1. Modify hours of availability based on case volume. When there are not enough procedures scheduled in one day’s work, Dr. Friedman suggests closing the center to save on staffing costs, which are arguably the biggest expense at an ASC. West Park aims to schedule at least 16 procedures for one day at West Park.
“We look at our schedule on a daily basis, and we schedule 25 cases for a full day and 16 cases for a half day,” he says. “We start by booking a full morning, and once a full morning is booked, we book an afternoon. If the afternoon doesn’t book up, we usually shift the patients to another day, turn off the lights and equipment, and go home early.”
2. Use downtime to do administrative work. Because the daily routine of caring for patients may not always allow administrative staff to get work done, administrators use the time that the facility is closed early to finish administrative work.
“Because we’re located in Florida, our facility is seasonal. Sometimes we have higher volumes, and sometimes we have lower volumes,” Dr. Friedman says. “If our volume is lower, we may close three or four times a month, during which time our administrators do administrative work.”
3. Cross-train staff to do clinical, administrative and clerical work. The staff at West Park Surgery Center is trained to do various tasks across the clinical, clerical and administrative spectrum, which allows flexibility in running a more efficient surgery center and helps cut staffing costs.
“We cross-train our labor team, so our director of nursing is a working administrator who works on administrative aspects focused on quality and finances,” Dr. Friedman says. “Our x-ray technician also has a lot of duties helping the front desk with stocking, case histories, condensing schedules and so on.”
Dr. Friedman says cross-training staff allows the flexibility to move and float staff members between the front office of the medical practice and the front office of the ASC. “We also train one full-time employee to work both the front office of the ASC and the front office of the medical practice, when it’s necessary,” he says. “This employee spends most of his or her time in the office of the medical practice, but can float to the ASC if the front office is out sick.”
4. Use a repair/maintenance vendor that can provide multiple services. West Park equipment is regularly checked for maintenance by a biomedical technician. In order to comply with AAAHC standards of equipment maintenance, Dr. Friedman says the maintenance and cleaning services are outsourced to one vendor who is able to offer those services for a large number of the equipment.
“When we look at our maintenance contracts, we try to use a vendor that provides multiple services, as opposed to one vendor that cleans monitors, one vendor that repairs C-arms and one vendor that repairs electronic beds,” he says. “We use a service that does a majority of our equipment, repairs our heating and AC, checks sterilization and so on. Also, repair/maintenance vendors are very responsive and can loan you a piece of equipment before a new pieces comes in.”
West Park also uses laundry services instead of tasking staff members to clean linens. Dr. Friedman says the surgery center saw a savings of $0.40-$0.50 per piece of linen by hiring laundry services. “It may seem like a small amount of savings, but every small saving eventually adds up.”
5. Monitor and measure the costs and efficiency of the facility. Dr. Friedman says ASCs also need to look at the managed care contracts of the organization to identify areas for improvement in efficiency.
“For example, if a facility is doing an implant procedure or a rhizotomy procedure, at times it may be acceptable within a global contract and at other times you may need to negotiate a carve-out because these procedures are more expensive and case costs are higher,” he says. “Also, an ASC should look at things like how long it takes to get authorizations for procedures from payors, as that can affect patient satisfaction and then later case volume.”
Dr. Friedman adds that when considering purchasing new equipment for the surgery center, the physicians and administrators will meet with vendors and obtain samples to have the physicians do a trial period with the product. After the trial period, the physicians will jointly agree on which product is best based on cost and performance standards.
6. Consider compounding pharmacies when purchasing pharmaceutical drugs. Although West Park works with vendors to purchase some of the drugs the ASC needs, it also visits compounding shops to find better deals on certain pharmaceutical drugs.
“To decrease the cost of pharmacy items, we may go to a compounding pharmacy,” Dr. Friedman says. “The benefit of buying from a compounding pharmacy is that some of the drugs may be cheaper to purchase, but not all of their items will be. This way, we can get a few items from a compounding pharmacy that are cheaper, and some drugs that are not cheaper we’ll get from our vendor.”
Read more about West Park Surgery Center.
