Using a Part-Time Administrator to Oversee an ASC: 5 Thoughts From MedHQ's Tom Jacobs

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In a large, multi-specialty surgery center, the role of administrator is critical to successful operations. Complex procedures in multiple specialties require a leader who can multi-task in clinical, business office and financial arenas, all while maintaining positive physician relationships and keeping staff happy. In a smaller ASC, though, this type of leader may not be necessary. Tom Jacobs, president and CEO of MedHQ, and administrator of a GI HOPD, discusses his experience as a contracted administrator.

Before Mr. Jacobs' surgery center was converted to a hospital outpatient department, it functioned as a two-procedure room GI center, performing about 4,000 cases a year. The original administrator had been with the surgery center for about three years when he received another job offer, prompting the center to look for a replacement. Because the center had assembled a strong team of staff members — including a nurse manager with over 15 years of experience — and achieved operational success under the old administrator, it was a relatively simple process to bring in a contracted administrator.

"It was a different situation than what you usually hear about," Mr. Jacobs says. "Usually the administrator is full-time. This was different because we had a very strong clinical manager with a business office staff that did a great job of running the center's processes." Instead of someone to handle day-to-day operations, he said the surgery center needed an administrator to look at the big picture: contract negotiations, hiring, board meeting supervision and strategic direction.

Here, he discusses five points on appointing a contracted administrator to assist in running your ASC.

1. Clinical and business leaders must be top-notch.
The day-to-day management for Mr. Jacobs' center was mainly left up to the nurse manager, who oversaw the clinical staff, and the office manager, who ran the business office. A GI tech was additionally responsible for material concerns, such as purchasing and inventory. "The previous administrator had gotten things into a normal routine, so the center was very efficiently run," he says. "The office manager made sure the schedule was kept up, and the clinical manager oversaw all clinical issues."

He says instead of day-to-day operations, the surgery center needed "coaching and guidance" in other areas. For example, as the contracted administrator, he was responsible for presenting the monthly financials, running the board meeting, and dealing with any out-of-the-ordinary employee problems. He also took care of contract negotiations and dealt with the billing company if problems arose. When industry changes impacted the center — such as the new Medicare Conditions of Participation — Mr. Jacobs lead the center in implementing the new requirements, though the staff members handled the inspection. "They just needed some leadership to get them through those changes," he says.

2. Administrator salary can be reduced considerably.
According to VMG Health's Multi-Specialty Intellimarker 2011, the average administrator salary for all multi-specialty surgery centers is $109,184. But a contracted administrator, who visits the surgery center on a regular basis but does not work full-time, can cost around half that, Mr. Jacobs says. "It was a great way for the facility to benefit from the administrator role without paying for the role full-time," he says.

3. Weekly office hours are helpful. As well as being available by phone and email every day, Mr. Jacobs says he spent one day a week holding office hours at the surgery center.

"I committed to being there once a week, so Wednesday I would work a normal day at the center," he says. "It worked well as a regular check-in, because most issues could wait until that day, and if anything else came up in the meantime, they could call me or go to the clinical or business office manager."

He says because day-to-day operations were mostly handled by the clinical and office managers, the administrator only needed to step in regularly to check on any serious issues or hold staff and board meetings.

4. A strong medical director makes a difference. In addition to the leadership of his clinical and office managers, Mr. Jacobs benefitted from a strong medical director in the facility. "The medical director was very hands-on and had a strong leadership role in the center," he says. "If you have a doctor who is very involved in the center and has great pride in ownership, that's a good situation for a contracted administrator."

He says this made it easier to facilitate good physician relationships even without the presence of a full-time administrator. If issues arose among the physicians, the medical director could handle them unless they needed to be escalated. He says it also helped that the physician practice was located next door to the surgery center. "The physician practice was in suite A of the building and the endoscopy center was in Suite B, so they're separated but in very close proximity."

5. Single-specialty ASCs are best-suited for the model. Single-specialty surgery centers, especially those that perform a limited set of procedure types, are probably best-suited for a part-time, contracted administrator. Mr. Jacobs' center performs about 10 different procedures, which he says helps.

"When you get into lots of different procedure codes and different supplies, there's more complexity in the operation," he says. "I think most multi-specialty facilities — or even single-specialty facilities with higher volume — have to deal with a lot more complexity in the higher-acuity cases."

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