Here are 10 ideas for improving profitability with daily activities at the surgery center.
1. Pre-op education. Greg DeConcilis, administrator of Boston Outpatient Surgical Suites, says his surgery center has undertaken a project in the last year to improve patient pre-op education. He says it can be difficult for PACU staff to address patient questions and education about postoperative care after surgery, since they're often stressed and busy.
He says instead, the surgery center started talking about those issues prior to surgery. The patient comes to the surgery center prior to surgery and answers a series of questions regarding their medical history, signs documents and undergoes a DVT risk assessment. The patient also has a phone conversation with a preoperative nurse who goes over what to expect during the surgery. When the patient registers, they are also given an iPad, which they can learn to use about the upcoming surgery and what to expect afterwards.
"It keeps things moving in the post-op area because the staff doesn't have to spend as much time educating the patients," he says. He says patients are also more able to digest information when they're coherent and not recovering from anesthesia.
2. Supply needs. Sandy Berreth, RN, MS, CASC, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., says her ASC asks physicians to fax over a reservation sheet that lists every supply the surgeon needs for the case. Surgery centers can improve efficiency if the right supplies are waiting for the surgeon when he or she arrives. That way, staff members don't have to scramble to stock the OR at the last minute, and the physician is ready to start the case as soon as the patient is ready. "It works really well to keep everybody on the same page," Ms. Berreth says.
3. Physician preference cards. Stuart Katz, director of TMC Orthopaedic Outpatient Surgery, says his surgery center updated physician preference cards in 2012, creating a "generic preference card" that gets pulled for every case. For example, when physicians perform knee arthroscopies, every physician receives the same items, in addition to any "extras" requested by each individual physician. For knee arthroscopies, Mr. Katz says out of approximately 25 supplies needed for the case, 20 are standardized and five are physician-by-physician. One of the differences is always glove size, because physicians have different sized hands and must be supplied accordingly.
Mr. Katz says the initiative has been extremely successful in improving efficiency and cutting costs. "We started with 2,000 preference cards," he says. "We looked at the supplies used for each case, and all the things that were the same across the board automatically made the generic preference card."
He says the physicians signed off on the initiative because they understood it would improve efficiency; staff are able to equip rooms much more quickly, and they don't open supplies that the physician won't use.
4. Supply storage. Chris Bockelman, administrator of Foundation Surgery Center of Oklahoma, says his surgery center completed a quality improvement study in 2012, focused on the facility's materials management process.
"We created a living, working document on the total revamping of central supply and materials management, and we decided to create a lean environment for our inventory," he says. He says the surgery center had a large room for storing medical supplies, but the room wasn't organized efficiently and it was hard to set par levels. "We ultimately transitioned the room into a sterile environment, instead of using the long hallway down the backside of the OR," he says. Now, he says, the staff can view all the supplies when they walk into the room and easily ascertain order points and complete accurate counts.
He says the surgery center has also concentrated on managing the most-used items — the 20 percent of supplies that are used 80 percent of the time. He says the ASC has been vigilant about implant logs as well. "Make sure you capture every one of your implants and compare it to what you bill the insurance company," he says. If you track your implants properly, one that isn't covered by reimbursement will "stick out like a sore thumb," he says.
5. Implant shipping. Shipping costs are significant for surgery centers ordering implants or other supplies on a regular basis, especially when those supplies are shipped overnight. There are several independent companies that can perform audits of the shipping logistics and pricing to help you negotiate a better contracted rate with shipping companies.
"With one ASC in Florida, which had a high volume of orthopedics and pain procedures, we were able to save $60,000 in shipping costs annually after renegotiating their contract," says Charles Dailey, vice president of development at ASD Management. "We forecasted this savings and showed it to the surgeons, which was huge. People take shipping costs for granted because it's important, but it costs so much."
6. Filing EOBs. If your cases come with high costs, it is essential that your schedulers know your expected reimbursement before they schedule a case, says Jennifer Morris, administrator of Stateline Surgery Center in Galena, Kan. If you book a case without understanding how the payor reimburses for the procedure, you may end up losing money unnecessarily. This problem can be avoided in a few ways: by hiring and training meticulous schedulers, by involving physicians in insurance checks and by keeping track of denials to inform future decisions. Ms. Morris' ASC takes a creative approach by filing explanation of benefits forms alphabetically in a notebook.
This means that even if your most knowledgeable office member is out of the office, someone else can pick up the notebook and determine how a case will be reimbursed. "The physician's office will call me, and I'll look up the payor and look up the code and say, 'We've done this before, and this is what happened,'" Ms. Morris says. She says this approach is especially important in an orthopedic-driven ASC, when cases can easily lose profitability if implants are not covered.
7. Timekeeping and payroll. ASCs can easily automate timekeeping and payroll functions to ensure employees are paid appropriately and on time. "With automated systems, ASCs are able to focus on running their business and focusing on their patients, which is really what they want to do," says Chris Schukies, an HR Services Client Representative with MedHQ. "Automating these systems save ASCs time and money, and can convert cumbersome systems into something that is very easy to use."
When an automated timekeeping system tracks the employee's time card and integrates the data with the payroll system, it ensures accuracy and secure data. With direct deposit the ASC saves time and money on mailing pay stubs.
"The automation is making things faster and more streamlined," says Ms. Schukies. "I think the way technology is going, it will get faster, and more information will be stored electronically. It will be easier for people to access this information."
8. Drug orders. Look at how your surgery center orders pain drugs and anesthetics to see where cost-savings could occur. Many centers order manually with paper, but there are new platforms available online to make electronic purchases which are more organized and limit user errors.
"These applications on the computer can also highlight when you are ordering a name-brand drug that has a generic equivalent so you can decide which one you want to order," says Mr. Daily. "People may not know there is a generic drug, so we encourage our administrators to use these applications."
These programs can also calculate the savings surgery centers achieve when ordering generic implants, which adds up to a significant amount by the end of the year.
9. Surgeon paperwork. Vicki Edelman, administrator of Blue Bell (Pa.) Surgery Center, says her surgery center asks surgeons to prepare the necessary paperwork before arriving at the ASC. "You don't want the doctor to come in on the day of service and do an H&P," she says. The chart should be ready to go as soon as the physician walks into the center, and consent forms should be signed beforehand. She says her center has been successful in training physicians to complete paperwork ahead of time by introducing the policy as soon as a physician starts at the center and then staying firm on the expectations.
10. Surgical checklists. Let physicians know a case cannot start until staff members have completed their respective checklists. Talk to physicians as soon as they start bringing cases to the center, and stand firm on your policy. "Right off the bat, our physicians knew that when we start doing things, we're going to do it right the first time and not cut corners," says Sherry Rogers, RN, CNOR, administrator of Tullahoma (Tenn.) Surgery Center, managed by USPI.
If her nurses tell the physician that he or she cannot start draping or cutting until the final checks have been performed, the physician listens. "The physicians are very open to the staff saying, 'You can't do that yet,'" she says.