Tactics to Curb 4 of the Top Endoscopy Center Cost Drivers

Lean operations are a staple of endoscopy center success, but there are always areas that threaten to drive costs beyond the budget.  

Andrew Weiss, CASC, administrator of the Endo Center at Voorhees (N.J.) and treasurer of the New Jersey Association of Ambulatory Surgery Centers, and Sarah Malaniak, CASC, administrator of the Ambulatory Center for Endoscopy in North Bergen, N.J., recount what they have done to cut four of the top costs at their centers.

1. Staffing. Regardless of size or specialty, staff salary and benefits inevitably top the list of ASC costs. The key to containing and reducing the associated costs begins and ends with benchmarking. "It has to be an apples-to-apples comparison," says Mr. Weiss. "If you are a one or two-room GI center, you don't want to compare yourself to a 10-room multispecialty center." Create internal benchmarks for staffing costs per case and hours per case. Compare those benchmarks to other centers of similar size and scope.

Regional regulations can also affect benchmarks. For example, in New Jersey state law requires a RN in each procedure room in addition to a CRNA in charge of airway management. In other states, a procedure room could be staffed with a CRNA and endoscopy technician, while a RN circulates between rooms. "Know your regulations and make a good comparison before you make any drastic changes," says Mr. Weiss.
At the Ambulatory Center for Endoscopy, Ms. Malaniak uses a mixture of flexible scheduling and per diem staff members to limit the amount of overtime and meet staffing hours benchmarks. She also works to keep staff members engaged in scheduling and overall operations of the center. "There is so much lost money when you have high staff turnover," says Ms. Malaniak. "Staff retention is another invaluable cost savings tool."

2. Benefits. When budgeting for employee benefits, it is important to shop around. "We were able to seize an opportunity this year through the combination of a higher deductible plan and offering our employees a health reimbursement account," says Mr. Weiss. "We were able to mitigate employee risk and keep benefits costs low." Always conduct due diligence when employee benefits come up for renewal. If you simply accept costs without due diligence it could a real missed opportunity, says Mr. Weiss.

3. Supplies. Snares, biopsy forceps and various medications are among the most common supplies ordered at an endoscopy center on a regular basis. Strategies to cut supply costs include:

•    Analyze invoices to minimize over-ordering and excess inventory
•    Create a regulated ordering process reviewed and approved by the administrator
•    Join a group purchasing organization
•    Implement supply packs to decrease waste

Always be open to savings opportunities offered by specific vendors. For example the Ambulatory Center for Endoscopy is able to save 20 percent on orders that they allow to be automatically shipped from a specific vendor. Vendors also often offer discounts of up to 3 percent for invoices paid early. Ask about discounts and take advantage of as many as possible.

4. Repairs. Scopes are some of the most important, and frequently used, pieces of equipment at an endoscopy center. As scopes pass through many different hands on a day-to-day basis, wear and tear is inevitable. But, the cost of frequent repairs adds up quickly. At the Ambulatory Center for Endoscopy, Ms. Malaniak and her staff began to notice that scope repairs were necessary on a monthly basis. Rather than dismiss this as a casualty of frequent use, she and her team dug deeper.

The scope technician, director of nursing and reprocessor led a study to determine the root cause. "We tracked the repairs and looked at everything as a whole," says Ms. Malaniak. The cause did not trace back to specific physician or staff member. Within a month, they determined the tagging bands being used were damaging the scopes.

Careful collection and analysis of data in any area of potential cost savings can bear fruit. In the case of the Ambulatory Center for Endoscopy, the price of costly monthly repairs was dramatically reduced by a simple switch in tagging bands.

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