Adding case volume is critical to improving or maintaining profitability at any ASC. As reimbursement drops and markets gobble up physicians for hospital employment, here are five ideas to improve case volume, from Chris Bockelman, administrator of Foundation Surgery Center of Oklahoma. Through these methods, Mr. Bockelman was able to achieve a 40-case-per-month increase in 2012.
1. Identify cases that should stay within the ASC. Some physicians may be taking cases outside the ASC without good reason, Mr. Bockelman says. Perhaps a physician takes higher-acuity cases to the hospital, then schedules other cases there because he doesn't like the commute. Perhaps he simply doesn't understand which cases are appropriate for the ASC and which are not.
He says there may be some confusion about whether heavier patients can be treated at the ASC. Generally, a surgery center can accept any patients of ASA classes I and II, and you may be able to accept class III if your surgery center is located near a hospital for transfers.
2. Talk to physicians about rearranging their block times. Physicians may be holding onto block time they aren't using at your center, creating volume problems by hoarding spots that could be filled with cases. If you find that certain physicians aren't using their block time, speak to them diplomatically about rearranging their hours to make room for other physicians.
"By discussing the opportunities to rearrange block times, I was able to double the days that certain volume-producers were using the ASC," he says. He says he still maintained a good relationship with the other physicians because he approached the subject with respect.
3. Add new physicians. Recruit, recruit, recruit: That's the motto of ASC administrators in 2012 and 2013. As reimbursement drops for certain surgery center specialties, recruitment is a high priority to ensure profitability. Mr. Bockelman says it's important at this time to have a "fluid governing board that is interested in helping the center position itself in the face of the federal healthcare bill." The governing board needs to be pro-recruitment and realize that commercial payor contracts are often 45-55 percent lower than rates at the local hospital outpatient department.
He says the biggest boon to recruitment is the reputation of his center in the local community. "We can utilize some of the newer partners we brought in during 2011, and follow that chain to other physicians in the market," he says. This is especially important if you're in a small community, where available physicians may be scarce.
4. Talk to physicians who are building their own surgery centers. Mr. Bockelman says his surgery center has experienced a threat to volume from surgery center physicians purchasing their own ambulatory surgery centers — one-physician ASCs that can be supported by their case volume alone. He says the answer in this situation is to work with the physicians, not against them. Just because a physician wants to open his own smaller center, that doesn't mean he can't continue to bring cases to yours.
"We've worked with them closely, because they've been good partners to us since we started out," he says. "We helped them get those centers up and running, and by doing so, created a very positive relationship where they still bring cases." He says while the majority of their cases will go to the physician-owned centers, it's better to maintain that positive relationship than to cut ties.
5. Understand the threat from local hospitals. Hospitals are recruiting physicians for employment in greater numbers than ever before, surgery center administrators say. Few markets across the country are immune; younger physicians are seeking the stability of a steady paycheck, and the entrepreneurial spirit seems to be waning as reimbursements ratchet down. "Before, it was my ASC up against ASCs recruiting my physicians," Mr. Bockelman says. "Now, you have the third leg of the stool, which is that they're also being courted by the hospital."
He says it's important to talk to physicians over time about hospital employment. Play the long game; don't wait until they're ready to move and then bring it up suddenly. Make sure that you're talking over time about the benefits of ASC ownership and the efficiencies of your ASC. You should also ask whether the surgery center can do anything to make the facility more attractive to physicians, and pay close attention to satisfaction surveys to spot problems.
1. Identify cases that should stay within the ASC. Some physicians may be taking cases outside the ASC without good reason, Mr. Bockelman says. Perhaps a physician takes higher-acuity cases to the hospital, then schedules other cases there because he doesn't like the commute. Perhaps he simply doesn't understand which cases are appropriate for the ASC and which are not.
He says there may be some confusion about whether heavier patients can be treated at the ASC. Generally, a surgery center can accept any patients of ASA classes I and II, and you may be able to accept class III if your surgery center is located near a hospital for transfers.
2. Talk to physicians about rearranging their block times. Physicians may be holding onto block time they aren't using at your center, creating volume problems by hoarding spots that could be filled with cases. If you find that certain physicians aren't using their block time, speak to them diplomatically about rearranging their hours to make room for other physicians.
"By discussing the opportunities to rearrange block times, I was able to double the days that certain volume-producers were using the ASC," he says. He says he still maintained a good relationship with the other physicians because he approached the subject with respect.
3. Add new physicians. Recruit, recruit, recruit: That's the motto of ASC administrators in 2012 and 2013. As reimbursement drops for certain surgery center specialties, recruitment is a high priority to ensure profitability. Mr. Bockelman says it's important at this time to have a "fluid governing board that is interested in helping the center position itself in the face of the federal healthcare bill." The governing board needs to be pro-recruitment and realize that commercial payor contracts are often 45-55 percent lower than rates at the local hospital outpatient department.
He says the biggest boon to recruitment is the reputation of his center in the local community. "We can utilize some of the newer partners we brought in during 2011, and follow that chain to other physicians in the market," he says. This is especially important if you're in a small community, where available physicians may be scarce.
4. Talk to physicians who are building their own surgery centers. Mr. Bockelman says his surgery center has experienced a threat to volume from surgery center physicians purchasing their own ambulatory surgery centers — one-physician ASCs that can be supported by their case volume alone. He says the answer in this situation is to work with the physicians, not against them. Just because a physician wants to open his own smaller center, that doesn't mean he can't continue to bring cases to yours.
"We've worked with them closely, because they've been good partners to us since we started out," he says. "We helped them get those centers up and running, and by doing so, created a very positive relationship where they still bring cases." He says while the majority of their cases will go to the physician-owned centers, it's better to maintain that positive relationship than to cut ties.
5. Understand the threat from local hospitals. Hospitals are recruiting physicians for employment in greater numbers than ever before, surgery center administrators say. Few markets across the country are immune; younger physicians are seeking the stability of a steady paycheck, and the entrepreneurial spirit seems to be waning as reimbursements ratchet down. "Before, it was my ASC up against ASCs recruiting my physicians," Mr. Bockelman says. "Now, you have the third leg of the stool, which is that they're also being courted by the hospital."
He says it's important to talk to physicians over time about hospital employment. Play the long game; don't wait until they're ready to move and then bring it up suddenly. Make sure that you're talking over time about the benefits of ASC ownership and the efficiencies of your ASC. You should also ask whether the surgery center can do anything to make the facility more attractive to physicians, and pay close attention to satisfaction surveys to spot problems.