Here are nine thoughts on benchmarking, healthcare IT and the changing nature of ASCs.
1. Surgery centers continue to have growth, albeit slower growth than over the last five to 10 years. The surgery center market remains somewhat recession resistant as opposed to recession proof. The recession resistance is in large part due to the fact that 30 to 40 percent of the payors for surgery centers are governmental payors who remain solvent.
2. Many surgery centers are seeing a decrease in their revenue growth rates. This includes a reduced growth rate in cases performed. ASCs also face a smaller number of reimbursement moats, less outof- network reimbursement and fewer payors who pay at discounts from usual and customary charges. These decreases combine to place a higher premium on intelligent management of surgery centers.
3. Increasingly, the safest employee in an ASC is the person who can understand how to effectively crunch numbers to give the board useful information and then drive change in behavior based on that information. Cost containment and business planning are critical and are highly reliant on data and cost information.
“Today’s IT systems provide access to detailed and immediate case costs, including all fixed and variable cost components,” says Ron Pelletier, vice president of market strategy for Source Medical Solutions. “Access to this data is crucial to maximizing revenue and profitability, and this means employing proven best practices for ensuring this data is captured at the point of care.”
One of these best practices is determining a process to gather and analyze data that is current rather than data that may be too old to accurately reflect the current trends and issues in a center, says Jeff Blankinship, president and CEO of Surgical Notes.
“The biggest problem today is that [ASCs] crunch these numbers, but the data is three or four months old, and they can never make an effective change at that point,” he says. “It perpetuates itself if you can’t get live data that’s within 24 to 48 hours old. Administrators who do all the crunching of numbers, it takes them anywhere from two days to a week to gather that data, put it in spreadsheets and get them out.”
Even when data can be gathered in a timely fashion, ASCs need to know about their options for how to respond to this data.
“Oftentimes, when they crunch these numbers on operations and other critical areas, a lot of their challenges are that they can identify certain areas in need of improvement but do they then know what options are available for trying to improve or change that behavior or specific area,” Mr. Blankinship says.
4. There is a small percentage of people (5 percent) who can really intuitively understand and fully assess data without great information technology. It is almost impossible to systematically build a center around these people.
“One of the common obstacles a center faces when attempting to produce meaningful analysis that can be used to drive decisions is access to all pertinent information, and this can be traced back to failure to capture relevant data,” says Mr. Pelletier. “To combat this, we must dismantle any barriers that exist in the technology and IT systems employed. Foremost, ease of use is critical to complete user participation.”
If an ASC invests in technology to support the efforts of staff members who can effectively analyze data through the use of the technology, it is critical then that ASCs avoid trying to cut corners that can hinder the benefits that the technology can offer to the center, says Mr. Blankinship.
“If they don’t share the same information and cannot access the same information on a timely manner — if they’re going off a paper chart (that needs to be circulated around the office) or can’t log in into a system because someone else is logged in or they don’t have a user’s license — all those things can slow up completion of the entry and analysis of data for a case’s life cycle,” he says.
5. There is a second set of people maybe (50 percent) who believe they can intuitively understand and assess the data needed without serious information technology tools. This group is the most dangerous in it thinks it can do this assessment but in fact cannot. These are the kinds of people who lead centers into situations where they may see 800 cases a month and still lose money.
6. All leaders need to learn how to use the information technology tools now available.
“On the billing and collections side, that’s where statistics and numbers really come in,” says Mr. Blankinship. “What you do on the front end as far as taking the patient’s information and the insurance information and all of those details … from day one, that effects the billing and collections cycle. Any errors or a lack of information in a data system affects the whole lifecycle as well back-end operations.”
7. There are approximately 15 statistics that a center administrator should know each day and each month (see “17 Statistics an ASC Should Look at Every Month” on p. 1). These are items such as cost per case, supply cost collected per case, hours per case, cost per hour, cases per day, cash collateral per day and cash paid out per day. The only way to effectively access this data in a timely manner is through the use of great information technology — hence, a great portion of this issue focuses on HIT.
8. The ability to obtain the data is just half of the equation. The second half of the equation is being able to implement and make changes in the surgery center based on such data. In essence, if you know that your cost of staff per case is too high, it is only helpful if you are then also willing to make decisions based on those statistics and reduce staff costs per case. Similarly, on supply costs, can you in a logical way sell your decision-makers on standardizing supplies? Can they make the right choices to reduce supply costs and bring costs more into line?
“Through technology, you don’t want to necessarily eliminate fulltime employees,” says Mr. Blankinship. “However, through technology, you can improve your manual processes and achieve more efficiency and accuracy. At that point, you can eliminate your hiring of temporary staff and temporary nurses and actually improve your operations by having more time available through automating those manual processes.
“That’s the whole key about understanding the data and making behavioral changes,” he says. “It’s not to be a threat to the current system; it’s to improve it.”
The future will bring significant improvements as technology is further integrated into the entire lifecycle of a patient’s case, says Mr. Pelletier.
“Once technology has fully moved into the OR and is available bedside, we will then see the next wave of how software can drive overall improvement to patient care, physician satisfaction and revenue enhancement,” he says. “For example, no longer will it be adequate to just have costing data available on the backend of a case. Instead, information relative to the case can be delivered real-time, such as reminders to document clinical aspects of a case that, left undocumented would not be billable. In addition, users must know at the point of care variables such as supply costs, and whether a supply is eligible for billing. Predictive and proactive data will be paramount to reimbursement.”
9. In essence, the person that can decide on the right data and find the data and then help use it to drive behavior and changes can be the most valuable player in a center.
Should you have any questions, or would like to share your opinion, please contact me at (312) 750-6016 or at sbecker@mcguirewoods.com.
Very truly yours,
Scott Becker