- Lack of payor contracts
- I “ask” my scheduler to schedule in the ASC but they keep ending up elsewhere
- I’ll lose my hospital block time
- I give patients options and they choose the hospital
- I’ll just do that pain case in my office
- You don’t have the right equipment
- I don’t have time to train your staff on my technique
- It’s too far
- I don’t like anesthesia
- I don’t like you
I’ve heard them all and although on few occasions there is validity to one of the above obstacles, particularly the one where they don’t like me, these are often just excuses for unwillingness to change routines that may have been in place for years. I always recommend recruiting your partners’ cases before you bring in new partners to work at the center. It is also easier to recruit new physician partners if you have a strong commitment from the existing partners.
We have been very successful finding substantial value in these centers by using the “Carrot & Stick” mentality through implementation of the below techniques. I’m a strong optimist and therefore, will begin with the “carrot” techniques followed by the “stick.”
Carrots
1. Scheduler luncheon. We often find that schedulers’ decide where patients flow to for surgery. Host a luncheon in your facility and “listen” to scheduler’s obstacles for scheduling patients in your center. We were blessed with two ears and one mouth; use this time to listen to your scheduler’s suggestions for increasing volume.
2. Administrator office visits. Send your administrator every single week to multiple partners’ offices. He or she will build rapport with the offices of those physician partners and find cases that weren’t getting scheduled in the ASC.
3. Coach physician partners. The physicians will often give the patient the choice of where to have surgery. Since infection rates are lower at an ASC, efficiency is increased and the cost to employer is considerably lower than the hospital, why give the patient the choice when the surgeon knows best site for an outpatient procedure. A surgeon should position surgical site as follows:
“Ms. Jones, you need to have your left cataract removed and I’m going to perform this procedure in my surgery center.”
This statement is simple and effective in utilizing the presumptive approach. We have had partners respond to an objection by Ms. Jones that she had her gallbladder out at the hospital by saying, “I don’t perform these procedures at the hospital but can refer you to someone else that does.” Ms. Jones always follows her doctors’ orders.
4. Offer to adjust the block schedule to better meet your partners’ needs. Maybe their add-on day is Friday afternoons at the hospital, when you could host in the ASC, reducing the possibility of ER cases bumping your add-on cases at the hospital. The physician’s wife will appreciate this when he doesn’t have to cancel dinner reservations due to delays at the hospital.
Sticks
1. Eliminate a low producing partner’s block time. This may seem counterintuitive but it sends the message that you are not going to incur costs to staff a room that is not going to be used.
2. Close your center for two days each week. Compressing your schedule and closing the center for two days sends the message that you are not going to allow a physician to hold his or her block time that is used 20 percent of the time.
3. Discussing the Safe Harbors. ASC operating agreements that govern the surgeon center include language regarding compliance with the Safe Harbors, which, in addition to numerous quality requirements also requires a surgeon owner in a multi-specialty ASC to conduct a minimum of onethird of his or her eligible cases in the ASC.
4. Cash call. Nothing promotes commitment like pulling out your check book to fund the expenses in your center.
Leveraging many or all of these techniques to recruit your partners’ cases will result in increased volume. If you are unsure of how to either implement these techniques or your cost to perform each case, find a development partner that specializes in turning around poor performing centers. This may be the best partner you ever recruited.
Mr. Bishop cbishop@ascoa.com is vice president of acquisitions and development for Ambulatory Surgical Centers of America, a leader in surgery center development and turning around failing centers. Find out more at www.ascoa.com.
