5 important investments for ASCs today from SCA CFO, CAO Caitlin Zulla

Caitlin Zulla, chief financial and administrative officer for Surgical Care Affiliates, delivered a keynote presentation at the Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs on Oct. 20, outlining five key investments for ASCs.

The five key areas Ms. Zulla covered in her presentation included:

1. Cybersecurity. There is a huge financial risk for ASCs that do not secure protected healthcare information. Protected Health Information (PHI) is valuable and without the right protection, ASCs could be a vulnerable target. SCA is investing around $1 million to upgrade all computers to Windows 10 this year due to the security features it provides, as well as educating staff members to avoid phishing attacks.

"Don't go it alone," Ms. Zulla said. "Cybersecurity is complex; there are experts out there and it doesn't necessarily have to be a healthcare expert, it can be in any industry. Whether it's Accenture or a local provider you want to work with, ensure you understand what they will provide and make sure it provides a return on investment for you."

2. Evolving workforce. Unemployment in the healthcare field is low, which can make it challenging to fill open positions. However, ASCs can differentiate themselves by offering competitive base salaries, benefits and retirement plans as well as work/life balance. ASCs can use benchmarking services to see how their benefits compare to others in the region. SCA has gone a step further by surveying employees on engagement and taking action. As a result of the surveys, SCA has become involved in more community service, including the One World Surgery initiative, a nonprofit that provides surgical services in Honduras, and invested in diversity and inclusion initiatives.

SCA now has multiple employee resource groups focused on areas such as female leadership and minority professional development. These initiatives have become part of the culture at SCA.

"It's all about sustaining momentum," she said. "The challenging thing here is that once you come up with a benefit you can't do it once and walk away. It’s part of your organization and based on my experience working with our employees, they notice whether or not employers do what they say they'll do. If you don't sustain that momentum it affects your credibility to recruit, so if you are going to say it, do it."

3. Opioid abuse. Across the country, families and communities are dealing with the effects of opioid addiction and abuse. In 2017, opioid overdoses killed around 49,000 people in the U.S., according to the CDC, and Ms. Zulla challenged all providers in attendance to consider how to make a difference in their communities.

"Understand that this problem is complex," said Ms. Zulla. "The issue can vary by region and by state. The federal landscape is changing dramatically as well, so understand the framework you're working in. Then take the time to walk around your facility and see if there are any opportunities to identify risks. Look at prescribing patterns, look at where the drugs are stored and inventory counts. Keep your eyes wide open. If you see something that can be changed, please change it."

4. Revenue cycle. Revenue cycle is the lifeblood of an organization, and ASCs are collecting an increasing amount of the overall payment from patients. As a result, organizations are tightening their revenue cycle management and investing in technology to improve the quality and efficiency of collections.

"Patients will have a bad experience if we don't handle the revenue cycle well," said Ms. Zulla. "They are going to forget about the amazing care they had at the surgery center and possibly not refer their friends and family. Sometimes, because revenue cycle isn't the most exciting part of healthcare, it's relegated to the bottom of the pile in terms of investment. That always makes me nervous. When you are investing in revenue cycle, you are really investing in the future of your organization, your cash and your success going forward."

5. Value-based contracting. Ms. Zulla sees value-based contracts as the future of healthcare, with physicians excited to participate. It takes significant preparations to develop value-based contracts or participate in risk-based programs. Physicians must also be aligned to reduce the cost of care.

"You have to recognize there isn't a one-size-fits-all approach to value-based care," she said. "It varies by payer, marketplace, specialties you offer, risk tolerance of physicians and quality of your surgery center. You are going to have to think creatively about the programs for your center. Once you are aligned and ready to go, you have to think through who your partner is going to be. Not all risk-based entities are the same; not all payers are equal. You need to think very hard about whether you and your payer are aligned and can make it work. The managed care contract is going to be critical, so make sure you have the right expertise with you to work out those details."

Finally, she suggested investing in technology to manage the complexities of risk-based contracts. ASC owners can use dashboards to make projections on the financial bundles to ensure the program is worthwhile.


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