Three administrators share the greatest obstacles facing their ASCs and the ASC industry in 2014.
This year has been a particularly tumultuous one for ambulatory surgery centers. In the first four months of 2014 alone there have been some landmark developments, including new movement regarding out-of-network reimbursement, last-minute preparation for then postponement of ICD-10, a rollout of new quality collections measures and the Office of the Inspector General's official recognition that ASCs are a multi-billion dollar cost-saver for healthcare at large.
Question: What is the most challenging problem your ASC faces this year?
Victoria Caillet, RN, CASC, CNOR, Administrator, Wooster (Ohio) Ambulatory Surgery Center: Being a multispecialty center, so far this year our biggest challenge has been with staffing and meeting our staff’s needs in terms of hours versus the number of cases we are getting on our schedule. We have been forced to turn down more cases due to higher deductibles, lower reimbursement rates and costs of the implants, as we are not always being reimbursed for them.
We are still ahead on the numbers of cases we have done over last year's numbers; however, the increase is has been with the lower reimbursement cases versus the more complex cases, so cash flow is actually down, thus making us really have to watch our man hours.
Joleen Harrison, RN, BSN, CASC. Administrative Director, Mankato (Minn.) Surgery Center: Responding to contract changes with the payers, watching for the Patient Protection and Affordable Act to take place as well as Medicare compliance changes for the ASC, while trying to keep the ASC physicians and staff in the know, are our biggest challenges this year.
I have had to keep a closer eye on the case cost for each specialty and any new services we want to add, which we have had to do in the past but now seems to be a regular weekly duty. Payers have found a new payment methodology — they have decided the ASC industry should save money for the insurance companies. The cost becomes an issue because our organization is smaller and the vendors negotiate on volume, which leaves little room for a center like ours, with orthopedics, to find ways of cost saving.
So it has become almost a daily review of finances and regular memo postings to or direct contact with the medical staff to keep them updated with compliance regulations from many institutes. We will continue to forge ahead with what we are doing now, change the parameters of our daily facility financial benchmarks, and go from there.
Gary Richberg, Administrator, Pacific Rim Outpatient Surgery Center (Bellingham, Wash.): When I speak with administrators across the country, they express an overall lack of applicable knowledge on the part of outpatient surgical providers regarding operational concerns in our industry. The number of surgeon owners who take advantage of resources regarding ASC business and management is much lower than expected, with all that is occurring in healthcare today.
Many surgeons fail to realize that ASCs are the lower cost provider of surgical care and have superior clinical outcomes compared to the hospital setting, however some surgeons continue to perform outpatient cases in an arena that contributes to higher healthcare cost for their patients and the healthcare system in general. Now, with the growing employment of surgeons by hospitals, lack of knowledge of the benefits ASCs provide is undoubtedly going to increase in general.
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