8 Steps to Increase Orthopedic Case Volume at an ASC

Orthopedic case volume is a high priority for surgery centers, as orthopedic cases can deliver a sizable profit and competition is high among ASCs and hospitals for surgeons. Thomas Holecek, administrator of Palos Surgicenter in Palos Heights, Ill., discusses eight ways ASCs can increase their orthopedic case volume.

1. Determine if orthopedics will work at your facility. Having a strong orthopedics program can be very beneficial for a multi-specialty surgery center because the specialty has not been so adversely affected by reimbursement changes, like other specialties have, Mr. Holecek says. This can cause volume problems for your center because orthopedics is an increasingly competitive specialty for surgery centers; leaders recognize the profit to be made from orthopedic cases, so they want to gain the loyalty of surgeons as soon as they enter the community. "Everybody would like a strong ortho presence," he says. "However, it is a challenge to develop and maintain."

2. Work with potential surgeons to get them comfortable with the center.
If you're planning to recruit a surgeon to your center, especially one who is just out of training, take the time to build the relationship and trust. Get him or her acquainted with your ASC, the staff, and your processes. Investing the time upfront to cultivate a relationship with physicians will be rewarded by their bringing strong volumes to your center.  Most physicians new to your ASC will have concerns about patient safety, efficiency, and the quality of your care. Mr. Holecek recommends meeting several times with each potential physician and discussing the following:

• Which procedures they wish to perform at the surgery center
• The insurance contracts they desire for their patients-discuss the pros and cons.
• Preferences for instrumentation and supplies
• Equipment the surgery center would need to purchase if you are adding new procedures
• Data on the surgery center's quality and safety
• The center's experience with orthopedic cases and the details of staffing and turnaround.

Once the physician has been approved by your center, encourage the surgeon to start bringing cases to the surgery center and then follow-up closely. Develop a good working relationship with the surgeon’s scheduler. Make sure your scheduler is facilitating, and not impeding, the scheduling of cases. Once the surgeon has performed some cases, you can evaluate their preferences. "This is how we have developed a relationship with one newer surgeon who is bringing us increasing volumes as his practice grows,” Mr. Holecek says. "As we work together, we get better and he gets more comfortable with us."

3. Build a relationship with a large orthopedic group in your community.
Mr. Holecek's center benefits from a strong relationship with a large orthopedic group in its community. When a new physician joined the group, Mr. Holecek was able to build a relationship with the new physician based on the existing relationship with that practice. He says building that relationship comes down to consistent communication.

This may seem obvious, but he says many ASC administrators aren’t often able to devote the time to visit the practice and talk to the key staff members, such as their administrator and scheduler. "The trust must be earned. You have to be a resource to them through the good days or the struggles to find out what's working and what isn't working," he says. "If a patient has a complaint or an issue, take the lead to follow-up completely until that patient is satisfied with the care given."

At some point, all ASCs experiences a change — such as a new scheduling system, staffing changes, EMR implementation, renovation or introduction of new procedure. Let the practices know about the changes in advance whenever possible. Also make sure to follow up with the physician's office staff regularly about preference cards and physician satisfaction to make sure you're maintaining loyalty among providers.

4. Consider expanding your specialty list — with the proper research. If you're introducing a new surgeon to your ASC, you may find that he or she wants to perform procedures that you have never done before. This is a great opportunity to increase your case volume, providing the new procedure can be done safely, efficiently and cost-effectively at your center. Patient safety, of course, should be your primary concern. Realistically, some procedures may be better suited for the hospital setting.

Next, you will need to ensure your staff has the requisite training and knowledge to perform quality work. A good example would be spine procedures: After extensive staff training on equipment and patient positioning by Regent Surgical Health nursing advisors, Mr. Holecek's ASC was ready to successfully perform microdiscectomy procedures. If you have staff members with experience in the procedure, they can mentor the others. If you are unable to provide the equipment, expertise, and available time to perform the new procedure, it is likely not a good match for your center or for an ASC setting. Also note that not all procedures are Medicare-approved for the ASC setting.

Profitability will be a critical concern for any new procedure. Mr. Holecek recommends calculating return on investment for the equipment required for the procedure. Look at your expected reimbursement and determine how long it will take you to get a return on your investment. Once you have those numbers, make sure they are presented to the board for approval. Mr. Holecek prefers to get ROI within a 6-12 month period, depending on the volume, reimbursements, and costs involved.

5. Improve efficiency.
If your surgery center is able to perform cases safely and efficiently, physicians will prefer bringing cases to your center. Mr. Holecek feels efficiency depends on many component parts working in harmony. For example, efficiency begins with scheduling. Physician schedulers should have no problems getting a case on the ASC books. You should also communicate well with patients during the pre-op call to make sure that patients arrive at the facility on-time, and that they are following all of their instructions, thus preventing unnecessary case delays.

In pre-op and the operating room, surgery center staff should work as a team to get the patient ready in a timely manner and turn over rooms quickly. Orthopedic cases are especially difficult in terms of room turnover because of the additional equipment, supplies, and instruments. "More time is required to turnover most orthopedic cases," Mr. Holecek says, especially compared to the other specialties at his center. Quick turnaround results in the physician staying close by, and being ready for the next case when you are.

6. Don't let case volume drop off during renovation. Mr. Holecek's ASC recently underwent a significant renovation to improve the facility and attract new physicians and patients. A facility renovation is a great way to boost case volume, since physicians and community members will notice your project and want to experience the newly- remodeled facility. On the other hand, a renovation can span several months and involve significant noise and physical change, creating an obstacle to maintaining robust case volume. Mr. Holecek says his ASC did not experience a decline in case volume during its renovation due to the ability of the staff to keep the ASC safe, clean, and functional.

"Physicians want to know whether the patient has a safe pathway throughout the continuum, if there are efficiency barriers, and if infection control is maintained" he says. "If they see you've maintained a good, clean work environment, they'll feel comfortable bringing their patients to you." He says he benefited from the expertise of the general contractor's adherence to healthcare regulations during construction, along with routine meetings with senior Regent Surgical Health advisors. Mr. Holecek performed required walk-throughs several times a day to make sure the corridors were clear and there were no fire or safety issues during construction.

7. Give tours to new physicians. If you become aware of new physicians in the area who might want to bring procedures to your surgery center, ask your current physicians to reach out to them and introduce themselves. "Your physicians can encourage their colleagues to come over and take a look at your surgery center," Mr. Holecek says. "For us, it helps that we have a newly renovated surgery center. It's very attractive, neat and like new. That's what they want." Market your center's most attractive features, such as its efficiency, its proximity to physician offices or its comfortable physician locker room and lounge areas.

8. Monitor volume trends to watch for issues. Monitor each physician's case volume and watch for unexpected drops, Mr. Holecek says. "If a physician's volume is trailing off, you need to investigate the reasons right away," he says. The physician may be dissatisfied, or he may be performing more cases that aren't appropriate for the surgery center. He also may be taking cases to the hospital without realizing they could be taken to the ASC.

Whatever the reason, follow up as quickly as possibly by determining from the physician's schedulers or the physician why volume is down. Once you understand the issue, work to remedy it and let the physician know you're trying to accommodate their needs.

Related Articles on ASC Operational Issues:
OB/GYN Surgeon Compensation: 13 Recent Findings
When Does Surgery Center Case Volume Peak & Valley: A Statistical Analysis of 9 Common ASC Specialties
Lessons From 35 Years in the ASC Industry: Q&A With Cypress Surgery Center Administrator Judy Graham

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