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ASC Operations Archives - Pinnacle III

Mar 13
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Advancing ASC Technology: The Industry's Next Big Move

Advancing ASC Technology: The Industry’s Next Big Move

By ASC Management, Leadership, Uncategorized No Comments

Healthcare is a field that is heavily vested in advancing technology. Physicians and their practice locations, including ASCs, are under great pressure to invest in new technology. Patients are expecting their healthcare facilities not only look modern but deliver an experience that also feels modern. A recent Black Book survey found, for their next healthcare purchase, 83% of consumers will seek providers offering the following four technologies: digital scheduling, online payment options, online portal and engagement capabilities, and results reporting tools.[1]

It’s not just patients who desire healthcare facilities using electronic solutions. Prospective physicians and staff may also find the prospect of using non-electronic solutions unappealing. This is most likely to be true for “digital natives” – those raised during the age of digital technology. Telling them they must use non-electronic solutions or outdated technology may be all it takes to lose physicians and/or job candidates.

Guidance on How to Effectively Add ASC Technology

Despite the growing pressure to add new ASC technology, surgery centers will want to be careful not to try to do too much, too fast. Here is some advice to help you make smart decisions.

Understand your options. As the demand for ASC technology has grown, so have the types of technology available. Our ASC recently implemented two new technologies. One was a texting program managed through an online patient portal vendor (read more about this program in my previous blog). The other was a surgery scheduling application. It allows any authorized personnel logging into the application – whether it be physicians, schedulers, staff or vendor reps – to see our current schedule. The application provides real-time updates when scheduling information changes.

These are just two of the many new technology options to hit the ASC market in recent years. There are also many vendors offering similar technologies. This makes it vital for ASCs to carefully research their technology choices. One way to find out about new solutions is by attending ASC conferences and visiting the booths of exhibiting vendors. Afterwards, you may find it advantageous to schedule demos and speak with other users of the technology. Remember, you should get all questions answered before moving ahead with an investment.

Resist hype. Refrain from implementing technology just because it is the latest trend. You may choose a solution that fails to fill a need as effectively as another option. Rather, consider developing a technology strategy with target initiatives that support specific organizational goals. Benefits of aligning with goals include stronger process efficiencies, cost savings, added functionality, and increased safety.

Involve end users. To help ensure successful adoption, I involve end users from the beginning of the research process. Users are typically more accepting of a new system when they understand how it will positively impact their jobs.

At our ASC, we focus on providing the appropriate amount of training for the appropriate length of time. We get staff feeling comfortable using the new system and avoid overwhelming them with unnecessary details about functionality. You can always provide additional training once staff grasp basic functions of the system.

Anticipate pushback. Resistance to a change of any sort is almost inevitable. That is true with the addition of new ASC technology, even if the technology has the potential to improve existing processes. Reasons for pushback can vary. Some staff may question changing a process if that process seems to still work well. Others may express concern about their comfort with using technology. Some physician owners may wonder whether the financial investment is worthwhile. Factor in resistance in your technology planning and be prepared to address it (see the tips at the end of this article).

Learn from experiences. Every new ASC technology implementation presents opportunities for learning that can be applied to future implementations. Following an implementation and initial use of a new solution, it can be helpful to assess the experience. What obstacles encountered – internally or with the vendor – could have been avoided? If strong resistance remained even after implementation, what can be done to better address it? If staff struggle to use the technology, where can training be improved? The lessons you learn can help make the addition of your next ASC technology a little easier.

Tips for Overcoming ASC Technology Resistance

As noted, you should expect resistance from at least some staff to the addition of a new ASC technology. I already highlighted the value of involving end users, which can play a critical role in overcoming resistance. Here are some other quick tips:

  • Be clear. Even before you select a solution, it is helpful to inform staff about your plans for the new technology. You may consider explaining your plan’s purpose and the benefits you anticipate achieving and letting staff know the decision has board support. As you move forward with the selection process, keep staff in the loop. This will help secure buy-in and build excitement.
  • Lean on your champions. When encountering resistance, identify team members most excited about the new technology and ask them to be your champions and cheerleaders for the project. Think about encouraging your champions to speak with peers about why they are excited and why everyone should share this feeling. Peer pressure can be a valuable tool.
  • Adjust training. Your staff will likely need different levels of training to become comfortable with a new solution. Be prepared to adjust training accordingly. Let staff know that training will be individualized, where necessary. You will likely need to spend more time with those less tech-savvy individuals on your staff. Their training should focus on building a basic understanding of and comfort with the solution. This can help alleviate fears of transitioning to the new ASC technology.
  • Lean on the vendor. You may want to invite vendor representatives to your ASC if they weren’t planning to visit already and ask them to present on the benefits of their technology. The vendors should allow staff time to ask questions. Some staff may be less hesitant to ask questions and express concerns to vendor representatives than to ASC leadership.
  • Celebrate milestones. The more positive energy you can associate with the adding of a new technology, the better. Celebrate significant milestones achieved during the project. These can include choosing a solution, beginning implementation, and go-live. Ways to celebrate include email announcements, posters, snacks, and catered lunches. By building enthusiasm, you may even bring your most rigid naysayers on board.

The addition of technology can transform ASC operations and bring about improvements throughout the organization. But if decisions are rushed, new technology can create significant problems with processes and personnel. Approach potential ASC technology additions with care and purpose. Doing so will better help ensure the solution you choose delivers on its promise.

Michaela Halcomb, Director of Operations

[1]https://blackbookmarketresearch.newswire.com/news/19-recent-healthcare-tech-start-ups-attract-instant-consumer-appeal-20556737

Jan 25
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ASC Case-Costing: Improving the Data Collection Process

ASC Case-Costing: Improving the Data Collection Process

By ASC Management, Leadership No Comments

For an ASC leader, understanding the financial impact of each surgery performed in an ASC is critical to the facility’s success. To achieve this, you must have detailed, accurate data on surgical costs and reimbursements.

Most facilities have software that produces reports which assist with gathering and modeling data. Depending on the resources available at your facility, the difficulty in gathering and using case-costing data will vary.

Avoiding ‘bad’ data

Some management companies, like Pinnacle III, employ a data analyst to provide tools to analyze the cost and reimbursement of cases. However, even with the help of a data analyst, the analysis will only be helpful if the data collection process is accurate and thorough. A common saying among data scientists is, “Garbage in equals garbage out.” For ASCs, if the person pulling the data does not have accurate data to work with, case-costing will be inaccurate.

Here are a few ways to avoid producing bad data.

  • Ensure staff are entering valid data into your software and paying attention to details. Educating staff about the impact of their role in this process is key. Staff mistakes, such as entering equipment cost as supply, can falsely inflate the cost of the case in your analysis. These mistakes are easily avoided by focused staff members who have received adequate training on their function and impact.
  • Update staff compensation. If pay rates aren’t current in your software, the labor costs associated with a case will be incorrect.
  • Engage your materials personnel. The material personnel are vital to keeping information current and accurate. Supply pricing changes must be up-to-date in your software.
  • Keep preference cards current. Make sure hold items are not listed as open. Ensure standard items used on every surgery are correct. This will avoid waste and reduce errors when accounting for what was used during each surgery.
  • Don’t forget supplies used outside of the OR. The supplies used in pre-op and PACU for a patient can seem insignificant. However, accounting for them with the surgery ensures general supply expenses spread among all cases is reduced. Create a pre/post bundle price for each type of surgery that gets added to the supply used. And don’t forget to include anesthesia supplies and drugs, which are often overlooked.
  • Include everything with a fee. Often there will be a charge for something, such as rental for a laser or a tray drop-off, that can be easily left out. If certain items are always used and the fee is known, add them to the preference card and include the fee in your software. Educate staff to facilitate understanding about which items carry a fee to ensure those costs are added to the case.
  • Accurately capture implants and instrumentation. Avoid including reprocessed items as an expense. Ensure fees are not attached to reprocessed instruments or they could be charged to the case as a supply used. Ensure implants used are reflected in your software with the appropriate price.

Final tips for case-costing analysis

There are obvious costs to capture, however, some items may be overlooked, particularly if you are not utilizing a data analyst. Some things to remember when gathering case-costing data are:

  • Include total visit time as well as OR time. The length of time the patient spends in the facility from admission to discharge is an important factor in the overall cost of a case.
  • Use your P&L to tie-in general expenses to be allocated among all cases as an indirect expense.
  • Include the payor mix. This is very important as the payor mix can be a contributing factor to variances among surgeons.
  • There is never too much detail. The process is tedious, but the result will benefit the ASC in many ways. The more ways the data can be sorted, the easier it will be to identify inefficiencies, waste, spending variances, long recoveries, and a variety of trends.
  • Separate supplies and implants. This will allow you to compare surgeons by case and identify opportunities for savings and standardization.

Once the data is gathered, configure it in a way that will allow you to study it from multiple angles (e.g., via a spreadsheet program). Begin with a broad view – by specialty, physician, CPT, or payor, for example. Then examine the subsets – perhaps by specialty/by physician or by physician/by CPT. If you notice significant variances, dig deeper to determine the cause. As you study the data you may find errors. Rather than being frustrated by inaccuracies, use errors as an opportunity to refine your processes and/or systems. Avoid sharing data with your surgeons until you are confident it is accurate. Seek their insights when sharing the information; they may be able to point to additional areas to investigate prior to making operational decisions based on the data.

As you refine your processes and systems, keep your staff and surgeons in the feedback loop. Addressing errors as they arise will create a more seamless process that allows you to focus on other improvement opportunities.

Stay tuned for the second-part of my case-costing blog series. In my follow-up blog, I will further discuss best-practices for analyzing case-costing data. I will also delve into ways to utilize case-costing data, and the benefit of engaging surgeons in the process.

Lori Tamburo, Director of Operations

Nov 14
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Understanding the Administrator's Role in ASC Quality Improvement

Understanding the Administrator’s Role in ASC Quality Improvement

By ASC Management, Leadership No Comments

A quality assurance performance improvement (QAPI) program has long been the foundation for the delivery of quality care in an ASC. That’s because an effective QAPI program helps improve all aspects of an ASC’s operations. Despite its longstanding importance, ASC quality improvement has taken on greater significance in recent years.

There are a few reasons why. Physicians, staff, regulatory bodies, payors and even patients are demanding increased transparency concerning quality and quality improvement data. Accreditation organizations are requiring a high-level QAPI process to meet standards. Reimbursement is increasingly tied to quality measures and outcomes. Reports of poor quality tend to make the news and spread like wildfire.

This makes it vital that a QAPI program be an organizational commitment for ASCs. It is the administrator’s responsibility to secure such a commitment from employees, management, physicians and the governing board. To do so, an administrator must be an active participant in ASC quality improvement and embrace the steps necessary for success.

10 Steps for Administrator Involvement in ASC Quality Improvement

Here are 10 steps administrators can follow to help ensure effective involvement in their ASC’s QAPI program.

  1. Understand your program. Allocate the time necessary to learn about your QAPI program, plan, and processes. Without a strong understanding, administrators cannot provide effective oversight and participation.
  2. Learn requirements. If your ASC delivers care to Medicare and/or Medicaid patients, you are required to meet the Centers for Medicare & Medicaid Services’ (CMS) QAPI requirements. As noted earlier, if your ASC is accredited, your QAPI program must comply with accreditation standards. While there is likely overlap between the requirements, there may be some differences. Understand what surveyors expect to see when they visit your ASC.
  3. Focus on what matters. ASC quality improvement can feel overwhelming when you’re unsure what areas of operation to focus on for improvement. Study performance data and identify those measures and benchmarks critical to your success. This will help ensure you measure, track, trend, report on, and improve what is most important to your ASC.
  4. Carefully select a program manager. While administrators should be active participants in ASC quality improvement, they do not normally serve as the QAPI program manager. Rather, they select and appoint a responsible individual. This person, who is often a nurse, must have interest, knowledge, and experience in quality improvement. Passion for improving care is vital to your QAPI program manager’s success. Also critical: administrative and organizational skills, including using spreadsheets and databases, and developing meaningful presentations for QAPI committee meetings. Note: Maintain a current, clear QAPI program manager job description for guidance and accountability.
  5. Establish oversight. Develop a process to ensure effective oversight of the QAPI program. Follow your organizational chart to maintain accountability of the employee responsible for the QAPI program. Include yourself on that chart as you will likely work directly with the QAPI program manager on specific projects.
  6. Support the program. A surefire way for a QAPI program to fall short of its potential is lack of support. Provide resources critical to a successful program. These can include time for the manager to work on ASC quality improvement, training, education (e.g., industry conferences, webinars, publications) and software. It also includes authority for the QAPI program manager to hold stakeholders accountable.
  7. Be active on committees. Take an active role on your QAPI committee. This will help you provide a comprehensive summary about QAPI activities to your medical advisory committee (MAC) and governing board.
  8. Serve as interface. As administrator, you are the interface between staff, physicians, MAC, and the governing board. You are responsible for maintaining an efficient flow of information regarding QAPI activities that help achieve objectives. Work closely with the MAC and governing board to ensure implementation of their directives.
  9. Stay involved. QAPI programs are most successful when administrators are continually involved, even when the program is delivering strong results. Such involvement demonstrates commitment and support. It also provides the opportunity to share input on benchmarking and studies appropriate and important to QAPI priorities.
  10. Keep current. Healthcare is a dynamic sector, undergoing frequent changes. This extends to ASCs. Administrators must keep abreast of industry changes that impact ASC quality improvement efforts. When changes arise, incorporate revisions to your QAPI process to meet new needs and requirements.

ASC Quality Improvement Quick Tips

The steps outlined above should help define your role in your QAPI program. Here are a few tips that can further boost your ASC quality improvement efforts:

  • Rely on your data. Using data helps administration make evidence-based decisions, allocate resources more effectively, and engage in targeted corrective actions.
  • Involve many staff in your QAPI program. This will help create a learning organization where ASC quality improvement processes are understood and improvements are sustained and built on.
  • Promote your program. Keep QAPI as a top-line item for MAC and governing board meetings. Share program results and explain how they improve your ASC. Provide this information to payors to further demonstrate your ASC’s commitment to quality.
  • Leverage partner support. If your ASC has a management company and/or hospital partner, its QAPI expertise can be an asset to the manager and program.

The importance of QAPI and ASC quality improvement efforts are likely to magnify as the demand for quality information and data grows. Quality improvement must be an ongoing effort if ASCs want to achieve meaningful results and maintain compliance. By carefully balancing their participation with QAPI program oversight, administrators can play a crucial role in achieving these objectives.

Ross Alexander, Director of Operations

Mar 22
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Running a Successful ASC Convalescent Center

Running a Successful ASC Convalescent Center

By ASC Development, ASC Management No Comments

When our ASC opened in late 2014, we had more to celebrate than a new surgery center. We also toasted the opening of our new ASC convalescent center.

Located in the same building, the ASC convalescent center (also referred to as our “recovery center”) allows our surgeons to perform more complex procedures in the ASC that require an overnight stay. These include total knee, hip, and shoulder replacements as well as spine procedures such as anterior cervical fusions and posterior fusions. Upon completion of these procedures in our ASC, we move these patients to the convalescent center. There they recover up to 72 hours under the supervision of at least two medical professionals. A registered nurse, always present, is joined by either a certified nurse aide or medical assistant. Together, they provide personalized care and attention. Meals are served and visitors are welcomed most of the day.

Without the ASC convalescent center, our surgeons would have to perform these procedures in a hospital. Thanks to the recovery center, more patients can take advantage of our high-quality, low-cost surgical care. Our ASC benefits by capturing more surgical volume. In 2017, more than 400 patients stayed in our convalescent center. In the fourth quarter of 2017 alone, more than 130 patients remained in the recovery center overnight.

While the growth is exciting, what’s even more gratifying is the feedback we receive from our recovery center patients. They rave about it on our patient satisfaction survey. One of the questions we ask is: “Would you recommend this facility to friends and family?” Not only will they circle yes, they usually add a comment along the lines of “I would absolutely recommend the Orthopaedic and Spine Center.” That tells me we’re doing something right.

Recommendations for Developing a Convalescent Center

Here are some of the key factors that contribute to ongoing success with an ASC convalescent center.

  1. Careful patient selection. The ability to send patients to the recovery center does not lower our ASC’s standards for patient selection criteria. Patients must be in generally good health. Those with an American Society of Anesthesiologists physical status classification of III or IV are better suited for the hospital. We do not risk patient safety solely to increase volume. Surgeons inform the ASC when they want a patient kept overnight and how long they anticipate the patient staying.
  2. Involved anesthesiologists. Our anesthesiologists are critical to selection and management of convalescent center patients. One of the reasons patients stay is because their procedures are more extensive. This usually brings a greater level of pain following the surgery, which must be managed appropriately. Anesthesiologists are always part of the surgery planning process, ensuring these patients are appropriate for admission and their pain levels addressed throughout their stay. They discuss the different options for anesthesia with patients. They play a vital role in our efforts to use pain pumps to help reduce patient reliance on narcotics.
  3. Appropriate reimbursement. Reimbursement for procedures requiring an overnight stay can be tricky. Not all insurance companies pay for services provided in a convalescent center. When this is the case, the reimbursement for the procedure itself must cover the ASC’s expenses and those associated with the recovery center as well as a reasonable profit margin. By taking the time to conduct a thorough cost-benefit analysis and understanding fully the expenses associated with running the convalescent center, we armed ourselves with data that has assisted with payor contract negotiations.
  4. Focus on compliance. A convalescent center receives regulatory scrutiny just like an ASC. Compliance shortcomings can jeopardize the ability to keep a recovery center open. Make sure you understand and follow state rules for operating an ASC convalescent center. For us, that includes a license, entrance, waiting room, and medical records system separate from the ASC. Although a hallway connects our ASC to our convalescent center, patients are still discharged from the ASC before they are admitted to the recovery center. Following these processes helps keep both facilities in compliance.
  5. Supportive physicians. We are fortunate our physicians embrace the recovery center model. They are able to bring more high acuity cases to the ASC, explaining to patients beforehand the value of staying in our convalescent center. We return the favor by working to provide our physicians and their patients with a great surgical recovery experience. Maintaining the support of our physicians is essential to our growth.

Quick Tips for Getting Started with a Convalescent Center

While it’s great to have the option of providing extended care for patients, running a convalescent center isn’t for every ASC. Here are a few quick tips to follow before you move ahead with opening your own recovery facility:

  • Know your state’s rules. Only some states allow an ASC to operate a convalescent center.
  • If your state has an active ASC association, reach out. They may be able to answer questions about state rules for recovery centers. Lean on your local health department for information as well.
  • Make sure you have commitment from physicians to bring enough overnight cases to justify the convalescent center. Without this commitment, you run the risk of opening a recovery center that will cost your ASC and its owners money rather than help generate revenue.
  • Speak with your payors about your plans. Gauge their willingness to cover the more complex procedures requiring overnight stays at a fair rate.

Opening an ASC convalescent center does not guarantee its success. You will need to encourage your surgeons to schedule these complex cases, when appropriate, at the ASC. Marketing the convalescent center can help attract new physicians. It can also motivate patients to speak with their surgeons about undergoing a procedure at the ASC and staying at the recovery center. When word spreads, you may even attract patients from outside of your market. As we have experienced, the hard work that goes into building and growing a recovery program is truly rewarding.

Jennifer Arellano, Director of Operations

Mar 15
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Hiring an ASC Clinical Director

Hiring an ASC Clinical Director

By ASC Development, ASC Management, Leadership No Comments

Recently I took some time to reflect on what I’m grateful for. The long list I came up with included my ASC clinical director.

Our clinical director does a lot for our center. She certainly makes my job as administrator easier. Concerns have never been raised about her work ethic and performance. I wouldn’t think twice about leaving the ASC under her command for an extended period of time. I know that, if an issue arises, she can effectively address it or find the resources to do so. You can’t put a price tag on that peace of mind.

An ASC clinical director is a highly important function within the facility. Finding the right person for this role can be difficult. The clinical director must possess a variety of qualifications related to both clinical and business operations. To find the optimal clinical director for your ASC, I have listed characteristics to hone in on during your search.

Clinical Director Characteristics

Several characteristics clinical directors should possess to help them succeed in their role are outlined below.

Relevant clinical background. The clinical director should have a solid understanding of their center’s specialty(ies). For example, at an endoscopy center such as ours, our clinical director’s gastroenterology background is valuable. If you work in a multi-specialty center, the clinical director should possess a broad surgical and PACU background.

The appropriate clinical background allows the clinical director to:

  • Understand the roles and responsibilities of their staff;
  • Fill in for clinical staff members if someone calls in sick or needs to take a break;
  • Understand how to meet the needs and requirements of physicians in their respective specialties;
  • Earn respect from staff and physicians because of a demonstrated knowledge and experience with the specialty(ies);
  • Support the delivery of high-quality care; and
  • Help the center meet accreditation and regulatory requirements.

Eagerness to learn. ASC clinical directors typically work their way into the position by ascending the ranks of the clinical staff. Clinical directors often do not possess a strong business background as they move into this leadership position. To perform successfully as a clinical director, though, one must understand the business side of running an ASC. This includes budgeting, expense monitoring, and third-party payer contracting and reimbursement.

A clinical director must embrace learning. Your ASC will benefit as your clinical director learns the ASC business and incorporates new knowledge into his or her approach to clinical responsibilities. A clinical director who is motivated to go outside of his or her comfort zone in the learning process contributes to the ASC’s success and is worth his or her weight in gold.

Responsiveness. ASC clinical directors should be responsive to their physicians and staff. They must know how to recognize when issues are developing, such as a dissatisfied physician or poorly performing staff member. They must also know how to deal with these issues in a timely fashion to avoid them becoming more significant problems.

For example, a clinical director should recognize when a physician is becoming busier and adding cases. Such a development touches on many aspects of an ASC’s operations. It may require hiring more staff, allocating more block time, and/or purchasing more supplies. The clinical director is not expected to address these potential developments independently. Rather, they may research the development and speak with other members of the ASC team about actions to effectively accommodate the growth.

Proactiveness. Strong clinical directors can foresee future challenges and know how to act in advance. When a clinical director is new to the position, these challenges may primarily be clinical in nature. The longer the clinical director is in the position, the more he or she should consider business and operational issues as well.

Effective communicator. Clinical directors should be strong communicators, an important ability for effective leaders. They must know how to engage in clear communication with everyone in the center, including physicians, staff, vendors, patients and their families.

Remember, effective communication is a two-way street. A clinical director should feel comfortable approaching others and promote an environment where others feel comfortable approaching the clinical director.

Giving Thanks for My Clinical Director

Our center recently went through an unannounced CMS survey. We were understandably stressed when it occurred, but no one panicked. The staff performed their job duties and provided the high-quality care that they do every day of the year. The physicians expressed complete confidence in the performance of the staff and the leadership of the clinical director. We passed the survey with no deficiencies.

This experience demonstrates how well our clinical director performs. ASCs typically have a small group of physician owners. The physician owners are likely to be critical of the clinical director because it is a clinical role. A successful ASC needs its physician owners to be confident in the clinical director’s leadership and ability to help run the center. If staff members feel the same way, employee turnover rates tend to be low. When staff members like their leaders and work environment, they’re not going to leave.

Patients notice this dynamic. They often comment, “You all seem to like your jobs and have fun here.” That speaks to how the center is managed and how ASC staff members feel about their culture and work environment. Much of this hinges on the presence of a strong clinical director.

Catherine Sayers, Director of Operations

Dec 06
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Overcoming ASC Management Nightmares: Physician Engagement

Overcoming ASC Management Nightmares: Physician Engagement

By ASC Management, Leadership No Comments

Third installment in the “Overcoming ASC Management Nightmares” blog series. Click here for Part 1 and Part 2.

ASC Management Nightmare #3: Physician Engagement

There’s no denying the importance of physicians performing procedures in ASCs. After all, without procedures, there is no ASC business. When physicians view performing procedures as their primary purpose in supporting an ASC, they may overlook the importance of physician engagement – a vital component of ASC operations.

Regulatory bodies expect to see ASC physicians – specifically owners – involved in all aspects of the organization. Compliance issues may arise when physicians fail to take an active role.

In addition, when physician engagement is lacking, financial problems can quickly arise. For example, in the absence of physician oversight, an individual’s desire to perform more procedures may lead to the addition of cases or purchasing of equipment that does not deliver a positive return on investment.

When physicians hire ASC management staff, they often intend to pass off the responsibility of running the ASC business. Managers must ensure physicians understand their required role in operations and its critical importance to the ASC’s success. This task is typically easier said than done.

Solution

Data is naturally attractive to physicians. Many of them likely chose to pursue a career in health care because it is a data-driven business. Consider statistics like life expectancy, death expectancy, surgical success rate, percentage of risk – physicians are used to sharing this type of information with patients.

To improve our ASC’s physician engagement, we’re working to cater to their love of empirical decision-making. In the past, we often relied on providing hand-collected and anecdotal data to help physicians make informed decisions regarding business operations. But since this data was not scientifically objective, it was not always effective in achieving our desired results.

To combat this perception, we are implementing computer programs that allow us to refine that data so it’s “hard and true.” These programs measure numerous data points in areas such as quality, volume, and case costing. We have used this concrete data in presentations to physicians and witnessed an emotional change. They are more willing to accept, assess and respond to the information. Physician engagement in ASC management is shifting from passive to active.

Lisa Austin, VP, Facility Development

Aug 03
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Managing difficult employee behavior

Help! My Employees are Keeping Me Awake at Night!

By ASC Management, Leadership No Comments

Lately, when faced with a work situation that taxes my emotional reserve and keeps me awake at night, I turn it on its head. I view the issue from a different perspective; change the tape that’s repeatedly playing in my brain by altering the order of the words.

For example, when I hear, “I’ve got a difficult employee and I don’t have a clue what to do,” I reframe the problem and respond with, “Let’s talk about the difficult behavior this person is exhibiting that is creating frustration for you in the workplace.” Shifting our dialogue to focus on the behavior rather than the person, creates a much-needed level of objectivity that allows for more effective problem solving.

Let’s face it, as leaders, we are bound to encounter employees who exhibit behaviors that are difficult to manage. An employee who simply fails to show up to work on time can create havoc in a facility. Being met with resistance when asked to perform a task in a specific way can derail a surgery center team’s attempts to ensure patient safety.

If you’re like most people, you don’t enjoy confrontation. So, you chalk the behavior up to “a bad day” or, when the behavior rears its ugly head consistently, excuse it with, “That’s just how Marianne operates. She’s not interested in hearing feedback.” But, it’s your job to deal with these behaviors effectively to minimize the ripple effects. The harsh reality is, if you don’t deal with difficult behaviors, the problems will only get worse. And, if you don’t document your actions, it is as if you never responded.

When you find yourself wondering why an employee is being so difficult, avoid succumbing to “stinkin’ thinkin’.” In other words, avoid personalizing the behavior.

Here’s an example. Tom, your receptionist/registrar, reports to the surgery center 10 to 15 minutes late every morning. He is responsible for checking patients in promptly. If he’s not there, patients either end up waiting for him to arrive or his co-workers must stop what they’re doing to perform his job. This is annoying enough on its own. But he has the nerve to saunter in with a Starbucks coffee in hand, jovially greeting everyone on the way to his workstation. The patients love him. They have no idea he’s the one who created the tension they sensed upon their arrival. As he settles into work, capably completing the tasks his co-workers have started for him, you overhear a steady stream of employees filing past your office muttering, “Really? He does this every day. Why does he insist on making everyone miserable? I’m tired of doing his job. Doesn’t he recognize we’ve got our own tasks to perform to ensure surgeries start on time?”

Tom, contrary to what is now popular belief, likely does not wake up every morning planning to upset everyone. He’s laid back – a strong suit when it comes to interacting with patients nervously anticipating their planned procedure – and approaches everything in stride, including sleeping through his alarm, a long line at Starbucks, and having to circle the parking lot three times to find an empty spot.

To deal effectively with Tom’s tardiness, it’s important to accurately identify the problem behavior. On the surface, it might appear the problem is slacking – showing up late because Tom wants others to perform his job. After all, that’s what his co-workers have surmised. However, after talking with Tom, you realize he is on a completely different wavelength. He truly is unaware his behavior negatively impacts the start of everyone else’s day.

Now that you’ve identified the true difficulty, you can effectively manage Tom’s future behavior by having a conversation with him. People who are on a different wavelength, need clearly defined communication that outlines expected results.

Your conversation may proceed along these lines. “Tom, I need you to be at your workstation ready to check in our first patient on time each morning. I expect you to clock in at 5:45, then immediately report to your desk to ensure you are prepared for 6:00 a.m. arrivals. Adhering to this regimen will serve our patients well. The value you bring to our organization will be enhanced when your co-workers realize they can rely on you to greet patients and get them checked in promptly. Our physicians will recognize a change in how quickly they are able to get started each morning. I’m going to document our conversation today as a coaching session. Now that you recognize how important it is for you to be on time to perform an essential requirement of your job, I’m confident you will figure out how to report to work promptly every day.”

I recognize this is only one example of dealing with a difficult behavior. And, more importantly, I’ve assumed the conversation went well. You talked to Tom, he saw the light, he altered his behavior, and being late to work is not something that occurs anymore. I’m aware, however, that’s not always the case.

My point is this: when you separate the person from the behavior, accurately identify the problem, and promptly address with the employee how their behavior impacts the organization, you have a much greater chance of achieving a successful outcome. Those successful outcomes will not only lead to a happier, more united facility, they will allow you to sleep much better at night!

Kim Woodruff, VP of Corporate Finance & Compliance

Jul 26
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ASC Infection Control Program

How to Develop an ASC Infection Control Program

By ASC Management No Comments

Surveillance, prevention, and control of infection in ambulatory surgery centers is a frequent deficiency cited in state, Medicare, and accreditation surveys. ASCs are required to have an infection control program that outlines purpose, goals, specific risks, methods of data collection, and strategies used. The program also must identify how and when the infection control program is evaluated. Because most centers do not have a full-time infection control nurse or officer solely dedicated to this role, this requirement can seem daunting. With some luck, the Infection Control Officer (ICO) might get to a meeting once a year and complete the training required to hold this position.

The purpose of infection prevention is to protect the patient, health care workers, visitors, and others in the health care environment. In an ASC especially, it needs to do so in a cost-effective manner. How can you effectively and efficiently ensure infection prevention in your setting?

1. Start by setting infection control program goals.

  • Identify and reduce the risk of endemic and epidemic facility-associated infections.
  • Report appropriate information to internal surgery center leadership and public health authorities.
  • Develop communication linkage between professional and health care workers, patients, families, public health professionals, and the community.
  • Create plans to respond to emerging infections and bioterrorism.
  • Promote a zero tolerance of hospital acquired infections (HAIs).

2. Explain how infection control is embedded in your organization. Spell out how the ICO integrates with committees, the reporting structure, and the sources utilized for evidence-based practices. For example:

  • The ICO is part of the Continuous Assurance Committee and oversees the infection control program.
  • Under the direction of the Medical Director, the ICO investigates all suspected outbreaks. This occurs in collaboration with the appropriate medical and administrative staff.
  • Using the most correct and useful statistical process, data is collected, analyzed, and reported.
  • The ICO has access to comparable community data to determine if rates within the center are above or below those in the community.
  • The ICO develops this plan using data from CDC/NHSN/NNIS.
  • The board of managers approves the infection control program, types and scopes of activities, and training materials. They review this plan at least annually to evaluate its effectiveness in the center.

3. Create a prioritized risk assessment. The risk assessment should focus on internal and external factors. This helps form a complete picture of the risks that exist. Prioritize the identified risks based on the potential impact, probability, and the organization’s preparedness. This is your base for determining what activities you should perform and at what intervals.

  • External: Consider patient populations and cultural reactions to health care. Examples are community issues, such as high rates of TB. These factors are not fixed. As situations arise in the community, a new risk assessment may be necessary.
  • Internal: Focus on your high volume/high acuity cases. Think about instrumentation and the associated cleaning problems (i.e., long, luminated). Consider the physical plant in which you provide care. Are there risks? Do you have a water feature in your lobby?

4. Identify and summarize your activities.

  • Remember to take credit for activities you already perform. This can include monthly and 90-day SSI surveillance, prophylactic ABO administration tracking, and bloodborne pathogen exposure monitoring/reporting and outcomes.
  • Based on your risk assessment, you may track things like monthly monitoring of SPD logs, environment of care items, and hand hygiene. Ensure each one of these activities has a summary explaining the process, frequency of tasks, and documentation undertaken.

5. Spend time discussing and documenting the strategies you will use.

  • A good general statement is “TJC, AAAHC, OSHA and pertinent federal, state, and local regulations pertaining to infection control are being implemented and followed.”
  • Include items such as staff training on PPE, TB, hand hygiene, and cleaning. In addition, list the local, state, and federal contacts and reporting requirements, as well as communication with other health care facilities and providers in your community.

It is important to formally evaluate and revise your goals and program, or portions of the program, at least annually and whenever risks significantly change. Make sure your evaluation addresses the assessment of the success or failure of interventions for preventing and controlling infections and responds to concerns raised by leadership or others. The evaluation should always address how relevant infection prevention and control guidelines are based on evidence and have evolved. In the absence of evidence, cite expert consensus.

Oftentimes, daunting tasks are made less so when you have a framework to follow. Once you get the ball rolling, you are more likely to find an internal champion to serve in the ICO role. Ensure you support your ICO as they tackle program specifics by allocating the funds necessary to secure appropriate training and advance program goals. Before you know it, you’ll have a thriving program and your ASC will significantly reduce the likelihood of being cited for an infection control related deficiency.

Jovanna Grissom, VP of Operations

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

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