10 Key Items for Great ASC Administrators to Focus On
At the 20th Annual Ambulatory Surgery Centers Conference in Chicago, three of those administrators discussed these core elements in a panel. Jersey Shore Ambulatory Surgery Center Administrator Marti Potter, Brainerd Lakes Surgery Center Administrator Sandi Berreth and DISC Sports & Spine Center COO Karen Reiter discussed their experiences as leaders at their centers.
1. Provide a great experience for physicians. Take care of new physicians when they first start bringing cases into the center and monitor which cases are brought to make sure preauthorizations are taken and the center will be able to collect. Then make sure surgeons are comfortable at the center.
"I think of my surgeon as my number one customer and if I can run the surgery center so they're finished by noon, that's great," said Ms. Berreth. "My surgeons expect to be taken care of and that's what I do. I focus on the people and make sure they are happy and healthy and taken care of while they're at work."
2. Manage staff effectively. Ms. Reiter is very visible in her facility and whenever an issue arises she's able to nip it in the bud. Her policy is to end gossip or rumors around the center as soon as possible and focus on building a positive culture at the ASC. "I stay with the people in my center all day long so staff members know I care," said Ms. Reiter. "I am very visible in my facilities."
ASC staff and physicians should have what they need to complete their jobs efficiently and effectively. "What I do is take care of the people who take care of the patients," said Ms. Berreth. "Every person who walks through my surgery center door as part of my staff or physician group has something different on their minds that day. Sometimes it's a challenge to switch their focus from personal issues; other times they are worried about finishing early to see their daughter's dance recital."
3. Utilize resources to their full potential. Ms. Berreth bounces rooms at her surgery center and trusts the OR manager to keep everything running smoothly and efficiency. "We utilize our anesthesia staff with CRNAs supervised by anesthesiologists to their full potential," she said. "I also have administrative staff members, such as my CFO, that I give full range to do what she's supposed to do. We have all the checks and balances in place to make sure our systems are profitable."
When the center runs efficiently and profitability extends to the physician owners, everyone is happy. "I think my staff does a wonderful job," said Ms. Potter. "My owners are very pleased with the profits and distributions."
4. Be visible and pitch in where necessary. Ms. Potter practices MBWA — management by walking around. "I'm very confident that most of the days my staff says 'thank goodness — here she comes'," said Ms. Potter. "I wear scrubs and pitch in where I need to pitch in. I think you have to take care of your people first. If your staff is happy, the surgeons are going to be happy 99 percent of the time, and when those contingencies are happy the business takes care of itself."
Delegating responsibilities is important, but there is never a job too small for the administrator.
"I think administrators should manage their job as if they were on a one-day contract," said Ms. Reiter. "Great administrators wear many hats. The administrators should be involved in every single aspect of the center; there is no one part you should not be touching. Know what is going on in your facility at all times; dollars can be made or lost during decisions in every part of the day."
5. Keep an eye on the revenue cycle. The surgery center depends on collecting payments on-time and in-full. "You have to pay attention to what is going on in the business," said Ms. Potter. "You have to make sure the claims are coded right. If you haven't gotten paid in 30 days, you're in trouble. Let the payer know you are watching and you want your money sooner rather than later."
The best type of employee to have in revenue cycle management is someone who is willing to go the extra mile, Ms. Potter said, to ensure things are done right. These staff members must also be able to collect from patients. "I don't ask the collectors to be nice," said Ms. Potter. "I ask them to bring me the money."
6. Internalize cost of care. The best administrators have an understanding of direct costs for care as well as costs at the granule level. They know what costs are per physician and what drives the cost differences, especially as they relate to implants. "We do a lot of case costing and serve cash patients," said Ms. Reiter.
7. Be mindful of case mix. There are some procedures that are more profitable than others based on payer reimbursement and cost per case. Great administrators know which procedures fall into which category and educate their physicians to bring a balanced case mix.
"Sometimes owners think profitability is based on volume, but bringing in cases that aren't profitable for the center doesn't really make you money," said Ms. Reiter. "What we really need to focus on is the dollars made and lost in a single day."
8. Educate patients with high-deductible plans. Performing cases for patients with high deductibles means the surgery center takes on more risk. An increasing number of patients are choosing high deductible plans, and even more are expected to enter into the market with health insurance exchanges.
"You've got to educate your patients so they know what they are signed on for," said Ms. Potter. "They need to have a mechanism to pay for care."
Surgery centers are investing more in staff members to educate patients and manage collections. "As time has gone on, we have really beefed up the people on the front end to educate patients," said Ms. Reiter. "We take the time to discuss their coverage with them and what will be required to pay their bill. People are surprised and upset."
9. Develop payment plans. In marketplaces with high unemployment or poverty where patients are unlikely to have the ability to pay their full deductible upfront, surgery center administrators are considering payment programs.
"We try very hard to be as compassionate as we can due to the income base at our ASC," said Ms. Berreth. "We've set up payment plans, and we'll even accept $20 per month payments. We deal with very proud people and they want to pay their bills."
Administrators can outsource the payment programs to a variety of experienced companies or hire staff internally to handle those accounts.
10. Prepare for the future. There are several changes in healthcare happening today and great ASC administrators always have a finger on the pulse of the industry. "We just started a conversation with our hospital because they understand far better than other places that as an ACO they have to be accountable, but also put the surgery cases where they would be most appropriate," said Ms. Berreth. "Sometimes, that's in our center. We can do them more efficiently with high quality and no infections."
In terms of reimbursement, Ms. Reiter saw out-of-network opportunities disappearing and has been working with insurance carriers to develop in-network contracts. "We've done a lot to gain a solid understanding of where our absolute coverage is," she said. "I'm seeing more and more insurance companies covering less and less OON."
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