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How Far Gone is Too Far Gone? An ASC Turnaround Story

Written by Ellie Rizzo | May 28, 2014

When does a center hit the point of no return for a turnaround? How far gone is too far gone? For the founding partners at the Surgery Center of Northeast Texas in Texarkana, that moment nearly came when they were literally locked out of their center's building.

Because of low case volume, the physicians were unable to pay their rent, which had led to the lockout. Being unable to do any further cases — a consequence of the lockout — would have eventually led to the expiration of their state license, so they reached out to Ambulatory Surgical Centers of America for help. In response, ASCOA sent an operations team to determine the next steps necessary to reopen the center as quickly and as safely as possible.

After the initial operations assessment, ASCOA placed Marlene Bell, RN, MN, CASC, CNOR, senior vice president of operations at ASCOA, with the Surgery Center of Northeast Texas to spearhead turnaround efforts in June 2012. "It took a while to do this turnaround. It's a small community, and the center had gained a reputation. But we figured it out, and now we're able to distribute on a regular basis."

The barriers to success were numerous. The center serves many Medicare and Medicaid patients, which means a portion of its cases have consistently lower reimbursements. In addition, when Ms. Bell arrived, administrative and staffing problems at the center had led several issues, including:

Ms. Bell recounts instance after instance of inconsistent billing, staff complacency and poor billing policies: "They weren't following up on bills on a regular basis. Their A/R days were in the 50s," she says. Their previous management situation wasn't helping. "They had had several different management companies, a physician told me, which had been collecting fees but not directing daily activities necessary for the success of the center. Those companies were not holding the staff accountable to job descriptions designed to optimize efficiency," she adds.

Working under the philosophy that the right people make the center, Ms. Bell set to work finding the individuals who would allow the center to thrive. Between Ms. Bell and several other ASCOA personnel, they recruited a new administrator, a new suite of business office employees and a trio of recruited physicians. "We did end up letting some of the clinical staff go. We're strict about following the way ASCOA does it, because we know it works. If staff is not willing to follow the policies, they're not a good fit for us," says Ms. Bell. With staff on board, the center was back on its feet.

Robin Walter, RN, the Surgery Center of Northeast Texas's administrator, really helped bring things together, according to Ms. Bell. "She helped the center totally gel — she's highly valued in our company," Ms. Bell adds.

Ms. Walter joined the center as clinical coordinator. Six months in to the job, the turnover of the administrator position occurred. With her two decades of ASC nursing experience and having worked with Ms. Walter for half a year, Ms. Bell felt she would make a great administrator for the center.

"When I arrived the problems were mostly failure to follow policies and protocols, little accountability and infrequent follow-ups. But ASCOA has an excellent framework for anyone who wants to succeed," says Ms. Walter, echoing Ms. Bell's comments about the necessity of the disciplined follow-through in every arena for ASC success.

"The staff here is great — they were just lacking in leadership. Once the staffing changes were made, everyone stepped up and showed they have what it takes to make a successful center," adds Ms. Walter. "The surgeons are extremely happy, patient reviews are wonderful, and it's great to see everything come together."

More Articles on Turnarounds:
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