10 Good Ideas to Grow Single-Specialty Surgery Center Case Volume

Here are 10 ways for single-specialty surgery centers to increase case volume.

1. Attract the majority of specialists in your area.
In large metropolitan areas, it may be difficult to attract the majority of specialists to your surgery center because some groups will already have competing affiliations; however, in small markets with fewer specialists, you may be able to attract a majority of available surgeons to your surgery center.

"In suburban centers, there is an opportunity to attract the majority of surgeons in a single specialty," says Catherine Sayers, director of operations at Pinnacle III. "That doesn't apply as much in large metropolitan areas where there are more specialists; you will have a harder time attracting them because they are already involved in other ventures."

However, in either situation, attracting more physicians will grow your case volume. The best place to begin physician recruitment efforts is within your current physician base. "Start with your current group and ask them to refer colleagues so you have a good basis for whom to speak to in the market," says Amanda Kane, manager of business development at Blue Chip Surgical Partners. "The most effective way to attract new physicians is through physician referrals."

2. Make sure surgeons are bringing all possible cases to the surgery center.
If surgeons aren't bringing all their ASC-appropriate cases to the surgery center, you are losing patient volume and revenue. The success of a surgery center depends on the physician partners and credentialed physicians performing cases there, so make sure you are accommodating the special needs of each surgeon.

"If you've got a busy surgeon who is bringing only some of his eligible cases to the center  and taking the remainder to the hospital, have a conversation about why that is and what you can do for him," says Ms. Sayers. "Figure out why those cases aren't coming your way — maybe the surgeon doesn't have enough block time – and see what you can do to bring those cases into your center."

Sometimes, physicians may be taking cases to the hospital instead of the surgery center because they aren't aware of advancements in technology making those procedures appropriate in the outpatient setting.

"With careful patient selection many more complex, higher acuity cases are being done safely in the surgery centers today," says Ms. Kane. "Surgeons are bringing ACL cases to the surgery center, as well as unicompartmental knee replacements, which haven't been done in the past. Expanding the breadth of cases really helps drive ASC volume without having to recruit additional surgeons."

However, make sure the surgeon is comfortable performing these more complex cases in the surgery center.

3. Engage in direct-to-patient marketing for patient-referred specialties.
Other specialties, such as endoscopy, depend more on patients scheduling their own visits. "In an endoscopy center, patients don't usually see the gastroenterologist first; they just know they need a colonoscopy and contact a center to schedule the procedure," notes Ms. Sayers. "Promote yourself as an open access endoscopy center and make it easy for patients to schedule with you directly."

Surgery centers focused on driving patient volume from direct-to-patient marketing can also participate in community outreach events to let potential patients know about their services. The physicians can host educational presentations or sponsor health fair functions.

"Our center is sponsoring a walk organized by the Crohns and Colitis Foundation. Our physicians are involved, which raises awareness for us in the community," says Ms. Sayers. "This works especially well in a smaller community where your visibility is high.  In a larger community, you might not get as big of a bang for your buck, but your patients see you out there and may be more likely to head your direction when the need arises."

Ms. Kane has also worked on campaigns to send mailings out to potential patients by zip codes advertising colonoscopies at the center. "We are doing direct-to-consumer marketing for colonoscopies, which allows the patients to call the center and schedule instead of going through PCPs," she says. "The nurses do the pre-screening and give patients the instructions over the phone. We have found that the direct access program makes it easier for patients to schedule their colonoscopies, which then leads to increased patient compliance for colon cancer screening."

4. Maximize efficiency for surgeon referral-driven centers.
For surgery centers driven by specialties where surgeons are usually responsible for bringing in the patients, such as orthopedics or general surgery, it's important to keep the surgeons happy. One of the best ways to make the physicians happy is by increasing efficiency, which will also allow more cases within an allotted timeframe at the ASC.

"You have to actively promote your surgery center to physicians by highlighting the efficiencies they will experience there," says Ms. Sayers. "Have on-time starts, well-trained personnel, educated staff members and good turnaround times, so things run smoothly. You also want to provide great customer service to patients, which will help attract those surgeons."

Fast turnover times are key for the surgeons because the more cases they can fit into their schedules, the more likely they are to use the center. "If the operating rooms are turned over efficiently and quickly, you are allowing for more cases to be done in a given day," says Ms. Kane.

5. Close the gaps in operating block schedules.
When surgeons have block time, make sure they are regularly using all of it. If they often have extra time, consider shortening their block to extend time for another physician or bring in a new surgeon who could use that time for additional cases. "Take a look at your schedule and make sure it optimizes times physicians are in the operating room," says Ms. Kane.  Efficiency within the schedule optimizes time that physicians are in the OR, and leaves unused OR time as an opportunity to bring in new surgeons.

6. Work with surgeon offices to make scheduling easier.
If it isn't easy for the surgeon's office to schedule surgery at the ASC, their office managers likely aren't scheduling all possible cases there. If you are trying to increase case volume, visit the surgeons' offices and find out how you can better serve them to bring in more potential cases.

"If you don't have a good relationship with them or there are too many hoops for them to jump through, they will go to a different surgery center," says Ms. Sayers. "If it's easy, they will be more likely to schedule those patients with you. Invest time in the relationship by periodically visiting the surgeon's office and make sure the relationship is working for all involved."

Keep in mind the specific processes each surgeons' practice likes to use to schedule a surgery; some prefer to fax information over while others send the patient's paperwork and history over the internet.

"Surgeon offices have their own scheduling preferences," points out Ms. Sayers. "Try to be the most efficient and user friendly facility for them by accommodating their preferences."

7. Reach out to referral sources and primary care physicians.
In some specialties, primary care physicians are the surgery center's main patient referral source. Primary care physicians will often tell patients they need a colonoscopy, and if there isn't an ongoing problem they'll refer them to the surgery center instead of a specific gastroenterologist, so make sure you are on friendly terms with those referring physicians as well.

"Building good relationships with primary care physicians is another way to bring in patients," states Ms. Sayers. Introducing the surgery center to local primary care physicians, holding functions that highlight the benefits of an ASC and discussing new technology with primary care physicians are all ways surgery centers can form meaningful relationships with these referral sources.

8. Negotiate implant carve-outs.
Single-specialty surgery centers should understand how to negotiate contracts for all their procedures, especially newer procedures, to make sure costs are covered; if they aren't, bringing those cases into the ASC isn't beneficial for the surgeon or surgery center from an economic standpoint. For example, in orthopedic or spine driven surgery centers, implants are among the biggest expenses per case and if they aren't carved out, a large chunk of the reimbursement will be spent to cover those costs.

"It's important to negotiate contracts that include carve outs for implants," says Ms. Kane. "Failing to do so will result in the loss of high revenue cases where the implants can be very costly."

9. Balance high volume months with low volume months
. Surgery centers can often predict that the end of the year will produce a higher volume of surgical patients because patients have met their deductibles, so they are more willing to undergo elective procedures. Winter months are also more active for the surgery center because fewer surgeons are on vacation.

"The fourth quarter is usually a busier time for surgery centers, and that's out of our control," says Ms. Sayers. "A slow month or two in the summer, driven by surgeons being on vacation, is also something you don't control. If you have a really busy month, try to find the reason and determine if there is a way to replicate that success in other months."

There are several different factors that impact a surgery center's busy months, such as location, specialty and demographics served. If you are a surgery center in Colorado with orthopedics, you'll see patient volume increase more during skiing months than other centers across the country.

10. Expand beyond the single specialty.
Sometimes expanding to related specialties can help single-specialty surgery centers drive additional volume. Orthopedics-focused surgery centers can add spine or pain management while ophthalmology surgery centers can bring in retina specialists.

"The options ASC administrators have to increase patient volume are endless," says Ms. Kane. "They can expand beyond the single-specialty footprint. One way to bring in a new specialty is to look into outsourcing equipment on a daily basis to accommodate those cases. The administrator will have to determine how many cases per day are needed to cover the cost of bringing in the outsourced equipment to determine if it makes sense."

Surgery centers can bring on these additional specialists for a trial period and rent their equipment during that time. Once the new physician is ready to purchase equity in the center, you can also purchase equipment for their specialty.

Additionally, consider adding non-traditional specialties to the surgery center.

"In competitive markets, you can look into specialties that were not previously considered surgery center specialties. For example breast surgery and cardiology groups doing pacemaker generator changes, can be done safely in the outpatient setting with careful patient selection," says Ms. Kane. "If you are in a market that has a ton of surgery centers, specialists are most likely involved elsewhere and there aren't a lot of free agents, so you'll want to look at new opportunities."

More Articles on Surgery Centers:

5 Areas Where Problems Occur Between ASCs and Anesthesia Groups — and How to Fix Them

10 New Surgery Center Plans & Openings

22 Surgery Centers Boasting 10,000-Square-Feet or More

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