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5 Common ASC Management Mistakes With Consequences

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Here are five common ambulatory surgery center management mistakes that impact ASC revenue and culture.

1. Relying on consultants for change. ASCs tend to forget to incorporate policies and procedures into its organization's culture. "The biggest mistake I see made is hiring a consultant and relying on them solely," says Scott Trimas, MD, owner of Atlantic Surgery Center of Jacksonville Beach (Fla.) and an AAAHC surveyor.

While consultants can offer valuable guidance during the accreditation process, organizations need to make sure the policies it has in place become a part of the internal culture of an organization. The on-site survey also includes brief interviews with key staff members to ensure the organization's policies are communicated to all employees.

2. Missing OSHA guidelines. Since staff training includes a number of different elements — infection training, risk management, orientation of job duties and so on. It is important that ASC leaders ensure that the staff is familiar with the appropriate Occupational Safety and Health Administration guidelines. Dr. Trimas says some of the most common OSHA guidelines missed at ASCs include:

•    Annual safer device checks
•    Proper biohazardous labeling
•    Proper biohazardous material storage

Missing OSHA guidelines could have a huge impact on the ASC's accreditation compliance.

3. Allowing pharmacy shortages and backorders. Surgery centers, along with providers across the country, have experienced drug shortages and backorders that could negatively impact their center. If ASCs aren't able to collect the required amount of materials or drugs on-hand because of national shortages, they need to document their backorder on the crash cart log and medication log to remain compliant.

"Contact the local authorities and ask whether they'd prefer you operate with an expired supply of drugs on hand or no extra drugs at all," says Sasso Consulting Founder and Surgery Center Coalition Co-Founder Marcy Sasso, CASC. "If they say to label the expired drug, do that. Others might ask you to substitute the drug with something else. Additionally, with syringes, you must label each syringe with the date and time if not for immediate use; medication drawn up in a syringe is only good for use within 60 minutes."

While it might be easier for anesthesiologists to draw up 10 syringes and have them ready to go, that isn't compliant and shouldn't be done, says Ms. Sasso.

4. Focusing revenue cycle data on A/R days. An efficient revenue cycle is an important part of ASC success, but it's more than just accounts receivable. "The biggest mistake ASC leaders can make is to not take an active role in their revenue cycle or to assume that revenue is optimal because you are able to make distributions," says Rebecca Overton, the director of revenue cycle management at Surgical Management Professionals. "In addition, focusing only on days in A/R without also focusing on cash collections can prove to be a big mistake. While days in A/R is a very important financial key performance indicator, using this alone as the measure for revenue cycle success is not advised."

Whether through internal leadership or outside revenue cycle professionals, successful ASCs have someone who understand payer contracting, billing guidelines, statutes affecting reimbursement, best practices and medical necessity guidelines at the help to ensure consistent cash flow.

5. Skimping on materials managers. Ambulatory surgery centers may not be as large as hospitals, but the amount of materials used still represents a level of complexity that needs to be carefully supervised. This represents a huge opportunity for cost savings – or a large drain on revenue. Someone needs to be placed in a role that oversees the materials the physicians and staff of an ambulatory surgery center are using.

A materials manager will not only monitor what materials are being purchased and used, but will also fight to get an ASC the best pricing. "A materials manager who has extensive experience in negotiating with vendors and contract pricing is critical," says Tracey Harbour, RN, BSN, administrator of Surgery Center of Pinehurst (N.C.).

ASC leadership must place the right person in that position. "Ensure that you hire a materials manager who is qualified to do the job. Check references, perform background checks and have a face-to-face interview," says Ms. Harbour. A qualified materials manager is necessary to prevent possible financial mistakes.

More Articles on Surgery Centers:
12 Statistics on Small ASC Gross Charges

Cost Cutting at ASCs: Best Initiatives From ASC Leaders

ASC Ownership Sales: 4 Things to Consider Beforehand


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