Reimbursement is increasingly uncertain as the healthcare industry rapidly progresses toward new payment models and sites of care. The ASC arena is not immune to these changes.
"As we all know, these reimbursement dollars seem to be dropping every year, and the supplies and the expenses that we have with running these centers seem to be going up every year," said Jeffrey Péo, chief development officer of Ambulatory Surgical Centers of America, in an April 25 webinar sponsored by ASCOA and hosted by Becker's ASC Review.
ASCOA, founded in 1997 by three surgeons, is an ASC management and development company. Since its inception, the company has developed or acquired 70-plus centers nationwide. Three executives from ASCOA shared their expertise during the webinar. They are:
• Margaret Chappell, RN, senior vice president of operations
• Sharon Johnson, BSN, RN, senior vice president of operations
• Ellen Wziontka, corporate materials manager
The executives discussed five areas that hold the most opportunity for ASCs to maximize their profits.
1. Staffing. Adequate staffing is a key aspect of surgery center success. ASCs need staff members with the right skills and attitude to get the job done. ASC staff members need to understand the differences between what is required of them at a hospital and what is required at an ASC, Ms. Johnson said.
"In an ASC, everyone has to jump in and be part of a team," she said. "Cross-training, flexibility — those things are key to a great staffing model because of the way an ASC runs. … You have to have the right people; they have to be the right fit for the facility; they have to be the right fit for the rest of the team."
When interviewing candidates for ASC staff positions, Ms. Johnson suggested trying to get a sense of their personality to ensure they are a cultural fit, and also make sure they have the skill set for the job that is available. She stressed that ASC administrators should conduct cross-training among employees to widen the staff roster in case of an emergency or if several staff members are on vacation at once.
Finally, it is important that ASC administrators keep up to date on regulatory changes regarding what kind of licensed professionals can do what kind of task.
2. Scheduling. ASC facilities typically use one of two types of scheduling: block scheduling or compact scheduling. Surgeons usually prefer block scheduling, as this allows them to schedule their office hours and cases at hospitals. However, block scheduling can leave surgery centers with a time block that is not used to its full capacity.
Some ASCs use compact scheduling, wherein cases are scheduled on a "first-come, first-served" basis. Surgeons tend to be resistant to this type of scheduling, but it allows ASCs greater flexibility in scheduling and helps ensure that the centers are performing the maximum number of cases that can be performed in any given time frame.
"It becomes more important to know your surgeons," said Ms. Johnson. "Each center is different, has different surgeons, different types of cases. So you have to tailor your specific schedule to be the most efficient for your center, whether it be block or compact."
Another important factor related to scheduling is taking patient recovery times into account. Ms. Johnson noted that high-acuity cases should be scheduled first if possible, to allow patients maximum recovery time in the post-anesthesia care unit.
3. Case volume. ASCs need to be strategic about increasing case volume, said Ms. Chappell. Administrators can look at numerous factors to determine why their case volume might be low, including the center's staffing, payer mix and proportion of in-network versus out-of-network cases, as well as instrumentation and technology. Make sure each of these factors is optimized at your center.
A lack of physician satisfaction may also be a reason case volume is low. "Talk to your physicians — get in front of them," said Ms. Chappell. "Are they leaving your center happy? Or are they frustrated and miserable? What is it that they actually need in the center? They'll tell you. Do they realize their schedulers are not sending every single eligible case to your center? If they're not, you need to have that talk with the physician."
4. Billing and collections. Emphasizing patient responsibility is essential for making sure your ASC is receiving accurate payments on time. Ms. Chappell suggested collecting copays upfront. Staff should call patients before they come in for their procedure to tell them how much they will owe prior to the procedure. This will also give staff the opportunity to explain the bill and field patient questions. Collecting upfront payments is the best way to drive down bad debt, she said.
Additionally, use the post-service appeals process and retroactively appeal denials when necessary. Use the tools on payer websites and review medical guidelines so you know what you can do to reduce the number of denials and receive additional payment.
5. Group purchasing organizations. While ASCs typically have materials managers, these individuals tend to wear many hats, and therefore may not be able to dedicate as much time to their core responsibilities as necessary. Ms. Wziontka said that when she visits an ASC, she usually finds numerous opportunities for cost savings via materials that are not on contract but should be.
ASCs have numerous contracts, so contracts dropping off without anybody realizing is a common issue.
"Contracts tend to fall off at any time," said Ms. Wziontka. "Reason one would be, they expire and they just drop off, and it would be better if the GPO was forthcoming, [letting you know] here's the issue, you have a contract, you're coming off that contract, be prepared to sign an LLC. But they aren't necessarily very good at doing that, so you're going to want to be able to look and see and verify."
Finally, keep an eye on your usage. If your materials usage increases significantly year over year, you could be eligible to jump to a better tier and receive better pricing options.
Watch a recording of the webinar here and download the slides here. To learn more about ASCOA, click here.