Effective Medical Director Leadership in ASCs

The following article is written by Robert Welti, MD, senior vice president of operations for Regent Surgical Health.


The role of the medical director has become increasingly important over the past year. In addition to the usual three-year accreditation surveys, many of our centers have experienced arduous validation inspections by CMS. Our medical directors have always been key participants in preparation for accreditation. Now the medical director must also serve as a sentry to detect and correct any ongoing deviation from CMS Conditions for Coverage after the three-year accreditation has been obtained.


Many of the new clinical requirements are quite perplexing to those of us who have been in practice for a long time, and there is almost always significant "pushback" from some of our medical staff. This is the setting in which the "people skills" of the medical director become very important. Flexibility, listening skills, creativity and a desire to achieve goals thru cooperation, rather than autocratic imposition, will help the medical director gain acceptance of needed changes in clinical practice. Remembering that the surgeon is our client as well as the patient, the medical director can remain a champion of performance and quality enhancement, while at the same time finding new and more efficient means to deal with new rules and regulations.


The role of the medical director in our centers is expanding into new areas. Many of our medical directors are taking an active role in information technology, especially with the introduction of electronic health records. At the Surgery Center of Anchorage, Medical Director Richard Liles, MD, has become a "power user" and instructor for the implementation of the ProVation EHR, and at the Texas Center for Special Surgery, Steven Schuleman, MD, is working with our administrator to introduce a web-enabled business intelligence application that turns ASC data into real-time actionable information (Amblitel).


Recruiting of new surgeons has always been an important duty of the medical director. Now that the ASC industry has reached a "mature" level of development, the number of eligible non-affiliated surgeons has markedly declined. The medical director is perfectly positioned to understand the structure of the local medical community and to identify and "reel in" potential additions to the ASC partnership. Our medical directors continue to exceed our expectations in their commitment and ability to help increase case volume. Medical Directors John Nhan, MD, at Advanced Surgery Institute in Santa Rosa and Shelli Tiller, MD, at Summit Surgery Center in Reno, both have deep ties in the community that are essential to surgeon recruitment.


The medical director can also help identify new "product lines" and help implement the clinical support for new procedures. Dr. Schuleman, at Texas Center for Special Surgery, spearheaded a drive to add cochlear implant surgery to the ASC's approved-procedure list and led the tough negotiations for pricing of the implant. Dr. Dan Sorenson and his predecessors at Surgery Center of Reno developed anesthesia and clinical protocols that led to the safe implementation of bariatric and complex spine programs in the ASC setting.


We also see a trend for medical directors to become more involved in the financial management of our centers, especially within the areas of supply costs and analysis of case profitability. Dr. John Anderson at the Southern New Mexico Surgery Center has been very helpful in payor contracting and development strategies. Our medical directors are developing an understanding of case-costing and facility reimbursement methodologies. With this new knowledge, the medical directors are taking an active role in controlling pharmacy costs and working with surgeons to identify cost saving strategies.


The role of medical director has evolved well beyond the traditional boundaries of QI committee participation and deciding on the appropriateness of any cases coming to the operating room. Effective medical director leadership can take your ASC to new levels of excellence.


Learn more about Regent Surgical Health.

More Articles Featuring Regent Surgical Health:

8 Steps to Increase Orthopedic Case Volume at an ASC

Regent Surgical Health Partners With CA Hospital, Surgeons on Two Joint-Venture ASCs

How ASCs Can Manage Expenses and Physicians

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