10 Key Concepts for ASC Leaders in Healthcare Delivery

Ambulatory surgery centers are poised to become leaders in healthcare delivery innovation because their existence depends on optimizing efficiency and while delivering high quality healthcare. In some cases, hospitals may want to partner with surgery centers to test new processes and ideas because the environment is so flexible.

Michael Abrams on ASC leadership"The ASC is an optimal environment for testing new processes and procedures because they do a limited set of procedures with a patient base that is less complicated than in a hospital environment," says Michael Abrams, co-founder and managing partner of Numerof & Associates. "An ASC is a good laboratory because they should typically have a high volume of a few key procedures which allows them to get a good baseline and genuine consistency in the procedure itself."

Here are eight ways ambulatory surgery centers can promote development and innovation to stay at the forefront of healthcare delivery.

1. Encourage innovative thinking.
Ambulatory surgery centers should have a structured approach to encouraging innovative thinking among physicians, staff and board members. While you can't force good ideas, you can create an environment that fosters new development.

"You can't make innovation happen; all you can do is help it happen or get out of the way," says Mr. Abrams. "There are things that administration can do to encourage innovative thinking, such as creating a structured process improvement activity."

Adding structure to the brainstorming process brings focused direction to the discussion. "Encouraging innovative thinking should be a structured but standing part of doing business," says Mr. Abrams. "It should be ongoing."

2. Conduct an operations assessment.
Conduct periodic assessments of operations to identify the clinical and non-clinical processes that need focused attention. This could mean benchmarking your numbers against internal and external sources or working with an outside consultant.

"There should be a regular assessment to identify processes that need attention, such as where you are spending too much time or if there are processes that could be done with fewer resources," says Mr. Abrams. "The next part of it is creating a disciplined approach to process improvement. Lots of places have process improvement initiatives that go on forever and don't deliver because they aren't disciplined."

People who are part of the process improvement effort must be accountable to the group for delivering specific results.

3. Reward the most successful innovators.
Make it possible for real innovators who make a significant change to your surgery center to share in the financial gains from their innovations. For example, this could mean a surgeon who helped cut the operating room time by 30 minutes for a particular procedure through innovative use of staff or technology.

"I think the ASC needs to find a way to financially compensate that individual," says Mr. Abrams. "Obviously you don't adopt an innovation unless it has been tested, researched and data has been gathered. But if someone takes the lead and drives the process to show it will save money, you need to reward them in some fashion."

Create guidelines to determine whether an innovation is worthy of rewarding, and what level of reward will be necessary.

"You need a structured approach to identifying which innovations really qualify for financial reward, what the rewards will be, and the process for publicly reinforcing those contributions," says Mr. Abrams. "You need to build the idea for reward into the culture for innovative contributions."

4. Monitor whether changes are actually made.
Once a new process is tested and agreed upon, make sure you are monitoring its use. If it's a change in the OR, all surgeons should be doing it every time.

"You need a structured approach to training everyone else around the innovation. One of the things that goes along with that is you need some sort of minimally intrusive system for monitoring practice patterns and costs by surgeon across key procedures so that you can see if everyone is consistently going through the agreed upon steps," says Mr. Abrams.

With a monitoring system, you can identify any outliers and bring them into the correct process.

5. Communicate significant changes with surgeons through data.
If certain surgeons fail to follow new processes and procedures, explain the benefits of the new process using data points. Have a conversation with these surgeons comparing them to their partners and show how they are costing the surgery center money.

"Physicians in general are scientists by training and part of the conversation needs to be some data, such as a graph of OR time, that shows where they compare to everyone else," says Mr. Abrams. "Show them their average compared to others. It appeals to the competitive instinct that most surgeons bring with them. Nobody likes to feel they are a laggard."

If surgeons continue to lag behind the pack despite your efforts, pull them aside again and ask what they need to make the change because they are costing the surgery center money by doing things the old way.

6. Keep an open conversation with other providers in the region.
Surgery centers can learn from their colleagues with open conversations about process management. In some cases, these networks can also include hospitals, especially if the surgery center is a joint venture with a local hospital.

"Even if the hospital has a minority stake in the center, there should be a relationship where they can have a conversation," says Mr. Abrams. "If the hospital is challenging the surgeon group to bring down costs, they become more efficient and deliver better outcomes, and it's in everyone's interest to do that."

This collaboration would be an opportunity for hospital partners or leaders to contribute to the overall success of the surgery center. "Hospitals have their own expertise and can be a participant in the process of evaluating what is going on and brainstorming new approaches," says Mr. Abrams. "That's a growth opportunity for everyone."

7. Bring in new technology for clinical and cost effectiveness.
There have been several technological developments over the past few years allowing surgeons to perform minimally invasive procedures in an outpatient setting.

"I'm astounded by the strides ASCs have made in being able to perform knee replacement surgeries virtually on a 23-hour basis," says Mr. Abrams. "There are significant opportunities for continued advancement in minimally invasive procedures."

Spine surgery is another big procedure that was once condemned to the inpatient setting, and is now an outpatient procedure with new minimally invasive technology, and many ASCs are taking advantage of these developments.

8. Collect and present outcomes data.
Surgery centers should find an effective method for collecting cost and quality data for use during payor negotiations, accreditation and marketing efforts. Build a database of quality outcomes, which will be helpful in the future.

"In many high revenue areas like orthopedics, reimbursement will be shrinking, or the rate of increase will slow, and there will be more barriers to people getting reimbursed for these kinds of procedures," says Mr. Abrams. "ASCs need to be thinking now about collecting data that they can use to make the case that their outcomes and process is superior. They also need to lower their cost because they almost certainly will be getting paid less in the future than they are now."

A big incentive for surgeons to work toward greater efficiency and superior outcomes is to defend the pricing they want.

9. Market yourself based on the data.
You can gather creative ideas about how to market your cost and outcomes data. Collect data on how quickly patients return to work after an operation, postoperative pain levels and other clinical metrics for your marketing material.

"It would be nice to say that your approach delivers better outcomes than other peoples' approaches and then be able to back that up with data," says Mr. Abrams. "It would be nice to say you'll have patients back on their feet pain free within 10 days, which is the average recovery time for a certain procedure. Then have the data to back that up because I think that's where things are headed."

This information can be used for direct-to-patient marketing, insurance company marketing or physician referral sources.

"I can see a point in the near future at which ASCs put that kind of advertising out there for patients because patients would have the choice of where to go through their health insurance exchange," says Mr. Abrams. "This data could be the reason patients choose your ASC over another."

10. Build consistency into every process. C
onsider how to schedule surgeries consistently to optimize operating room and employee time. As you foster your ASC's culture of innovation, building the right team will be critical.

"Healthcare in the future is going to require some level of consistency and process, whether it's how you book an appointment or how you put in a knee implant," says Mr. Abrams. "Have consistency in how it's done because consistency is the most efficient and effective way to get things done."

As an example, one of the orthopedic groups Mr. Abrams worked with had incredible consistency in this department. He asked the department leaders how they were able to get everyone to buy into their program to perform at a higher level.

"They said that they had worked with people extensively to ensure that they understood the value of a consistency and their expectation that the team would adopt a common clinical approach. In the end, those that simply wouldn't go along were asked to leave and were replaced," says Mr. Abrams. "That does have to be a consideration in hiring and retention. We want people who are going to be innovators, but not somebody who insists on being an exception."

More Articles on Surgery Centers:

4 Commonly Overlooked ASC Benchmarks & How to Benchmark Correctly

5 Core Concepts to Drive Revenue at Ophthalmology ASCs

8 Points of Survival for Surgery Centers After ACOs

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