Q: Can you describe the eye ASCs you manage?
Dwayne Kertanis: The surgery center in Newington has four ORs and 42 credentialed physicians, another in Milford has two ORs and 22 physicians and the third in Waterford has two ORs and 20 physicians. Constitution Surgery has a minority stake in all the centers it manages.
Q: How has the recession affected your centers?
DK: One and half to two years ago, it was a little scary. Volumes were down. Cataract surgery is usually considered an elective procedure. It seems that some patients decided to wait. Newington was stagnant the past two years and Milford was down 4 percent. But this year volumes are back up again. Newington is up 4 percent and Milford and now is up 8 percent.
Q: What have you been doing to keep costs down?
DK: If you have a one-specialty center, there is a great opportunity to standardize. Get physicians on as many standardized processes as possible. Get them to use the same lenses and develop customized packs.
Q: How did you develop customized packs?
DK: One example is a disposable back table kit, which includes drapes, syringes, a basin, standardized blades. This requires working with the physicians. Ask them, “What do we actually use during a case?” Physicians tend to be cooperative if you discuss the option and how much the center could save if it standardized. If you can show them the finances and get them a good deal, it’s usually easy to convince them. They need time to discuss it. There may be a few surgeons who will continue to put in a more expensive lens.
Q: Should you regularly review what is in the pack?
DK: Yes, because some items may not be used enough and should be pulled out. For example, we had latex gloves in the customized pack but had to take them out because some patients had a latex allergy. If you notice a trend, such as syringes in the packs not being used by some surgeons, then you need to pull them out. You have to throw away an unused syringe because it has to be taken out of its sterilized container to put it into the pack.
Q: What other areas you look at to increase efficiency?
DK: Surgeons’ use of block times. Sometimes I’m the bad guy. I’ll monitor their surgery time. If their not utilizing it, I’ll approach them and present the data to them. It’s hard to argue with statistics. It also helps to have a physician in the wings who is asking for more block time. The surgeon who empty blacks might want to consider giving up one day and filling the remaining block time more efficiently. Another area is turnovers. We’ve achieved very fast turnovers, as little as four minutes.
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