12 Focus Areas to Boost Surgery Center Case Volume & Revenue in 2014

Four surgery center leaders weigh in on how they aim to accomplish the goals of increased case volume and revenue at their ASCs.

Surgery center leaders are constantly on the look out for ways to drive their centers' case volume and revenue. As 2014 approaches, the goals remain the same, though the industry challenges continue to evolve. Four surgery center leaders map out their game plans for success in the new year.

Rick Sizemore1. Physician recruitment and engagement. New physicians are one of the most direct routes to increased case volume and revenue. "Everyone wants to recruit new physicians. We are always keeping our eyes open," says Rick Sizemore, RN, administrator of Spartanburg (S.C.) Surgery Center.

Physician recruitment goals can include a search for additional surgeons performing cases in an existing specialty at the ASC or surgeons that can introduce a new specialty. Mr. Sizemore always keeps a look out for physicians that have grown dissatisfied with a hospital or become open to the idea of performing cases in the ASC setting.

Keeping an open line of communication with physicians to check on their needs and promote a positive relationship build engagement and satisfaction. A group of neurosurgeons regularly refers pain management cases to administrative director Teva Eiler's center, UPMC Hamot Surgery Center in Erie, Pa., but there is the untapped prospect of inviting these surgeons to perform spine cases at the center. Satisfied and engaged physicians, whether neurosurgeons or physicians of a different specialty, will be more receptive to a conversation about bringing new cases or even opening up a new service line at an ASC.

2. New partnerships. New alliances can help weather the changing healthcare market and provide new opportunities for growth. At Island Endoscopy Center, Bruce Feldman, MS, CPPM, administrator and director of operations, is exploring a number of options.

Currently, a group of seven GI physicians performs cases at the center. Of those seven, three physicians are owners in the center. The center's leaders are looking to expand the ASC's syndication through taking aboard more owners from the existing group and opening the door to investment for other GI physicians in the community. When physicians become owners they typically show more dedication to the center's success, which leads to the possibility of new cases and increased volume.

Island Endoscopy Center's leaders are also considering a larger partnership. "We are looking at potentially taking on a hospital partner to use their leverage to get better contract rates," says Mr. Feldman.BRUCE FELDMAN PORTRAIT

3. Marketing initiatives. It is no secret that patients are hopping online to shop around for healthcare options. Many centers, such as Island Endoscopy Center, will be there for patients to find. "We have created a website, a Facebook page and social media marketing campaign," says Mr. Feldman.

The center has an IT consultant to help shape the process from website maintenance to search engine optimization. Island Endoscopy Center is also in the process of developing a monthly newsletter to keep the content on its web pages fresh.

Gabby White4. Quality and benchmarking initiatives. Data is a powerful tool, whether for contract negotiation or internal analysis. "Determine quality metrics that should be met for all patients or departments and set targets against benchmark data," says Gabrielle White, RN, executive director of ambulatory services and network development at Hoag Orthopedic Institute in Irvine, Calif. For example, patient satisfaction surveys are a significant source of data that can be used to improve customer experience and satisfaction.

5. Efficient scheduling. Smooth, efficient scheduling and healthy case volume go hand in hand. "If you aren't doing cases, you aren't making money," says Mr. Sizemore. At Spartanburg Surgery Center, leaders take advantage of block scheduling. Surgeons do five or six cases in a row without travelling back and forth from the ASC to a hospital or physician office. The staff supports a rapid turnover time and time between cases verges on nonexistence. "Efficient scheduling means I can do 30 cases and have everyone gone by 5 p.m. instead of completing 15 cases by 7:30 p.m.," he says.

Efficient case scheduling is paramount to achieving high volume, the backbone of revenue, but efficient staff scheduling is equally important. Salary and wages are the highest surgery center expense. Too much overtime can lead to an unnecessary drain on revenue. Judicious schedulers can see the difference minimizing overtime hours can make. "I have seen payroll go down more than $4,000 from one pay period to the next," says Mr. Sizemore.

6. Managed care contract negotiation. Healthcare costs are rising and surgery centers cannot afford to leave managed care contracts untouched. Payer negotiation and renegotiation is a continual and vital process to increase reimbursement, and therefore revenue. "If you have bad contracts, case volume won't compensate," says Ms. Eiler.

Fostering working relationships with payers allows surgery center leaders a greater level of productivity in negotiation. "With cuts in reimbursement you have to watch every penny," says Mr. Sizemore. "Contract negotiation is painstaking. You have to work with them, be diligent and be patient."

"Beyond rates, the center needs to sell itself to the payer," says Ms. White. "Demonstrate the value the center brings to the patient and the payer with the high quality care being delivered and positive outcomes results in fewer costly complications."

7. Bundled payments. "Bundled payment offers price transparency and predictability, something missing in healthcare today," says Ms. White. As smaller organizations, ASCs have the ability to adopt bundled payments at a quicker rate than hospitals and health systems, gaining a competitive edge. The ability to offer true transparency will appeal to payers, self-insured employers and patients.

Successfully building this type of model involves trust between the center and all providers, careful coordination and implementation of a clear claims processing and payment system. "If centers can reduce costs in the delivery of care, they will gain improved margins through the bundled reimbursement," she says. This gain can even be used to attract additional providers and cases.

8. Case revenue optimization. When analyzing case load and its price, constantly check if the center is being paid appropriately and whether or not implants are receiving coverage. Insurance verification and upfront payment become even more necessary as the industry norm shifts towards high deductibles and copayments.

"The chances of receiving payment after the procedure decline dramatically," says Ms. Eiler. If payment in full cannot be given up front, a likely circumstance as deductibles inch towards figures like $10,000, surgery center leaders can set up feasible payment plans for patients or consider third party financing options.

After procedures are performed, ASC leaders such as Ms. Eiler ensure that denials are tracked. "We need to see where we aren't getting paid, find the pattern and cut off the problem at its source," she says.

9. Supply management and standardization. The cost of medical supplies, equipment and drugs is escalating. Cost containment is key to allowing surgery center revenue growth. A careful ordering protocol will ensure that supplies are not sitting on the shelves unused for too long, risking expiration. Group purchasing organizations can help surgery centers obtain favorable pricing.

Surgery center leaders can also negotiate vendor contracts. Look for areas of leverage. For example, Island Endoscopy Center has a high case volume, more than 10,000 cases each year. "This gives us clout with certain companies," says Mr. Feldman. At Spartanburg Surgery Center, Mr. Sizemore and his staff look at vendor contracts each week, examining prices and even trying out different brands to find the best deal.

As surgery center leaders wade through a sea of different products and associated contracts, it becomes apparent that a narrowed focus could lend a hand in supply control. Though complete standardization of supplies may not be possible, talk to physicians about their case costs and offer alternatives to the items that are driving the cost up.

10. Maximization of staff time and involvement. Turnover time, physician level of comfort and quality of patient care are direct staff responsibilities. Everyone has to contribute. "Cross train your staff so they don't fall into one particular role," says Mr. Feldman. If each person can fill multiple roles, the chances of downtime or an unaccomplished goal are diminished.

Since an ASC's staff is such a powerful asset, leaders should make an effort to involve each member in the center's operations. "If the teams understand these simple wants and needs of the customers, it helps give them direction and sets the expectations of the center as a whole," says Ms. White.

11. New technology. Technology is rapidly evolving and healthcare is racing to keep up. "This is one of the last industries that has not embraced technology, to our detriment," says Ms. Eiler. "We need to do a better job."

From electronic medical records to online patient satisfaction surveys, technology represents an opportunity ripe for the picking. "Adding a new technology to increase volume is a good option however, it requires diligence in researching costs, reimbursement and interest and support from the physicians before taking the leap," says Ms. White.

UPMC Hamot Surgery Center has adopted an online payment portal. Ms. Eiler and her team screened a number of vendors, selected the system that fit their center and within two weeks the system was operational. As surgery centers take on new technology and learn to integrate it into daily activity, the window of opportunity will widen. "Imagine the opportunity for efficiency and all of the data that we will have access to," says Ms. Eiler.

12. PPACA. The Patient Protection and Affordable Care Act, though a source of contention, does represent a chance for increased patient volume and revenue at ASCs. As more people obtain health insurance, the patient pool is going to grow. The state exchanges mandated by the PPACA will also impact ASCs, the effect of which is yet to be fully realized.

"We haven't been approached yet by most of the plans participating in the New York state exchange, but it will be interesting to see how many eventually will approach us to be a participating facility," says Mr. Feldman. "We are waiting on the sidelines to see how it all pans out."

More Articles on ASC Issues:
5 Coding & Billing Changes to Anticipate in 2014
Developing a Convalescence Center: One Ambulatory Surgery Center's Journey
10 Key Legal Issues for Ambulatory Surgery Centers Today

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