Six ambulatory surgery center administrators share the changes that have been made in their center due to healthcare reform.
Q: What aspect of healthcare reform has required the biggest change in your center?
Janice Stewart, RN BSN, Nurse Administrator of Surgcenter of Bel Air (Md.).
Many patients are facing issues of obtaining insurance policies with very large deductibles in order to afford the policy. They are then not able to have any elective surgery because they cannot afford the deductible. We have seen many cancellations due to patients deciding they just cannot afford the deductible or the time off of work.
We have been working with patients to make payment plans and alternate collection plans, but then this affects our upfront capital. The volumes have decreased from several years ago and I think this is in part due to the patients' inability to pay. We have been looking at ways to help patients afford to have surgery.
Monica M. Ziegler, MSN, CASC, Administrator, Physicians Surgical Center (Lebanon, Pa.) & Center for Specialized Surgery (Bethlehem, Pa.).
Personally, I am frustrated by the sequestered payments. ASCs are currently being paid 87 percent less than hospitals for the same procedures, and then Medicare deducts another 2 percent, because they can. Medicare replacement plans are attempting to also deduct the same 2 percent; however, some of them have applied the sequestered payment process incorrectly. We've notified them and they are fully aware, but they have not been able to correct their system to date. Thus, they take 2 percent off the top of the normally approved payment amount.
Then they pay 80 percent and charge the patient 20 percent co-insurance. This is an incorrect application. They should take the approved amount due to the ASC, charge the patient 20 percent of that amount and then pay 78 percent of the approved amount instead of 80 percent. This incorrect process has been in place since the inception of the sequestered payments. If we operated this way, we would be shut down.
Jennifer Butterfield, RN, MBA, CNOR, Administrator, Lakes Surgery Center (West Bloomfield, Mich.).
Change is the new norm. I think we should make change management obsolete as an acronym because it's what we are doing everyday. If you can't handle change, leave healthcare ASAP! Something new stemming from healthcare reform comes across my desk every week. It's creating such drag that I find it difficult to leave my office some days to check on how my facility and staff is doing. If I'm not out there (chatting it up with physicians, seeing how the managers are doing, how the staff are feeling, marketing, etc.), then I'm not moving our business forward.
In our government's efforts to reform healthcare, they have taken a top down approach. So the top says do this and everyone below them has to react. What's actually happening is that there is so much change (almost everything from having an EHR to ICD-10 to reimbursement cuts) that organizations cannot handle it. Think about it raining, raining every single day. What happens? The earth cannot soak up that much rain, so it creates rivers, where rivers shouldn't be and lakes where lakes shouldn't be. Mountains become mudslides, houses fall into rivers. It cannot rain change every single day!
There needs to be some stability, otherwise you will lose the the foundations of your organization, your people. People cannot handle stressful change every single day without wishing like crazy they were anywhere else but at work. If able, great people will exit healthcare jobs. The college bound will seek to learn fields other than healthcare and we will be in way more trouble than we are at present. So as a facility, we've had to adapt to how we hire, how we manage and how we lead.
Stephanie Martin, BSN, RN, CNOR, CASC, Administrator, St. Augustine (Fla.) Surgery Center.
The amount of time that we spend on reporting has increased. Between collecting data and ensuring it is entered the same day the patient has surgery to avoid delays in the billing process, reporting has increased the time my staff spends on paperwork and clocked in. The number of hours we have spent chasing issues with QualityNet in order to meet the requirements for reporting measures ASC-6 and ASC-7 has been frustrating and a drain on resources.
Lynn Winter, RN, BSN, Administrator, Surgical Center of St. Louis (Bridgeton, Mo).
At this point I don't know if anyone really knows what the end results of healthcare reform will bring. The biggest change for us is the physician's fear of inability to maintain a private practice. This fear is leading them to become hospital employed, which will dictate where they perform their cases (pulling them away from our ASC) and how they will provide care.
Bruce Kupper, CEO of MEDARVA Healthcare, Stony Point Surgery Center (Richmond, Va.).
While we at Stony Point know that we provide high quality care, preparing the data and reporting it in the format that CMS requires continues to demand a considerable effort.
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