walkthrough.  This isn’t something most administrators do.  But you might be surprised how much you can learn from a quick visit to patients before their procedure.

2. Keep it a management responsibility.

Rounding is best performed by an ASC’s managers. They’re in an optimal position to represent the facility then take what they learn and turn it into actionable information.

The task should not be delegated to staff even if management is busy.  It is up to other members of the facility’s leadership team to step up if a round cannot be completed by the manager who was originally assigned the task.

3. Educate on processes.

Effective rounding is not improvised.  Education is vital and may need to be tailored to each individual.  Some types of education to consider follow:

  • What to say to start conversations
  • What questions to ask (i.e., a script)
  • How to respond to different comments and questions from family members and patients
  • How to approach strangers and speak with them (and do so confidently)
  • How to read people
  • How to document what is learned (see #4 below)
  • When to elevate an issue and involve other managers or physicians

The goal with rounding is to move through the lobby or pre-op, meet people, make connections, gain information, provide information, and move onto the next person.  Upfront and ongoing education will help make rounding an efficient and productive process.

4. Make the documentation easy.

The quality of the documentation can make rounding a success or failure.  To achieve the former, develop a standardized form those conducting rounds can fill out quickly and legibly.  Include the specific questions you are likely to ask and spaces for notes.

Also, include a checklist of topics on which you are likely to receive feedback. Topics could include wait times, requests for information, communication, and case delays.  Again, leave spaces for notes.

5. Use what you learn.

What you ultimately do with the feedback gleaned during rounding is as important as the rounding itself.  Establish processes for how feedback will be presented in meetings, how to determine what to focus on, and how changes or issues will be addressed.  Develop an organized way for your team to consider any problems you discovered, figure out solutions, and disseminate information to staff.

The benefits of rounding may not be noticeable immediately.  It’s not a process you can conduct for a day or week and expect significant changes.  It may take a few business weeks of consistent rounding to deliver results.

6. Hold your team accountable.

There is a reason the first step highlighted above is the need for consistency.  If a round is skipped one day and there is no ramification, soon there will be a day where two rounds are skipped. Then three. When this occurs, rounding will start to feel optional.  Managers, with their very busy schedules, may find other pressing tasks to fill the time once allocated for rounds.

That’s why it is not only important to plan who will perform rounds and when, but also ensure anyone who does not perform an assigned round is held accountable.   

7. Give rewards and recognition.

Rounding is intended to help bring about improvements.  When improvements are made, rewarding and recognizing team members who made them happen can be an effective way to bring attention to the ongoing importance and value of rounding.

Rewards and recognition can occur when a rounding manager connects with a patient or family member and receives a great suggestion or a staff member takes on greater responsibility to help implement a change.  Rewards can take the form of small gift cards or entries into drawings for more valuable gift cards. Recognition may take the form of singling out specific team members for praise at staff meetings.

8. Focus on engagement.

If a rounding program is the passion project of a single manager, it is doomed to fail.  Rounding must be ingrained in all managers and staff as a critical component of your ASC’s operations. Your team must believe in its purpose and not merely view rounding as yet another task to complete.

In the early stages of a rounding program, emphasize the objectives of rounding: to bring about operational improvements that will make everyone’s job easier and better while making sure patients and their families are safe and comfortable.  When managers are enthusiastic about performing rounds and staff are eagerly awaiting new feedback to drive improvements, you will know your rounding program has established a strong foundation for success.

Jebby Mathew – Director of Operations

Apr 12
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change

Achieve Meaningful Change in Your ASC With a Plan

By ASC Management, Leadership No Comments

Viable contributors to our healthcare system consistently demonstrate the ability to implement effective changes.  Being flexible and able to adapt quickly to patient, provider, and payer developments in your market is critical to your ASC’s success.

Typically, change is not comfortable for most of the workforce including leaders. That’s where having a plan comes in handy.

Here are some key plan components that will help you effectively engage your team and adhere to a path for successful implementation of change.

Communication

Communication concerning the change is vital – but it cannot just be communication from the top down.  Communication must occur between leadership and staff, not from leadership to staff.  Make sure input is solicited from everyone involved in making the change as well as those persons affected by the change.

Convey the reason(s) for making the change.  If your team members understand why the change is necessary, they are more likely to buy into the change and actively participate in the process.

Lay out a timeline for the change process.  Although the timeline may need to be adjusted throughout the process, providing a general outline of the plan provides your ASC team an opportunity to envision the path ahead.  They can prepare for what is going to happen and when, and contribute to the end result.

Training

Training may be a crucial component of your plan.  Many changes in ASCs today encompass new technologies – implementing electronic health records and patient portals, upgrading phone systems, or adding new surgical/clinical procedures, for example.

To ensure staff become comfortable using, and maximizing the benefits of, new technologies, extensive hands-on training may be necessary.  While it may be tempting to provide this education in the fastest and least expensive way possible, doing so may end up costing more in the long run.

One of our ASCs recently went through a software system transition.  The vendor offered off-site training for super-users.  We invested the time and money to send three members of the ASC’s team to receive that upfront training.  Upon their return to the ASC, these super-users were extremely valuable in educating and supporting their fellow staff members and physicians during the onsite training process. The team required less intensive training from the vendor, which ultimately saved time and money and promoted a smooth “go live” environment.

It is important to note that people learn at different paces.  When training team members, make sure individual needs are addressed.  More training may be required for some, while less training is necessary for others.

Counseling

It is not likely everyone will be on the same page the moment you start moving forward with implementing a change.  Some members of your team may embrace the change from the beginning and easily move through the process. Others may exhibit various levels of resistance.

Team members who are hesitant or actively pushing back against a change will require additional attention.  Engage them in conversations to learn about their reservations.  Answer questions about why the change is necessary.  Provide emotional support.  You may not be able to eliminate all their concerns but taking the time to listen and actively support them throughout the process will elicit more positive engagement.

Individuals providing support and engaging in these conversations do not necessarily need to be formal leaders. In fact, peers who have bought into the change may better understand a fellow team member’s struggle and more effectively facilitate their colleague’s buy-in.

Leadership

For a plan to be successful, leadership must be 100% on board throughout the change process.  They are the change champions.  This is true even if leaders are uncertain about the change or the approved approach to making the change.

In times of uncertainty, leadership must come to terms with the situation, put feelings of doubt aside, and figure out a way to stay positive.  This can be difficult, but the emotions leadership project — whether intentional or not — are inevitably picked up by staff.

Monitoring

An effective plan for change should take the ASC through completion of the process.  Ensure the plan spells out how you will monitor if the change achieves its intended short and long-term goals. 

If the change does not deliver the benefits you were hoping for, additional improvements and other changes may be required.

It is also important to evaluate if the change has any unintended effects on your facility’s operations.  For example, changes can affect customer service and the organization’s culture. Sometimes these changes are positive.  However, if a big change affects these or any other processes negatively, you will want to go back to the drawing board and work to right the ship.

Catherine Sayers – Director of Operations

Apr 06
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ASC Team

Harnessing the Power of Your ASC Team

By ASC Governance, ASC Management, Leadership No Comments

Organizations who harness the power of teamwork thrive.  You can sense their vibrant energy the minute you step through their front door.  Positive momentum permeates every aspect of their business.  Their collaborative spirit is infectious.        

Teamwork in your ASC can easily make the difference between your place of business being merely another place to work or a workplace of choice.  It can also make the difference between your ASC being yet another place to receive care or the preferred patient option for ambulatory surgical services. 

ASC leaders who understand who makes up their team and what allows for a dynamic work environment are better equipped to harness the power of their team.

The diagram above is a visual representation of an ASC’s stakeholders.  Let’s explore how to engage individual team members to create a vibrant team.

What is Important to the team?

Whether an ASC is in the planning stages, has recently opened, or is in its tenth year of operation, the organization’s mission statement is critical to developing and maintaining its goals.   It serves as the cornerstone of the ASC’s culture. 

A properly crafted mission statement –

  • Communicates the purpose of the organization
  • Serves as a filter to separate what is, and is not, important to the organization
  • Clearly states which markets the organization will serve and how
  • Communicates a sense of intended direction to the entire organization

The mission statement guides the actions of the ASC, articulates its overall goals, provides a path to achieve those goals, and ensures decision-making is in keeping with those goals.  It provides the framework to develop the company’s strategies.

When crafting a mission statement, consider –

  • Quality and consistency
  • Customer service
  • Diversity and individuality
  • Professionalism
  • Specific ideals of a sponsoring or partnering health system or organization

Although it is not uncommon for a mission statement to remain the same over time, it should not remain static due to inattention or apathy.  Markets, goals, leadership, and organizations change and evolve.  Review your mission statement on a regular basis to ensure it reflects any substantial changes.

The Team

Physicians

As I have discussed in other posts, physicians become members of ASCs for a variety of reasons. Ensure you recruit physicians based on how they will function as part of your team. Careful selection is the key to success. If physicians participate for the right reasons and their previous track record demonstrates they are “team players,” integrating them into your team should not be difficult.

Because physicians interact daily with your patients and staff, it is critical for them to buy into, and actively support, the ASC’s mission and culture.  There is no quicker way to undermine the effectiveness of your workplace than to work with physicians who do not respect your organization’s purpose.

Board of Managers

Ideally, the ASC’s Board of Managers (BOM) should create the facility’s mission statement, be involved in its regular review, and develop any revisions.  By setting the facility’s policies and procedures, hiring its medical director and management team, and crafting the mission statement, the BOM is the de facto owner of the ASC’s culture.

BOMs facilitate team dynamics when they are comprised of a diverse group of investors, representing different physician groups and specialties.  When the facility is joint ventured, it is important to include hospital executive representation on the BOM.

Ultimately, the most important characteristic for board members to possess is a willingness to participate and devote the time necessary to enthusiastically engage in facility-related discussions. Board members who stay informed about facility performance and operations and consider the perspectives of all stakeholders regarding ASC topics make sound business decisions.

Medical Director

The medical director is selected by the BOM.  As with physicians, this selection needs to be based on the individual’s track record of being a “team player.” Initially, the medical director will be involved in developing the ASC’s policies and procedures.

Most importantly, the medical director is charged with supporting clinical and administrative staff, enforcing policies and procedures (along with the BOM), and effectively maintaining the facility’s culture.  This will include addressing professional issues related to physicians and staff that are averse to the desired team environment.  The medical director will also function as a team member in multiple operational areas including scheduling, staffing, inventory, operating room utilization, etc.

Clinical and Administrative Staff

A popular saying is, “Hire the right people and get out of their way.”  This holds true not only for employee skill sets and work ethic, but also for their ability to effectively function as members of a team.  Educating staff about the ASC’s mission and the BOM’s commitment to that mission sets the stage for a well-informed team ready to fulfill the desired expectations.

It is critical to support and empower clinical and administrative staff to take action and make the decisions necessary to fulfill the ASC’s mission.  For example, they must feel comfortable reaching out to ASC leadership when quality of care or customer service issues are being compromised.

As new team members are added through growth or attrition, ensure a consistent message is relayed by the physician owners, BOM, medical director, and the facility’s management team. This will ensure the desired team dynamic is preserved.

Management

Management is comprised of the ASC’s administrator and their team of program leaders.  The role of management is to own the ASC’s mission and consistently promote that message to all team members in the facility.  This is the responsibility the BOM entrusts to the center’s management. Management accomplishes this by expecting, promoting, and modeling excellent working interactions among all stakeholders.  Recognizing the contributions of all team members in pursuit of the ASC’s goals and carrying out its mission allows a team atmosphere to flourish.  

Finally, management is responsible for ensuring team members who are not bought into the organization’s mission, or do not have the skill set to contribute to that mission, are appropriately removed from the mix.  Jim Collins, renowned management consultant and author, said, “The only way to deliver to the people who are achieving is to not burden them with the people who are not achieving.” [1]

Conclusion

In conclusion, I am reminded of a speech given by legendary University of Michigan football coach Bo Schembechler.  It is simply referred to as “The Team! The Team! The Team!”  There are numerous YouTube versions of the speech.  My personal favorite is one pulled from a news clip (approximately 2 minutes long).  In his speech, Bo reminds us there is nothing in life we will achieve as an individual that will provide us more personal satisfaction than what we will achieve as a member of a team.  The team can be defined in many ways – your family, your place of worship, your work place – the list goes on.  The underlying message is this:  leaders need to provide the unwavering vision, mission, and culture necessary to make sure all stakeholders have a chance to experience the sense of team accomplishment described so powerfully in Bo’s speech.

Robert Carrera – President/CEO

[1] Good to Great:  Why Some Companies Make the Leap & Others Don’t, James C. Collins, 2001

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

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

Dec 30
Love2
Attract Surgeons

How to Retain & Attract Surgeons to Your ASC

By ASC Management, Leadership No Comments

Do you have a favorite store where you enjoy shopping? It may be convenient to your home or office. They always seem to have what you need.  And, when you can’t find something, friendly staff members are readily available to assist you. It may not be the least expensive place, but the service and atmosphere make the extra dollars spent worthwhile.

Think about your favorite restaurant – perhaps the excellent food was the original draw.  But you keep going back because the service and overall feeling you have while you are there adds to your overall enjoyment.  It wins out often despite the multitude of dining options available to you.

Then there’s that shop you use to service your car or bike.  When you call, they always remember you.  When you walk in the door, the owner and staff greet you as if they genuinely care about your business.  They provide you with service options that may not always be the most profitable for them, but may make the most financial sense to you.

When we consider how to retain and attract surgeons to our surgery centers, it is helpful to keep these types of experiences in mind.  I purposely mentioned retain first.   It is much easier and less expensive to keep current business than it is to attract new business.  This is especially true for surgeons in an ASC. Emulate the owners and staff members at your favorite businesses who provide you with the quality customer service you appreciate.  Ensure the actions and attitudes of everyone at your center convey to your physicians their business is valued.

Surgeons use ASCs for a variety of reasons.  Here are six ways you may be able to attract them to your center:

  1. Consistently provide outstanding customer service. One size doesn’t fit all.  Surgeons value different aspects of their customer experience.  They may be drawn to measurable factors – low infection and transfer rates or high patient and physician satisfaction, for example.  Or, it may be as simple as the reliable availability of competent staff, the proper equipment, and necessary supplies.
  2. Save them time. When you save surgeons time, you improve their quality of life.  This can be as simple as your center being near their home or office which reduces time in the car.   On time starts and rapid room turnover times strongly impact surgeon time.  And, if the scheduling process is convenient for physicians and their staff, they are more inclined to use your ASC.
  3. Ensure quality. In today’s healthcare environment, quality should be a given.  When we are asked to revitalize struggling centers, we rarely encounter ASCs providing poor quality of care. Surgeons look for measurable factors when assessing quality – make this information available to them.   They also want to see the high nurse to patient ratios they have come to expect in an ASC.  Lastly, quality usually comes down to perception – is your staff knowledgeable, skilled, and experienced?
  4. Offer extensive managed care participation. Provided you are not an out-of-network center, physicians and their offices do not want to have to choose their site of service based on remembering which center participates with which third party payor. Being able to offer surgeons the full spectrum of managed care plans in your market makes your center a more desirable place to work.
  5. Provide return on investment. Most investors subscribe to a simple formula.  If they are receiving distributions – tangible ROI – they are much more likely to participate.  If distributions are far and few between, investor participation decreases and your ASC has minimal opportunities to recruit new surgeons.  Managing your center in a fiscally responsible way with financial stewardship in mind affords you opportunities to both retain and attract new physicians. 
  6. Add value. Be able to answer the question, “What have you done for me lately?”  Constantly look for ways to add value to the lives and practices of the surgeons who use your ASC.  Focus on the items I’ve outlined above and never rest on your laurels.

Rob Carrera – President and CEO

Dec 01
Love0
Busy Professionals

Time Savers for Busy Professionals

By ASC Governance No Comments

For busy professionals, there is no doubt we live in a world where time savers feel like life savers.  Work-life balance is essential but it’s increasingly difficult to achieve.  During my tenure managing numerous surgery centers, I sought ways to make my days feel less daunting and leave feeling more accomplished at days’ end.  Here are a few tips I’ve gathered over the years to organize and save time in my daily routine:

1. Take time to start your day with a short exercise period and/or meditation.  Both activities can help you organize your day. If your mind is scattered, your day is likely to follow suit.

2. Ensure your day’s agenda and goals are realistic. Prioritize your task list to ensure you complete the most important items first.  Create a flow to your routine that allows you to smoothly transition from one item to the next.  Nothing gets accomplished if you are trying to tackle multiple projects simultaneously. 

3. As you accomplish your agenda and goals, check them off your list. Take a moment to relish your success.  You got something done – acknowledge it and let that propel you toward tackling the next item.  Crossing items off your list can be a small but significant reward for staying motivated.

4. Minimize disruptions and personal interactions by using this technique: If someone enters your office space unscheduled to chat and there is no extra time in your schedule, stand up.  This non-verbal cue signals you are involved in something or have somewhere to be.

5. Stay on task when in meetings and on conference calls. Tangents and side conversations waste valuable time.  Focus on the purpose of your meetings.  If you discover an unrelated item that warrants discussion, schedule another time to talk about it.

6. Do not procrastinate. If it’s on your daily list, do your best to complete it.  Procrastinating drains the energy you sparked from accomplishing your previous task.  Avoid losing the momentum you built.  If you continuously dive into mindless to-do items, you’ll find yourself having to complete all the important tasks you avoided at the last minute and under greater stress and anxiety.

7. Keep phone calls concise and on point. Long conversations not only create fatigue, they cost you time.  Suddenly your day got a lot shorter while your list stayed the same length.  Don’t let long phone calls throw a wrench in your routine and create unnecessary chaos.

8. Ask for help or delegate when the need arises. The onus doesn’t have to always be on you to handle everything.  If you work with a team, there is a reason you call them teammates.

9. Take time out for yourself. This may be a 10 or 15 minute break to get your mind off the work you are doing and rejuvenate. These little breaks can go a long way to help your mind reset and refocus.

10. Move unaccomplished items to the next day’s agenda. It won’t always be possible to tackle everything on your daily to-do list. Don’t push yourself to the limits for the sole purpose of crossing them off.  Sometimes it’s just not worth it.

11. Create your next day’s agenda and action plan before leaving work. Just like a football team studies before a game, get ready for tomorrow by figuring out your action plan ahead of time. This will allow to enter your office ready to go when you arrive in the morning.

12. Stay hydrated. This is not a time saver, but helps with clear thinking and prevents fatigue. Taking care of your body is crucial to your ability to attend to tasks while not draining yourself in the process. Your health should always come first!

These tips can lead to an easier-to-manage routine that should help you be – and feel – more productive.  Being productive does not equate to constant fatigue.  These adjustments take time but will go a long way toward helping you feel energized.  Busy professionals should feel accomplished at the end of the day.  Hopefully these tips help get you there!

Rick DeHart – Principal Partner