6 Ways to Keep Eligible Cases at Your ASC: Advice From Dr. Brad Lerner of Summit Ambulatory Surgery Centers

Brad D. Lerner, MD, FACS, clinical director at Baltimore-based Summit Ambulatory Surgery Centers, discusses six ways to keep all ASC-appropriate cases in your surgery center.

1. Look at top procedures by CPT code and break down where cases are taken.
Dr. Lerner says his surgery centers look at their top procedures by CPT code and determine how many cases each physician brings to the surgery center versus the hospital. "I can look at the breakdown and say, 'Let's look at laser vaporization of the prostate. You did two in the surgery center but 20 in the hospital. Can you help me understand why you are performing such a high number of these cases in the hospital instead of the ASC?'"

Dr. Lerner says he and his nursing director look at these statistics on a quarterly basis and compares the data to the previous year to determine how case volume is shifting. He says these statistics are essential to know where your "problem areas" lie. Once you know a physician is taking a particular procedure to the hospital more often than the ASC, you can sit down and talk to him about his reasoning.

2. Consult with physicians about which cases are appropriate for the ASC.
Some cases simply aren't appropriate for surgery centers, including those where the patient has a high BMI, significant co-morbidities or historic problems with anesthesia. The level of case acuity that surgery centers are willing to accept varies — some won't perform anything above an ASA II, whereas others are willing to consider ASA IIIs and even IVs under special circumstances.

Dr. Lerner says it's important to have a conversation with your physicians about which cases are appropriate for the ASC. He says this is particularly crucial with younger physicians, who have spent years training in a hospital setting and may be somewhat gun shy about bringing cases to the ASC. "Part of my job is to educate them," he says. "If a patient has co-morbid issues of concern but they are stable and treatment has been optimized, the patient may still be a candidate to have their procedures performed in an ASC setting. If there is any doubt concerning suitability for the ASC, a consultation is obtained with the anesthesia medical director." He says this is particularly true for a specialty like urology (which makes up the majority of case volume for Dr. Lerner's centers), where cases are generally low-risk.

3. Don't be afraid to use outside vendors that may charge for their technology, technician or disposable supplies.
Physicians may take cases outside the surgery center if they feel the ASC does not stock the supplies and equipment they need. Especially if they've practiced in the same hospital for many years, they may not even stop to inquire as to whether the ASC has a certain supply or piece of equipment. Dr. Lerner says this is another area where physicians need additional education.

There may be certain lines of service that are suitable for the ASC but lack the critical volume to justify purchase of the equipment. If a proper cost analysis is performed and it is still cost-effective to perform a certain procedure in the ASC, it should be done. Examples in Summit ASC include laser treatment of bladder stones and prostate cryoablation. Over time, if case volumes increase, alternate arrangements can be investigated to purchase the equipment and train existing personnel in the technology.

4. Re-evaluate block time on a quarterly basis.
You may need to re-assign block times if your physicians need more or less room than you've allocated. If a physician doesn't have enough block time at your ASC to handle all his cases, he may tell his scheduler to start moving them elsewhere. Dr. Lerner recommends looking at block time regularly to make sure no cases are being unnecessarily shifted to other facilities.

"We may have a doctor whose practice is growing and who is running close to 100 percent of block time," he says. "I would need to have a conversation with this doctor and discuss whether we need to give him more. At the same time, if we see a doctor with chronically low utilization, we may reduce their amount of block time. We encourage the physicians to contact their respective nursing manager or the medical director if they are experiencing difficulty scheduling cases within a reasonable period of time."

5. Hold monthly meetings between physician schedulers and ASC leadership. Dr. Lerner says his administrative staff holds monthly meetings with physicians' surgical posters to strengthen the relationship and go over which cases are suitable for the ASC. They also address any concerns that the posters may have related to scheduling of cases and issues with block or open time availability.

"We're in constant communication with our posters about what can and can't be done in the ASC — and then within certain lines of service, which insurance plans should and shouldn't be done in the ASC," Dr. Lerner says.

6. Decide which procedures are not financially feasible for your center.
In order to schedule appropriate cases at the ASC, you need to know which procedures are profitable or not profitable based on your insurance contracts, Dr. Lerner says.

"For certain lines of service or procedures, some insurance carriers will reimburse differently in the ASC while others may not reimburse at all," Dr. Lerner says. "It is important to perform regular cost analyses and try to renegotiate contracts with insurance carriers and even look for carve-outs when applicable."

Related Articles on ASC Turnarounds:
5 Trends for ASC Administrators to Watch
10 Reasons Physicians Take Cases Out of Surgery Centers
5 Ways to Make Surgery Centers Better

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