The major decisions that changed 24 ASCs for the better this year

From transitioning to a four-day workweek to implementing new payer contracts, 24 healthcare leaders shared with Becker's the best decisions their ASCs made in the last year. 

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at its 29th annual conference, the Business and Operations of ASCs, on October 25-28 in Chicago. The following are answers from our speakers.

To learn more about this event, click here.

Question: What one decision or change from the last year had the biggest positive impact on your surgery center?

Adam Roggia. CEO at Sports Medicine Associates of San Antonio: We worked hard to improve communications across multiple surgery centers and to bring in line centralized scheduling. For many, this was a big win since insurance companies continue to make it more challenging to schedule patients in a timely manner. There is still quite a bit of work left to do to get it more refined, but it is making a positive impact for our patients. 

Alejandro Badia, MD. Hand and Upper Limb Surgeon at Badia Hand to Shoulder Center (Doral, Fla.): The biggest change for 2022-23 is the continued shift of particular surgeries from the hospital to the outpatient environment. With payers finally realizing this is a positive change, it allowed many colleagues with in-network practices to eventually shift over particular surgeries such hip/knee replacement, lumbar fusion and pacemaker insertion to the more cost-effective ASC environment. I have been doing shoulder, elbow, wrist and thumb arthroplasty for over a decade via my out-of-network practice, but it was a constant struggle with the carriers for facility coverage. That is finally changing, although the irony is that most upper limb joint replacements are still not on the "covered list" even though we don't walk on our hands. The reality is that volume of procedures, not clinical appropriateness or surgeon decision-making, is what has driven that change. I look forward to a day when the entire ecosystem actually collaborates to do what is best for patients, our troubled healthcare system and our national economy.

Alfonso del Granado. Administrator and CEO of Covenant High Plains Surgery Centers (Lubbock, Texas): The one decision from the last year that had the biggest positive impact on our centers was to lease the DaVinci surgical robot. Although the cost per case is much higher on average than the same procedures performed laparoscopically, we had unused time slots that could now be filled productively, and we were able to help one of our partner groups whose members were having trouble booking robotic cases at our partner hospital across the street. We will be performing a second performance review in January to decide whether to continue the program, but so far the financial impact has been positive, and the indirect benefits have been significant.

Alyson Hughes, MSN, RN. Director of Nursing at Andrews Institute Surgery Center (Gulf Breeze, Fla.): Improving communication:

1. Daily leadership huddles at 9 a.m. daily (info shared at this huddle then disseminated out at individual department huddles) 

2. Monthly newsletters

3. Monthly staff meetings 

Andrew Lovewell. CEO at Columbia (Mo.) Orthopaedic Group: One change that we made from last year that has had the biggest positive impact on our practice and ASC is starting a work comp bundle program. We have signed an exclusive contract with a work comp provider to get all orthopedic/musculoskeletal cases in our area and provide bundles. On top of that, now that we have built the referral pathway we have started seeing more work comp volume for our other ancillary services that are encompassed within our practice. 

Chris Shaver, MD. Gastroenterologist at Birmingham (Ala.) Gastroenterology Associates: The one decision that made the biggest positive impact on our three single-specialty surgery centers was block schedule optimization through intensive, centralized scheduling. This enables us to backfill vacant procedure blocks with other physicians. This also enables us to move around our pool of employed CRNAs, to minimize the cost of excess locum hires. The strategy of aggressive attention to scheduling, enables us to increase our procedure numbers and associated pathology and anesthesia revenue, while helping us control anesthesia overhead. 

David Jevsevar, MD. CEO at OrthoVirginia (North Chesterfield): As an orthopedic CEO and practicing surgeon, I've witnessed firsthand the transformative impact of outpatient hip and knee arthroplasty on our surgery centers. Firstly, these procedures significantly enhance our center's efficiency, allowing us to treat more patients without the need for extended hospital stays. This not only streamlines our operations but also translates to a notable reduction in overhead costs associated with prolonged inpatient care. Furthermore, offering outpatient services has substantially elevated our facility's appeal to patients seeking faster recovery times and a return to the comfort of their homes post-operation. From a business perspective, incorporating these procedures has diversified our service offerings, positioning our centers at the forefront of innovative, patient-centric orthopedic care.

Emily Spooner. CEO of South Florida Same Day Surgery Center (Pompano Beach): South Florida Same Day Surgery Center decided to implement a new ASC software platform in the last year and it has changed our center in the most positive ways. Due to the lack of staffing in the healthcare industry, this program has allowed us to be more efficient without as many employees. Using one platform for all our surgery center needs has greatly impacted our productivity, especially scheduling surgeries. It has really streamlined the process of the complete revenue cycle management.  

Genevieve Kragness, PhD, RN. Nurse Manager of Surgical Services at Marshfield (Wis.) Medical Center: We adjusted our block schedule to a four-day workweek, which turned out to be a staff satisfier and had a very positive impact on our productivity and efficiency. Staff love having Fridays off and are more willing to work extra and pick up open shifts since this change. Our block utilization went from 46 percent to over 75 percent in under one year, and our volume is actually higher than it was in the prior year despite having less available block time for elective cases. This decision was surprisingly effective and has been one of the best changes we've made in recent history.

James Chappuis, MD. Orthopedic Spine Surgeon and Founder and CEO of Spine Center Atlanta: The biggest change we have made this year that has had the biggest positive impact on our surgery center is partnering with Ospitek and embracing new technology. Ospitek provides software and technology solutions promoting better patient experience and workforce productivity. This year, we have seen improvement in our efficiency of communication, education and patient care excellence. The technology helps us build a bridge between ourselves and our patients to provide peace of mind, even through the increasing volumes and demands of an outpatient setting. Providing a visual representation and automated tracking of the patient's journey, Ospitek keeps our staff, patient and patient's caretaker on the same page to help keep full transparency of the trajectory of the pre-op, procedure and post-op care as well as allow more time to focus on patient care.

Jitander Dudee, MD. Surgeon and Owner of Medical Vision Institute (Lexington, Ky.): The change that has had the most significant positive impact on our surgery center is staff training and development, especially in the implementation of electronic health records. Investing in staff training and development programs has improved the skills and knowledge of our healthcare team. When staff are properly trained in the proper use of a well-customized EHR, it streamlines patient data management, enhances communication among healthcare providers, reduces paperwork and improves the overall efficiency of patient care. This leads to better patient outcomes and increased operational efficiency.

Joe O'Brien, MD. Medical Director of Minimally Invasive Orthopedic Spine Surgery at VHC Health (Arlington, Va.): In the last year, committing to performing spine and joint replacement in the surgery center has made the biggest difference.

John Prunskis, MD. CEO and Medical Director of the Illinois Pain & Spine Institute (Elgin): Having a scheduling coordinator whose sole job description was to get advanced pain procedures approved.

Mark Mayo. Founder and Owner of Mark Mayo Healthcare Consultants and Administrator of Associated Surgical Center (Arlington Heights, Ill.): 1. There remains a shortage of experienced nurses, which makes case scheduling harder (limits the number of operating rooms you can run and limits the length of the surgical day to one shift).

2. There is a growing shortage of anesthesiologists (MDs or DOs).

3. As our ASC bounces back from COVID-19 restrictions, there is a steady return of GI patients who put off elective or follow-up procedures during the pandemic.

4. I think across the board the public has become more aware of the option of selecting an ASC as opposed to going near the hospital, and I am surprised at the positive image patients have about ASCs (high quality, patient-centered care, small, lower infection rates, cost-effective).

Mary Meier-Mathias. Administrator at Eye Center of Columbus (Ohio): A positive impact of our ASC this year was the expiration of the federal Public Health Services Act for COVID-19.  The staff morale has increased since, as they knew we were transitioning away from an emergency phase. We were able to respond to a rapidly evolving pandemic, come out at the end with the knowledge and understanding and are now in a better place. I am very proud of our entire staff for standing by us. 

Michael Powers. Administrator of Children's West Surgery Center (Knoxville, Tenn.): Employee engagement and satisfaction. We have made a very intentional focus to ensure we remain competitive in both compensation and benefits to not only local ASCs but also hospitals. In addition, we make it a priority to remind our employees that they are valued. This is accomplished in many ways, such as leadership rounding to inquire of any frustrations happening on a regular basis and removing it or explaining the reason of why! Also, soliciting from employees any ideas they have that may both improve operations and efficiency while being employee friendly. Lastly, we can do small things such as buy special pens, provide lunch or desserts, food trucks and in fact ice cream trucks and Christmas lunch and gifts each year. Showing the employees in many ways that they are valued and appreciated and how they fit into the overall scope of what you are doing is a great tool for employee retention. Reminding everyone of their mission, knowing that they will support what they help to create, and intentionally hiring staff that will be a positive fit within the organization's culture is key. At the end of the day, we are all just human beings that want to feel admired and appreciated. 

Miguel Afonso, MD. Medical Director of Gastroclinic (Libson, Portugal): In 2022 we needed to increase our operational excellence, and we reached out to a data-driven tech company that helped us to increase consistency of current process flow, simplify how cleaning activities are performed, and implement some task reallocations and shorten turnover time by rescheduling patient arrival time and pre-anesthesia preparation. After their intervention we were able to reduce the fatigue of the surgical team, increase the number of surgeries per operating room and OR team, and increase the financial performance of the OR. 

Monina Pascua, MD, PharmD. Gastroenterologist and Clinical Medical Director at Oregon Clinic (Tualatin): One of the changes that our ASC made was directed resources towards expanding our direct-access colonoscopy program to facilitate increased screening and surveillance colonoscopies through our ASC without having to wait for an office visit. This was quite helpful as the screening age was lowered to 45. This expansion included having trained nursing staff do extensive reviews of the medical records and over-the-phone histories to expedite scheduling and reduce unanticipated cancellations at the time of the procedure. This has improved our efficiency, increased our access to office visits by allowing physicians to see patients in the clinic for acute and chronic needs.

Njideka Nto, MD. Medical Director and Family Medicine Consultant at Mediclinic Middle East (Dubai, United Arab Emirates): One change from last year which has had an impact on our ambulatory center is the expansion of scope of services permitted by our regulatory body for ASCs, as this is fostering and facilitating emigration of care from hospitals to the community. In addition, automation of some aspects of revenue cycle management via utilization of artificially intelligent smart systems is an area that holds promising value.

Noelle Diesfeld, BSN, RN. Senior Clinical Director of Perioperative Services at Scottsdale (Ariz.) Shea Medical Center and Piper Surgery: At Scottsdale Shea Medical Center we decided to move a robot to the outpatient center on campus. We created a list of cases that would be appropriate for the outpatient setting. We vetted the concept through various committees as informational, stating that moving certain patient types to the outpatient setting would create better robotic access within the inpatient setting. Surgeons engaged and started scheduling their lower acuity patients in the outpatient setting. Additionally, we routinely look one to two weeks ahead and move patients from the main operating room grid to the surgery center. We notify the surgeons and allow refusal based on established criteria. Following this change, our overall robotic utilization (a total of six robots) has increased. Notably, the robot in the outpatient environment is at a strong 62 percent utilization.

Omar Khokhar, MD. Partner at Illinois GastroHealth (Bloomington): Our decision to consolidate two centers to one has had dramatic outcomes. This decision has improved net income, significantly decreased overall cost of supplies, decreased duplication of equipment, eliminated leases and allowed us to create a staffing model to accommodate filling blocks to 85 percent capacity in a condensed four-days-a-week operating hours. 

Philip Louie, MD. Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): The economic landscape of our healthcare system has been in some disarray over the past year. We have been struggling on several fronts right now, and the financial losses have compounded the situation. Cuts in healthcare funding and competition for budgets are forcing us to find ways to improve the efficacy and efficiency of how we deliver care in an ASC. One of the biggest areas of our ASC growth has been our ability to practice a bootstrap ethic — investing where it makes sense, but ruthlessly staying frugal everywhere else. We have invested in Jackson frame beds and processes to perform lumbar fusions. And we have purchased endoscopy equipment and will begin offering this to our patients as well. Thus, despite the cost-cutting around us, realizing that the adversity we are facing isn't just a threat to be contained, but rather a unique opportunity for our ASC to grow and invest in the future.

Thomas Moshiri, MD. Chief Business Officer at Arizona Pain Relief and Arizona Pain Specialists (Phoenix): Instead of trying to be a jack of all trades and master of none, as an interventional pain ASC we decided to focus exclusively on advanced procedures such as MILD, SCS trial and implant, PNS trial and implant, SI joint fixation etc and have re-worked our processes and billing systems to maximize efficiency and patient care along with revenues.  This has had a significant impact on our surgery center.

Vianka DeJesus. Operations Manager at NYU Langone Health and NYU Langone Orthopedic Hospital (New York City): If I had to pinpoint one specific change that had the biggest positive impact on our surgery center, I would have to say our efforts toward increased visibility, communication and accessibility of the surgical coordination staff and associated surgical departments within. Interdepartmental communication has allowed for increased efficiency within the post-operative and post-operative process leading to patient satisfaction and better overall care. Evaluation of our processes on multiple levels has allowed for the voices of our employees to be heard and for them to witness their suggestions implemented in real time. We were able to witness patient satisfaction and employee engagement all in one stellar initiative.


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