5 Strategies for Successful Orthopedic ASCs From ASC Administrator Karen Cannizzaro

With new procedures, varying payor reimbursements and rising implant costs to consider, running a profitable, orthopedic-driven ASC can often be a delicate balancing act of conflicting demands. Karen Cannizzaro, CASC, administrator at Physicians Day Surgery Center in Naples, Fla., provides five strategies for satisfying physicians, patients and payors while maintaining a profit-driven and increasingly efficient ASC.

1. Keep track of competing ASC closures. ASCs looking to recruit orthopedic physicians in scarcely populated markets should keep an eye on the status of competing ASCs nearby, as a business closure could present an ideal opportunity to acquire new physicians.

When a nearby ASC ceased operations last year, several orthopedic physicians from the competing center joined Physicians Day — a first in the center's 15-year history, Ms. Cannizzaro said. This transition proved effective in increasing the center's caseload by more than 50 percent in the latter half of 2011, she said, and the center's five orthopedic surgeons now perform a combined 150 cases per month.

''We knew that the other center had some business issues, and the surgeons began discussions about coming over to our center as business was winding down,'' Ms. Cannizzaro said. ''They were the closest center to us in specialty mix and size, and we felt very fortunate to be able to do that.''

The recruitment opportunity was particularly welcome at a center like Physicians Day, where the majority of the owners have been with the center since its inception in 1997, and in a market like that of Naples, Fla., where available physicians are rare.

''Our local market is such that there are virtually no physicians that are not currently invested somewhere,'' Ms. Cannizzaro said. ''When there is a new face in town, the courting begins.''

2. Cross-train nursing staff and emphasize collaboration with physicians. A center's efficiency level and overall quality of care can be heightened with a cross-trained staff. Specifically, nurses can be cross-trained to float between pre-op, OR and recovery, said Ms. Cannizzaro. From a practical standpoint, this also means that staff members are able to substitute for one another during vacations and can coordinate shorter or longer days depending on the surgery schedule.  

Employees are also trained to avoid unnecessary financial burdens for the center by paying close attention to supply costs and reimbursement, particularly when working with physicians during surgery.

''Our staff is very much aware of the fact that you can make an otherwise profitable case in the OR unprofitable by opening too many surgical trays or supplies if you're not sure that you need them,'' said Ms. Cannizzaro. ''They may suggest an alternative product to physicians, or wait to open something so that different trays and implants aren't opened unnecessarily for one procedure.''

3. Coordinate block time schedules with busy physicians. Orthopedic surgeons with heavy case volumes should aim to schedule their cases according to a block time system, Ms. Cannizzaro said. To implement this, she tracks the amount of weekly and monthly cases each surgeon brings to the center and works to allocate consistent OR times, such as every Monday afternoon or all day every Thursday, for each surgeon.  

''It helps physicians schedule and fill their days efficiently,'' Ms. Cannizzaro said. ''It prevents us from having cases scattered all over the place, where the staff is waiting on the next surgeon to come in. Everybody’s expectations are very clear.''

4. Develop a consistent formula for evaluating new products and procedures. In the midst of what can be an overwhelming influx of sales proposals for new products and instruments, it's important to carefully and systematically evaluate the cost effectiveness and efficiency that each one can bring to the center.

Medicare patients are susceptible to wrist fractures, for instance, but wrist plating systems tend to be cost prohibitive, Ms. Cannizzaro said. When considering fixation systems for fractures, a center must pick products based on a comparison of how much money could be lost on a case.

The same rules apply when considering new procedures. It's important to consider which surgical procedures require things like video towers — orthopedic and gynecological procedures typically do, for example — and whether the center can accommodate that without any conflicts.  

''We look at the overall cost of the procedure or supplies and whether we have everything here or will need to acquire more instrument trays or equipment to accommodate it,'' she said. ''We also look at the length of time in OR, the anticipated recovery time, the reimbursement from payors. We need to analyze if it will impact other cases we do, or negatively affect our patient flow on certain days.  Mixing many specialties together can be challenging.''

5.  Work to control implant costs. Surgical implants require a continuous balance between choosing the right implant for the patient, getting the implant at the best possible cost and securing adequate reimbursement from payors. This can be particularly complex when orthopedic surgeons within the same practice each have their own practice habits and the ASC wants to standardize supplies, said Ms. Cannizzaro.

''As an administrator, you really have to nurture relationships with physicians, patients and payors,'' she said. ''We have also nurtured our relationships with our vendor reps and feel confident that our pricing is competitive and they have provided all of the value added incentive that they can. If we all don't make a little bit of money, none of us can stay in business.  That's reality.''

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