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ASC staffing Archives - Page 2 of 2 - Pinnacle III

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 18
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Relieving the “Financial Pain” of Surgery via an ASC Financial Counselor

Relieving the “Financial Pain” of Surgery via an ASC Financial Counselor

By ASC Management, Leadership No Comments

With more employers offering high-deductible health plans as an affordable insurance alternative, health care providers recognize their patients’ out-of-pocket financial responsibility is steadily increasing. ASCs often struggle with adeptly handling patient communication regarding this monetary component of surgery. It is challenging enough for most patients to understand the nuances of their health insurance plans without adding the potential stress of thoroughly evaluating their personal financial obligations for each episode of care. Patient satisfaction surveys frequently reflect this stressor. However, this added challenge is easily avoidable with clear, advance communication. Many ASCs have responded to this patient need by adding a financial counselor to their staff.

Educating patients is the most effective way to minimize confusion, maximize time of service collections, and increase patient satisfaction. Reading an explanation of benefits (EOB) can be daunting. Deciphering up to four EOBs for one surgery can be downright overwhelming and, in some cases, shocking. In 2015, 77 percent of consumers reported they were confused by the explanation of benefits they received from their health plan. Seventy-six percent were confused by bills from their providers. By the time a patient is scheduled for surgery, they have often received an estimate of charges and made a payment to their physician’s office, not realizing there is a separate financial obligation to the facility and, in many cases, the anesthesiologist and/or pathologist.

Creating an ASC financial counselor role ensures your facility has a dedicated person responsible for patient communication and financial education in advance of surgery. The ASC financial counselor also plays an integral part in preparing cost-benefit analyses and providing the details to management for consideration.

When contemplating the addition of an ASC financial counselor, items you may want to evaluate include the following:

  • Is the ASC maximizing time of service collections?

    • A financial counselor will improve the percentage of up-front collections through patient education and setting expectations. Advance communication allows patients the time necessary to plan for their financial outlay. By adding an ASC financial counselor, patients receive this information in a timely manner, depending on when the surgery is scheduled.

  • Does the ASC have a high percentage of bad-debt write-offs or accounts in collections?

    • A high percentage of write-offs and accounts referred to collections is indicative of failure to maximize up-front collections or develop formal payment plans. In contrast, a dedicated financial counselor clearly communicates the financial obligation to the patient and formulates a plan for payment in advance of the patient’s episode of care. This includes a written contract if payment is not made in full by the day of surgery, thereby eliminating confusion and creating a firm commitment of payment from the patient.

  • Is the ASC aware of the costs associated with the cases they perform?

    • ASCs, like other businesses, must evaluate which surgeries consistently lose money. The ASC financial counselor is tasked with flagging such surgeries and assisting with minimizing up-front losses. Oftentimes, properly evaluating and documenting these surgeries will provide your payor contracting team with the leverage they need to negotiate proper reimbursement.

  • Is the ASC receiving negative feedback regarding finance on patient satisfaction surveys?

    • Patients will be much more pleased with their overall experience if they fully understand their financial obligation and do not face unexpected or minimal post-surgery expenses when their EOBs arrive.

  • Does the ASC have the case volume to support a full-time or part-time position or can this responsibility be added to an existing employee’s job description?

    • A high-volume center will benefit from adding this position as a full-time role. This person provides a final verification of demographics, as well as confirmation of insurance authorization, leading to fewer avoidable denials. A financial counselor is valuable to every ASC, regardless of size. If the center cannot support this position independently, consider adding the responsibilities to an existing front-desk role.

An ASC financial counselor typically reduces frustration for patients as well as staff. Having a person dedicated to this role improves collections, reduces bad-debt, decreases avoidable insurance denials, and minimizes financial losses due to poor reimbursement, all of which bringing substantial value to the ASC.

Lori Tamburo, Director of Operations

Nov 06
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Overcoming ASC Management Nightmares: Finding OR Nurses

Overcoming ASC Management Nightmares: Finding OR Nurses

By ASC Development, ASC Management No Comments

First installment in the “Overcoming ASC Management Nightmares” blog series. Click here for Part 2 and Part 3.

One thing I’ve learned over the years is that if you hold an ASC management position, there’s always something that will keep you up at night. Whether your ASC has been open one day or 10 years, dealing with challenges is the norm. How you address those issues is what really matters.

This is the first installment in my “Overcoming ASC Management Nightmares” blog series which will explore the challenges robbing me of precious sleep. Fortunately, I’ve been successful in taking steps to keep these nightmares at bay. I suspect other ASC managers are experiencing these nightmares too. Hopefully my solutions can help put your mind at ease.

ASC Management Nightmare #1: Finding OR Nurses

The motto “If you build it, they will come” may have served Kevin Costner’s character in Field of Dreams well, but it typically doesn’t help ASCs when it comes to attracting staff. I recently helped build a new ASC. The first question each of the prospective administrators asked was, “How are you going to find staff?”

Nearly everyone I encounter is trying to figure out the answer to this question, particularly when it comes to hiring OR nurses. You can be in an area oversaturated or under-saturated with ASCs. In either case, you likely won’t find a large pool of good quality OR nurses to choose from.

How did we get here? Formalized educational forums for non-OR nurses to receive OR training is lacking. New nurses coming out of nursing school often feel they have received enough clinical education to justify a management position. The OR setting is heavy on mature nurses who are likely to retire in the coming years.

If you want to recruit high-quality OR nurses away from existing employment, prepare to pay them more than you pay your current pre-op and PACU nurses. You may need to offer OR nurses a different tier of benefits to entice them to join your ASC. Successful recruitment may even require you provide a substantial hiring bonus and cover relocation costs.

Adding OR nurses can affect many different layers of your business and operations, including physician/owner satisfaction, financials, and morale. Unfortunately, there is a lack of resources to help address this nightmare without breaking the bank.

Solution

Rather than look outside of our ASCs for OR nurses, we are looking within. We are implementing training programs that afford non-OR nurses the opportunity to become OR nurses. The Association of Registered Nurses (AORN) develops and sells the program’s infrastructure. It is comprised of a syllabus and criteria for staff to meet.

If a staff member expresses an interest in becoming an OR nurse, ASC management assesses the individual’s qualifications. When the nurse is in good standing and possesses the appropriate skill level, we purchase the AORN program on their behalf.

Once in the program, nurses in training work and are paid for their regular shifts. However, they do not perform their normal pre-op or post-op functions. Instead, they shadow a current OR nurse who serves as their mentor and helps provide on-the-job training. The trainees must complete homework and take tests on their own time. When they successfully complete the program, they transition into the OR.

We make a substantial investment in these nurses. Not only do we cover the cost of the program, we also pay another nurse to cover their responsibilities during their training. To enter the program, nurses sign an agreement with the ASC. They must remain with the ASC for an agreed-upon length of time that allows the facility to recoup its investment. If the nurses fail to complete the program, a payback mechanism in place.

Our use of the program is in its infancy, but the results are encouraging. Knowing we have a mechanism to help us groom our own OR nurses provides great comfort.

Putting Your ASC Management Nightmares to Bed

As long as you are in an ASC management position, don’t expect many anxiety-free evenings. That’s not unusual when you directly impact the success of a business and safety of people.

But try not to feel like you need to come up with all the answers to the challenges your ASC faces on your own. Brainstorm with people inside and outside of your organization. If you’re experiencing a challenging situation, chances are that others in ASC management are as well. When you connect with likeminded people working in the same industry, you can problem solve together.

And try not to be afraid to talk about the issues that are keeping you up at night for fear that it makes you appear vulnerable. I believe it does just the opposite: When you identify an issue and attack it head-on, you appear stronger. After all, no one has all the answers. Simply acknowledging there is a problem oftentimes makes it easier to develop a solution.

Lisa Austin, VP, Facility Development