Here are 14 goals ambulatory surgery centers can work to achieve by the end of 2011, as identified by Joan Dentler, president of ASC Strategies; Reed Martin, chief operating officer of Surgical Management Professionals; and Joseph Zasa, managing and founding partner of ASD Management.
1. Add one more physician to your ASC medical staff. At your next employee staff meeting, ask employees if they know any unaffiliated physicians that might be interested in doing cases at your facility, says Mr. Martin. And at your next medical staff meeting, ask your physicians if they know of any surgeons new to the area, unaffiliated with other health systems or not invested in another ASC.
"Meet these potential new doctors at their office and bring their favorite lunch if it helps your cause," he says. "Invite them for a tour to see your facility, your equipment and staff, and to meet with a few of your doctors and anesthesia providers. If they are interested, have a credentialing packet ready and be able to talk about potential investment opportunities down the road."
2. Prepare to take inventory. "Get ready to take inventory at year's end," says Mr. Zasa. "Work with your accountant to see if they need to be onsite when it is taken. We believe it is a good idea to take inventory at least twice per year, particularly if you use electronic inventory programs."
3. Survey your physicians. On at least an annual basis, you should take the time to survey each of the surgeons on your medical staff to find out what is working and what isn't, says Ms. Dentler.
"Pay close attention to the ones who may have reduced utilization, and find out why," she says. "Sometimes there can be simple adjustments to operations that may bring them back into the operating room."
In conjunction with this, she says ASCs should review current block time utilization and make changes to maximize efficiencies.
4. Perform case costing. Mr. Zasa advises ASCs to prepare an analysis of their top three most costly procedures. "Do it on a per surgeon basis to compare them against their
peers," he says. "If possible, obtain benchmark data. The hope is that you can change
behavior so that there is standardization on supplies and implants."
5. Reduce your accounts receivable days to 35. To reduce your A/R days, bill as many payors as possible electronically and evaluate your process for correcting electronically submitted claims, Mr. Martin says. Meet weekly with your business office manager and evaluate the follow-up process on the larger claims over 60 days.
"Is the reason for the claim rejection getting corrected? Are the claims worked every two weeks? Are some of your physicians taking too long to dictate operative reports?" he says. "If so, and if a meeting with the physician doesn't improve results, utilize statistics and peer pressure to improve timeliness. Track denials and correct the reason for the denial so that it doesn't keep happening."
6. Clean up, update and/or load current (accurate) data into your IT system. "You need to have a 'real-time' idea of what is going on with your ASC operations," Ms. Dentler says. "Too often reports are built from incomplete or out-of-date data and therefore have little meaning when it comes to making management decisions. Remember: 'garbage in-garbage out.'"
7. Conduct a revenue cycle review. Look at your payor contracts, coding, collections, denials, etc., and set performance goals for the coming year, says Ms. Dentler. "Just because money is coming in, it doesn't mean your collecting every penny," she says. "If you haven't performed a third-party coding/billing review in 2011, you should schedule one before the end of the year. This is important whether you are performing the function in-house or outsourcing. Any good coder/biller — or company — should welcome a third-party audit."
8. Analyze your group purchasing organization. This is a good time to shop group purchasing organizations to ensure that you are getting the best deal for your supplies, Mr. Zasa says. "Make sure that you have an audit tool to objectively check if you are getting the correct GPO pricing," he says.
9. Perform a global analysis of your market. Mr. Zasa advises asking yourself these questions: "Is it time to look at a joint venture with a strategic partner? Does partnering with a hospital make sense? Are your physicians' practices being bought and/or are their referral patterns impacting your center?"
10. Reduce excess medical supply inventory by year's end. Identify all inventory in your ASC with over 45 days usage on hand, Mr. Martin says. "List from highest inventory value over 45 days to lowest and make highest excess inventory items a reduction priority," he says. "Work with vendors to see if you can return for credit or trade the excess inventory."
You should also evaluate any substitution possibilities for this excess inventory and determine if other ASCs or a hospital might buy the excess at a discounted price. Finally, donate inventory not likely to be used, he says.
11. Meet with your local hospital. If your center isn't currently associated with the local hospital, set up an appointment to meet with the CEO and see how you can better work together in the coming year, Ms. Dentler says. "Many hospitals are looking to align with freestanding ASCs to provide lower-cost environments for outpatient surgical cases that aren't appropriate for on-campus ORs."
12. Improve your OR utilization statistics. Taking a few steps can help you significantly improve your OR utilization. Mr. Martin advises ASCs to track late starts, especially the first start of the day because a late start here can have a snowball effect.
"Track block utilization — decrease block for [the] bottom 10 percent utilizers and increase time, if needed, for top 10 percent utilizers," he says. "Review your process for releasing unused block time. [Is] the medical staff and their schedulers aware of openings early enough to fill in gaps in the schedule?"
13. Review your service contracts. This includes management agreements and anesthesia contracts, says Ms. Dentler. "Be sure the scope of services and fees still match your needs and everyone is performing up to the agreed upon standards," she says.
If you don't have performance standards set for your vendors, insist on revising contracts to include them before any extensions. "It is a competitive market out there and you should require quality outcomes the same way your surgeons and patients (and payors) demand it out of you," Ms. Dentler says.
14. Evaluate payor contracting. Consider that it may be time to renegotiate third-party payor contracts, says Mr. Zasa. "Use your cost data to obtain carve outs on high-cost procedures (see #4)," he says. "Be prepared with as much data as possible. Further, audit random claims from the carriers as part of your compliance plan to ensure that they are paying properly."
Learn more about ASC Strategies www.ascstrategies.com. Contact Joan Dentler at jdentler@ascstrategies.com.
Learn more about Surgical Management Professionals at www.surgicalmanprof.com. Contact SMP at info@smpsd.com.
Learn more about ASD Management at www.asdmanagement.com. Contact Joe Zasa at joezasa@asdmanagement.com.
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10 Ways to Lower ASC Supply Costs