13 Essential ASC Benchmarks & How to Stay Ahead of the Curve

Measurable benchmarks are crucial to running a successful surgery center. The most successful surgery centers track clinical, financial and efficiency-focused data. Administrators can track data from one month to the next to identify and project growth. They can also compare the center's data with local and national statistics to see how they compare. When surgery centers are involved with management companies, they can benchmark against other centers managed by the same company. They can also use numbers gathered by the Ambulatory Surgery Center Association and companies such as VMG Health to benchmark their center on a national stage.

"We are looking at our data continuously and comparing those benchmarks of our facility with the rest of Pinnacle III facilities and the ASC Association," says Diane Lampron, administrator at The Surgery Center at Lutheran in Wheat Ridge, Colo., and Peak One Surgery Center in Frisco, Colo., which are affiliated with Pinnacle III. "It gives us a lot of knowledge as to what other people are doing and were we fit in."

Here, three surgery center administrators discuss what benchmarks they rely on daily, monthly and annually to run a profitable ASC.

Daily benchmarks

1. Staffing needs. Kathy Leibl, administrator at Blue Ridge Surgery Center in Raleigh, N.C., which is affiliated with Surgical Care Affiliates, directs her managers to utilize a daily hours log to help the center develop labor targets.

"The hours log helps us judge where we are going to be on our labor so we can develop our staffing needs and patient flow throughout the day," says Ms. Leibl.

Carolyn R. Hollowood, administrator at City Place Surgery Center in St. Louis, which is affiliated with Meridian Surgical Partners, says her surgery center also benchmarks staffing hours per patient. "I make sure the staffing involved coincides with the number of patients we have," she says. On a weekly basis, she examines how many hours each staff member is spending per patient from the time patients arrive at the office through their departure.

2. Spending reports. Ms. Leibl receives spending reports daily from SCA, which she compares to the estimated annual budget for the year. "This is a good tracking tool to allow us to see what our spending is on a daily basis," she says. "We can see if we are over or under budget."

If the center is over budget, Ms. Leibl meets with the purchasing coordinator to see whether there were any issues requiring special supplies for certain cases.

"These reports help us manage the inventory and our costs," says Ms. Leibl. "The purchasing coordinator knows the supplies he needs and he reviews special needs with the OR manager before submitting them to me. I approve everything he orders or requisitions first. Once it's ordered and I've approved it, the order comes back to me before we pay for it."

3. Case volume. Monitoring case volume daily is essential, both to maximize volume for the month and to understand the long term trends.  Ms. Leibl and her team compare each physician's volume to their plan for the month and use the information to have conversations with the doctors and the office staff.

"We try to plan for every physician vacation when we set the budget and it's not always perfect so by studying the data daily and having an open dialogue with the doctors about their volumes we can identify opportunities to capture more cases," says Ms. Leibl.

4. Patient satisfaction. Surgery centers should have a way to measure patient satisfaction, which often means collecting patient satisfaction surveys. At Ms. Leibl's surgery center, patients can drop their surveys in a lock box before leaving the center and she tracks their responses.

"I can monitor the feedback from patients, which alerts me if there is an issue," says Ms. Leibl. "At least once per week we have core leadership team meetings of the management team and we discuss any issues that arise. We are a very close knit group, and meeting regularly helps us communicate. That's important to having a successful facility."

Monthly benchmarks

5. Infections, complications and transfers. Clinical benchmarking is important for proving the quality of procedures performed at your center. Some surgery centers, such as Blue Ridge Surgery Center, have a quality coordinator who reports on infection rates, complications, wrong site surgery and unplanned transfers. The categories can be broken down even further to track antibiotic delivery and shaving instances.

"If we feel like we are seeing a negative trend on one of these issues, we bring the leadership team together to discuss what the problem might be and how to achieve the best resolution," says Ms. Leibl. "We communicate with our team about the data, which is updated each quarter. If our data is improved, we give kudos to our team. We are always trying to improve."

Additional benchmarks Ms. Hollowood tracks at City Place Surgery Center include:
•    When the antibiotic was  administered
•    Unexpected patient care within 24 hours after  surgery
•    Patients who remain in the recovery room longer than two hours
•    Patient burns
•    Patient falls
•    Post-surgical wound infections
•    Surgical site hair removal

"We use these benchmarks to provide safe and efficient patient care," says Ms. Hollowood. "We also conduct handwashing surveillance to make sure everyone is doing what they should in terms of infection control when as they transfer from patient to patient. In addition, we practice mask surveillance to make sure no one is wearing their mask outside of the sterile quarter."

6. Room utilization.
Every month, Ms. Hollowood gathers the data from hours spent delivering care per patient and room utilization to derive the monthly percentage of room use. "I balance what we have available with what we actually used so we can improve for the next month," she says. "Usually it's a pretty easy fix, if you are watching it on a monthly basis. If you let the problem go for six months, it's not as easy to find a solution."

Efficiency is a key element to physician satisfaction, says Ms. Lampron, and quick turnover times are important. "We benchmark how long it takes for us to clean the room and set it up for the next case after the first patient leaves the OR," she says. "We also look at how physicians are using block time in the OR. If they are using the room for surgery 75 percent to 80 percent of the time, that's good. If the physician is only using the room 50 percent of the four hour block schedule, we need to adjust their schedule for a higher utilization rate."

Adjusting the schedule might mean finding a different time or day that works better within the physician's schedule.

7. Physician growth.
It's important for surgery centers to grow from year to year, and one of the ways to measure growth is through physician performance. Ms. Leibl's surgery center looks at physician case volume on a monthly basis and compares their numbers to previous year. There are several factors that could impact case volume, including vacation time, seasonality and the economy.

"The economy has periodically affected patient volume over the past few years," says Ms. Leibl. "Deductibles are becoming higher. For instance, ENT physicians may see a lower case volume because co-payments have grown from $25 to $75."

8. Patient and staff revenues.
Ms. Hollowood receives critical management reports every month detailing revenue factors. "On the revenue side, review at gross patient revenue — were there refunds? — and then I review net patient revenue and then net patient revenue per patient," she says.

The revenue reports also depict efficiency based on staffing. Ms. Hollowood looks at paid time off hours each month, total hours worked by all staff and how many full time employees worked per month. "With this report, I can look at the hours staff spends per patient and the payroll expense," she says. "I look at the payroll per case and then I look at the total payroll as a percentage of net revenue."

9. Accounts receivable.
Each month, Ms. Hollowood is able to see data on the center's accounts receivable and A/R days outstanding. These reports also include the total operating income, operating income per patient and operating margin as a percentage of net revenue.

"I look at all of these numbers every moth to give me a snap shot of activity," she says. If there are still outstanding claims or denied claims the center needs to resubmit, Ms. Hollowood knows the issue and can make sure it's dealt with. She compares her center's revenue cycle management statistics with others in several categories, including:
•    Number of claims denied
•    Number of claims filed
•    Collection goal met
•    Dictation delays greater than 48 hours
•    Medical records reviewed

"We use these accounts receivable benchmarks to figure out whether there are claims we haven't collected on or accounts we must resubmit for paper or electronic claims," says Ms. Lampron. "Identify the accounts to need to re-examine for reimbursement. If you are getting a lot of denials, figure out what you need to do to lower that number."

For example, if your claims are often denied for incomplete patient information, implement a strategy with your front office staff so they get all the information upfront for submitting to payors. Other problems may occur if the claims aren't sent out quickly enough.

"We look at how quickly we are billing insurance payors, and if we aren't quick enough, we try to find out what is impeding that process," says Ms. Lampron. "Physicians might not have the dictated operative report needed for the coder. If there is a lag time between the operation and dictation, we work with the front office staff and medical records personnel to help facilitate the physicians getting their dictions in more quickly."

10. Case scheduling.
Surgery centers can glean helpful information by monitoring the number of cases scheduled per month. Record the number of cases scheduled inappropriately — such as scheduling the wrong procedure or scheduling the procedure on the wrong day — and work toward minimizing mistakes. The statistics Ms. Lampron looks at include:
•    Whether the cases are scheduled accurately
•    Efficiency of case scheduling
•    Whether cases are scheduled 24 hours to 48 hours before an operation
•    Whether the staff has enough time to prepare for the case
•    Procedure start times
•    Amount of time taken for each case
•    Cancellations

"To stay efficient, we need to know whether the cases are running on time or going over," says Ms. Lampron. "If a is surgeon often over time we want to know whether they are taking a break or whether their cases are just running 45 minutes longer on a regular basis."

11. Cancellations.
Cancellations on the day of surgery can have a big impact on your surgery center. By the morning of surgery, staff members are already scheduled and the OR is already reserved, so when cancellations occur those resources are lost. Ms. Lampron looks at information every month on the cancellation rate for patients after are admitted as well as the reasons behind those cancellations.

"The cancellation is usually based on the patient's health status, meaning there was an issue that wasn't known ahead of time, such as a blood pressure increase on the morning of surgery," says Ms. Lampron. "However, there are some things that could have been caught during a pre-surgical phone call — such as the medications patients didn't stop taking before surgery — and we need to catch those to decrease cancellations."

12. Staffing needs and payroll.
Every month Ms. Lampron examines the daily, weekly and monthly statistics about how many full time employees are on payroll and how many hours staff members reported working per case. She also looks at how many cases per work FTE are being done.

"We are continually looking to meet our staffing goals," Ms. Lampron says. "Salaries are one of the highest costs for surgery centers and we want to make sure we are being efficient based on case volume."


13. Physician satisfaction.
Along with compiling all the clinical and financial data from the previous 12 months, it's important to gauge physician satisfaction every year so you can resolve any issues physicians have and accommodate their continued use of the center. Key questions to ask physicians include:
•    Would they recommend the facility to a colleague
•    How well they like working at the facility
•    How well they feel the management company handles issues
•    Whether there are any issues with their staff

"We found that if you ask a few direct questions you get a better response rate," says Ms. Leibl. "We also give them an opportunity to respond if they have a comment about the center. We're fortunate that our physicians are extremely happy; we have recorded 99 percent to 100 percent physician satisfaction over the past three years."

More Articles on Surgery Center Benchmarks:

20 Statistics on Physician Compensation for 5 Key Surgery Center Specialties

20 New Statistics on Surgery Center Staffing Costs

16 New Statistics on Surgery Center EBIDTA

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