5 Priorities for Surgery Centers in 2012

Debra Stinchcomb, RN, BSN, CASC, consultant, and Regina Boore, RN, BSN, MS, CASC, president of Progressive Surgical Solutions, have a busy year ahead of them. They run a consulting company for surgery centers that provides the "gamut of services," from development to financial management to compliance consulting. According to Ms. Boore and Ms. Stinchcomb, 2012 will bring several changes for their company: First, the opportunity to work with more hospital-affiliated surgery centers, and second, the expansion of their online management tool. They also plan to address the startling lack of staff education in surgery centers with educational tools and webinars.

Ms. Stinchcomb and Ms. Boore have years of experience in surgery center management — as ASC administrators, consultants, association presidents, accreditation body surveyors and registered nurses. Here they discuss several tasks they would prioritize for surgery center leaders in 2012.

1. Achieve stronger surgeon leadership.
Ms. Stinchcomb and Ms. Boore say the most successful surgery centers usually have the strongest surgeon leadership. They say that some physicians — particularly those whose surgery center works with a management company — may not realize the impact their leadership can have on surgery center profitability. "They don't realize how much they can contribute, ultimately to their own benefit," Ms. Boore says.

This year, if your surgery center doesn't have several strong physician leaders, ask your partners to participate in operational and financial decisions. Physicians should be involved in contract negotiations and physician recruitment: The presence of a physician helps convince payors of the clinical quality of your surgery center's work, and physicians can provide a "behind the scenes" look to colleagues considering surgery center ownership. Ms. Boore and Ms. Stinchcomb say this process can and should start with the surgery center medical director — frequently an anesthesiologist. "Having a medical director engaged is extremely helpful," Ms. Stinchcomb says. "They may even be more engaged than the surgeon partners because they often really know what's going on in the community."

2. Groom nursing leaders to take over when older nurses retire. The nursing population is aging, and surgery centers that don't prepare may find themselves scrambling for providers in a few years. "Over the next 10 years, a lot of them are going to be making their exit," Ms. Stinchcomb says. "We need to find the next round of leaders in terms of clinical leadership and expertise." She says surgery centers should start putting certain nurses — the "heirs apparent" to the ASC's clinical leadership positions — through nursing training.

Ms. Boore adds that surgery center nursing leaders should be given training on the financial and operational aspects of the business as well. Clinical leaders can be more effective if they can double as financial and operational experts. "In a lot of surgery centers, the director of nursing is sort of isolated in terms of being aware of everything it takes to run the organization," she says. "They would benefit from exposure to contracting or rates. One thing that would be easy is to start exposing nurse managers to more information and help them have a better, more comprehensive understanding of the business as a whole."

3. Boost quality improvement efforts. Ms. Stinchcomb says many surgery centers lack a robust quality assessment performance improvement, or QAPI, program. She says because surgery centers are staffed so tightly, administrators end up putting off paperwork and other requirements until the last minute. "We often find that QAPI tasks such as benchmarking result analysis and annual reviews (contracts, QAPI, IC, CEMP) are not completed unless a strict agenda is developed," she says. "Time and resources must be dedicated to ensure compliance with a robust QAPI program."

Ms. Boore agrees that administrators need to make note of every regulation and requirement that needs to be met and then make compliance into a routine. "It should be part of their daily, weekly, monthly and quarterly program so that everybody knows what's going on," she says. She says this process may be even more difficult for centers that were in existence before 2009, when surgery center conditions for coverage changed.

4. Start a staff education program. Ms. Boore says staff development and education is one of the most critical areas for focus in 2012, in large part because so many surgery centers lack a staff education program. "In the hospital it goes without saying that they've got nurse educators and ongoing staff education and development all the time," she says. "We've gotten by without devoting a lot of resources to staff training and development."

She says as more and more complex surgeries move into the surgery center environment and compliance requirements expand, staff must have a greater understanding of regulations. Ms. Boore says a mentoring program can also help surgery center staff learn about the business aspects of your ASC.

5. Redouble physician recruitment efforts.
Ms. Boore and Ms. Stinchcomb agree that many surgery centers need to embrace a strategic succession plan for the next 5-10 years. "With many mature centers, a lot of surgeons have done really well with owning their surgery center, but they haven't been planning for a succession plan," Ms. Boore says. "In some cases, they think they're sitting on a little gold mine for when they retire, but there ends up being nothing to sell." She says some centers that were built before 2003 aren't even up to current safety codes and don't meet current standards in terms of compliance issues. "In that case, the physical plant isn't even worth much," she says.

Ms. Stinchcomb says surgery centers should be continually looking for new opportunities to recruit physicians. "Never sit back on your laurels and think, 'Isn't this great,' even if your surgery center is full," she says. Surgery center administrators should be considering new specialties and new surgeons to make sure the center can maintain robust case volume even when partners retire.

Learn more about Progressive Surgical Solutions.

Related Articles on ASC Turnarounds:
20 Statistics on Physician Specialties With the Most ASC Investors
4 Ways to Boost Surgery Center Profitability This Year
8 Points on Physician Engagement in an ASC

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