Here are four best practices your ASC can follow to best take advantage of growth opportunities.
1. Reach out to the medical and local community and boost volume
Improving case volume is an essential step for any growing profitability surgery center and in orthopedics in particular.
“Everything in a surgery center is driven by volume,” says Sandy Berreth, administrator of the Brainerd Lakes Surgery Center in Baxter, Minn. “If you don’t have patients, it does not matter if you have the latest and greatest technology. Elective surgery is how ASCs are driven, and unless the surgeons (whether partners or not) bring their patients to you, it just doesn’t matter about anything else — it is all about the patient!”
A good opportunity for growing your case volume is to find willing and experienced surgeons who would like to partner with your center. In addition, in-community recruitment is also an excellent chance for your current surgeons to become more aware of the medical community around them and what the needs this community has.
Nancy Burden, director of BayCare Ambulatory Surgery Centers in Tampa Bay, Fla., says that one way to accomplish this is to introduce your surgeons to local primary care physicians. She offers the following suggestions on how administrators can facilitate this meeting:
- Take your surgeons or their internal office marketing representatives on ride-alongs for a day or half-day with pre-planned primary care office visits.
- Provide advice to orthopedic office marketing representatives, such as building a marketing plan, insights into the local medical community, sharing community demographic information sources such as public access county/state databases, etc.
- Help facilitate private physician-to-physician meetings, such as lunches in a physician’s office.
- Take the surgeon’s business cards to referring physicians.
In addition, surgeons can benefit by reaching out to members of the community — those who are current or may be future patients. Chris Metz, MD, an orthopedic surgeon at Brainerd Lakes, suggests that education is a good way to generate more interest in the center.
“We’ve done presentations on arthritis, hand procedures, carpal tunnel and other types of procedures we perform at the surgery center for the community,” he says. “It gives a chance for people to come down and see the center.”
These types of events can help raise community awareness, not only about health conditions but about the surgery center as well. According to Dr. Metz, the hope is that patients will think of the surgery center the next time they have to have a procedure. As result of these presentations, he says case volume at his center has increased.
In addition, Dr. Metz says that at the end of each day at the center, he receives a list of the patients and procedures he has performed that day. Either that evening or the next day, he or a nurse will call the patient to check in and see how they are doing after the surgery.
“It takes no more than two or three minutes,” he says, “but it means a lot.” These calls have helped patient satisfaction rates go up, which encourages more word-of-mouth referrals. “You can spend all the money on ads and marketing,” he says. “The ‘good word’ spreads must faster.”
2. Take proactive approach to move cases from inpatient to outpatient
As technology advances, it may be possible to move more and more cases from the inpatient setting to the outpatient setting.
Dr. Metz notes that over the past 10 years, most shoulder surgeries are performed at surgery centers. Most of this movement is due to advancements in surgical technology, especially in pain management. He mentions the need for an ASC to have an “aggressive, well-trained anesthesia staff.”
Therefore, in order to move more cases from the inpatient setting to the surgery center, it may be important to establish an excellent pain management program. According to Dr. Metz, many centers are trying to “treat pain before the patient has it” by using oral medications before surgery to treat pain after surgery.
Ms. Burden mentions that some of her anesthesiologists perform anesthesia blocks prior to the surgery to reduce post-op pain.
Marie Lee, surgical services administrator for the Ambulatory Surgery Center at Northwest Health in Springdale, Ark., notes the benefits of using anesthesia blocks. “Patients who are eligible via health/medical status/ clearance, and are given anesthetic blocks, have shorter recovery time and less post operative pain,” she says.
Donna Quinn, director of the Orthopaedic Surgery Center in Concord, N.H., suggests that orthopedic ASCs should consider expanding their practices to include outpatient spine procedures. “We now perform lumbar microdiscectomy and anterior cervical fusion procedures on an outpatient level,” she says. “Reimbursement for these procedures can be very good. That being said, patient selection (health wise and insurance payor) is crucial to success.”
Another opportunity to grow volume is to handle cases that require longer stays. “Many centers are performing all orthopedics cases at surgery centers,” says Ms. Berreth. “The key to cases that require longer hospitalization and rehab is to have 23-hour care beds available. Another option is to make an agreement to transfer these patients to a rehab center, not an acute-care facility,” as Medicare does not allow this.
Ms. Quinn also sees including total joint replacement as possible area of growth for orthopedics in surgery centers. However, she sees problems with patient transfer to rehab facilities that are far from a center. “I guess in the right setting this could work — where the ASC has a 23-hour facility and maybe the rehab center is attached,” she says.
“I am not convinced that I personally would want to have a total joint procedure and then be sent home or to a rehab facility within 23 hours,” she says. “I guess in the right setting this could work — where the ASC has a 23-hour facility and maybe the rehab center is attached.”
However, there are some stumbling blocks when it comes to moving more cases from inpatient to outpatient settings. One such area involves insurance reimbursement for implants, says Greg Roberts, an orthopedic surgeon at Upper Cumberland Orthopaedic Surgery and Upper Cumberland Physicians Surgery Center in Cookeville, Tenn.
“Many of our cases that we could do well and probably save the patient and insurance company money are currently not possible at our center,” he says, because many insurers only cover the center fee, not the implant, making some procedures not yet financially practical in the surgery center setting.
“If we could get this corrected, I feel that the patient, the center and the insurance company would benefit,” Dr. Roberts says.
3. Associate with sports medicine programs
Ms. Lee notes that building a relationship with sports medicine programs can be a great asset to a surgery center.
“A close relationship with area schools and sports programs, including injury prevention programs, promotes confidence and support of your orthopedic program,” she says. “When sports injuries are treated successfully at your facility, the extended family will also consider your services.”
In order to make of the most of this affiliation, she suggests making major public relations efforts to inform the community about the partnership.
4. Avoid bad contracts
An ASC can hinder growth in a number of ways, including signing unprofitable contracts with payors. Ms. Berreth suggests that “going” non-participating, or out of network, when it comes to managed care contracts can often be a successful alternative for ASCs.
“Private payors can make or break surgery centers,” she says. “They set reimbursement rates to centers and often are inflexible and because of their size versus a surgery center’s size. Negotiations can be difficult, and additionally, contracting needs due diligence to be successful.”
If negotiations fail to produce a better, more profitable contract for the ASC, sometimes it is wiser not to sign the contract rather than agreeing to a contract just to boost patient volume that could lead to losses.
She notes that “going non-participating” can be a “battle” with members of your ASC that is difficult to fight and win as many may be skeptical of moving from in-network to out of network. “The governing board needs to lend its support to whatever the decision,” she says.
Ultimately, there are benefits to going out of network. “The primary benefit is higher reimbursements and less write-offs,” Ms. Berreth says. “It is all about cash-flow and revenue.”
Contact Renée Tomcanin at renee@beckersasc.com.
