Improving Efficiency: 4 Best Practices for Surgery Centers

Here are four best practices to improve efficiency at ASCs.

1. Go paperless. For the Jacksonville Center for Endoscopy, where nearly 32,000 procedures are performed annually, the hard-dollar annual cost savings from transitioning to paperless totaled more than $26,000 just in the elimination of paper and printing costs and storage fees, says Sean Benson of ProVation. Since deploying dictation software and an EHR to replace, respectively, physician dictation and perioperative paper charting, the Jacksonville, Fla.-based ASC is also saving up to two hours each day that were previously lost to chart pulls.

"We have seen an increase in the accuracy of information entered into our systems because fewer individuals are involved with data entry," says JCE Administrator Cindy Hall, RN. "Eliminating the need to scan patient consents into the system has also resulted in savings of both time and the costs associated with shredding paper copies."

JCE has also found that the workflow and process improvements made possible by its EHR have had a direct impact on its bottom line in the form of faster revenue cycles and increased revenues through higher patient volume. As many as five days have been shaved off the billing cycle — days previously spent waiting for the various reports necessary to complete billing. Now, billing reports are generated and submitted daily.

In particular, JCE has found that billing for facility fees is accelerated because physician charges are captured automatically. Further, the documentation improvements facilitated by automation enables JCE to avoid under-coding, increasing revenues in addition to speeding the revenue cycle.

Finally, JCE's EHR has enabled faster and more efficient scheduling, which results in fewer cancellations. Other process improvements include faster registration and patient histories, and, most importantly, faster patient throughput.

2. Benchmark your procedures internally. Collect data on cost per case at the center for each procedure and physician to see where the surgery center needs to improve efficiency. "Start by selecting your five highest volume procedures and then calculate the cost per case for each physician within those procedures," says Michael Abrams, co-founder and managing partner of Numerof & Associates. "Focus on the small number of physicians that make up roughly 80 percent of the cases in each procedure."

Once the numbers are crunched, determine who is most efficient and share process with other surgeons.

"The larger objective would be to close the gap between the most and least efficient physicians," says Mr. Abrams. "If you can close that gap to make everyone as efficient as possible, you will do better financially as a result."

After internal benchmarking, you can use national statistics to benchmark your center against others. However, keep in mind that national statistics are the average of surgery centers across the country and you want to be well above average. "You are benchmarking yourself against the average, so strive to be much better than those numbers," says Mr. Abrams. "You want to be in the top quartile. If possible, find data sets allowing you to do that."

3. Shorten turnover times. Facilities must have a realistic vision of their turnover times and always work to make that time shorter. If there isn't enough time planned between patients to turnover the room, the next case will start late and both patient and physician time will be wasted. This also means staff will stay longer and place a burden on the payroll.

"The single most expensive waste in the facility comes from wasting time, and waste means inefficiency," says Larry Teuber, MD, chief medical officer and president of Medical Facilities Corporation and founder and physician executive of Black Hills Surgery Center. There will be some unforeseeable delays, such as difficult intubations, problems during induction, problems because the patient is obese or technical challenges during surgery that could make the procedure run over schedule.

When delays are unpredictable, the center can roll with the punches; however, when delays occur due to physician tardiness or inappropriately scheduled OR times, there are ways the surgery center can eliminate them.

4. Unclog post-operative rooms. Your ASC will be able to perform more cases — and therefore make more money — if your pre- and post-op processes are efficient. According to Rajiv Chopra, principal and CFO for The C/N Group, anesthesiologists are a major factor in how fast a patient recovers from anesthesia, and a skilled anesthesiologist can mean patients feel better faster and can free up the post-op recovery room for the next case.

"Your anesthesia can make a difference," Mr. Chopra says. "Once the surgery is done, how quickly are patients recovering so they can leave the facility? A lot of this ties back into anesthesia, and if you don't have an anesthesiologist with that skilled component, it can create challenges for you just from a recovery time perspective." He says safety and quality can be maintained without clogging up the post-op recovery room and delaying the process for other patients.

More Articles on Surgery Centers:

6 Ways to Prevent Physicians From Leaving Your ASC

How Many Surgery Centers Do Management Companies Oversee? 44 Statistics

Bundled Payments, Narrow Networks & Acquisitions: 5 ASC Reimbursement Trends to Expect in 2013

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