Ann O'Neill, RN, MBA/HCM, director of clinical operations for Regent Surgical Health, discusses four commonly overlooked surgery center benchmarks, as well as seven steps to benchmark correctly in an ASC.
1. Employee and physician satisfaction. Ms. O'Neill says many surgery centers neglect employee satisfaction surveys, which can help immensely in keeping valuable employees at your ASC. She says employee satisfaction should be benchmarked internally, meaning that you compare your results to the ASC's history, rather than to other surgery centers in your market. Joyce Thomas, senior vice president for Regent Surgical Health recommended forming an "employee relations council" that takes the data from the survey every year and looks for areas of improvement. "The council is run by the employees, and you let them address the issues and come up with solutions," she says. "The council would have a representative from each patient care area — a surgical tech, an RN, a sterile processing employee and some front office and business office staff."
She says employees on the council may come up with "quick fixes" that contribute a lot to satisfaction with little effort or money. For example, the ASC might institute regular staff meetings to communicate what's going on in the organization, if employees respond on the survey that they don't talk enough with administration.
She says while the employee council is intended to concentrate on employee satisfaction, it could also branch into physician satisfaction. "Gather your employees together with your medical directors, and brainstorm how to make the experience better for physicians," she says. She recommends asking questions about why the physicians chose the facility in the first place; how competent ASC staff members are; whether the facility's physical plant is sufficient; how easy the physician finds scheduling a case; and how patients respond to their experience at the ASC.
She says both surveys — physician and employee — should include "general questions" that leave enough space for feedback and comments.
2. Turnover of supplies. Ms. O'Neill recommends looking at how frequently your surgery center orders supplies to determine whether you're wasting money on shipping charges — or wasting money on supplies that you never use. "Ideally you would achieve a just-in-time inventory, and how you do that is benchmarking against yourself," she says "If you're ordering supplies twice a week, you may be spending money on shipping and handling that you don't need to." She says your ASC may be able to save money by ordering supplies once every two weeks.
She recommends looking ahead to the number of cases scheduled in a given week and ordering supplies based on that case volume, rather than placing rush orders because you don't have enough supplies or ordering in bulk so far in advance that you don't know whether you'll need what you're buying. "If you have a supply that you only use four times a year, you don't want to have 15 sitting on a shelf, but if you have something you use every single case, you need to know that you have two weeks' worth," she says.
3. Type of procedures performed at the ASC. Ms. O'Neill says some ASCs don't keep up with the type of procedures that can be performed in the ASC setting. CMS keeps a list of Medicare allowable procedures for the ASC setting on its website, and surgery center administrators should check the list at least annually to determine whether any new procedures have been approved. Private insurance companies will also provide updated lists of ASC allowable procedures.
"If you're not keeping up with your competitors in terms of what payors will allow, you're using opportunities for revenue," she says. Look externally to your competitors to determine whether other centers and your local hospital outpatient departments are performing procedures that you could add to your surgery center. Evaluate the reimbursement potential and if it makes financial and logistical sense, start the conversations with your providers.
4. Staff compensation. Ms. O'Neill says surgery center leaders should always benchmark staff compensation, to ensure they're competitive within their local market fostering recruitment and retention of talented employees. She says the website Salary.com is a useful tool in benchmarking salaries; you can enter a wide range of job descriptions and filter the results by zip code. While the methodology is proprietary, Salary.com uses employer-reported data as a primary source in its calculations. While other salary surveys frequently organize salary data by region — "northeast," for example — Salary.com dissects your area to the lowest level (down to a zip code), giving you a good idea of what the local facilities would pay your nurses.
Once you have an idea of the average salary for a particular position in your area, Ms. O'Neill recommends creating one to three wage ranges for each position in your ASC, depending on skill sets required. For example, an entry-level nurse might make a minimum of $30/hour and a maximum of $45/hour. The wage ranges have to be competitive with the basic market and correspond to the individual's contributions to your center.
Decide which attributes demand more money. In this case, a nurse who can work two different patient care areas (e.g. the pre-op and the PACU) might be in the entry level range, and a nurse who competently works in three patient care areas (e.g. pre-op, OR, and PACU) may be moved into a higher salary range. "It establishes incentive for people wanting to contribute more," she says. "When you implement an objective system, your salaries across the board don't become skewed and your staff feels fairly compensated." If someone hits the maximum wage level in their range, there should be an opportunity for them to earn more if they are willing to contribute more. Some lesser skilled positions only require one wage range to be competitive
She says compensation should also be part of your employee satisfaction surveys. On an annual basis, ask your employees how they feel about salary and benefits, and welcome suggestions for improvement or change.
5. How to benchmark:
Ms. O'Neill offers the following steps for accurate and successful benchmarking in an ambulatory surgery center. These are very much like the steps in "nursing process," "project management" or any "performance improvement" methodology.
1. Identify and describe where there is a gap within your organization that needs addressing
2. Determine what data you need to collect and your method of collection. For example, you might track costs per case for a specific specialty for six months. Make sure you're comparing "apples to apples." Don't track costs per case for GI and put the data into the same bucket as costs per case for orthopedics. When you take the average of the two costs, you will end up with a number that isn't as useful because of the vast discrepancy in cost.
3. Analyze where you are and how you compare. After six months, take your average cost per case for your specific specialty and compare it to data from industry surveys or peer ASCs in your area. Determine how well you're doing or, conversely, how drastically you need to overhaul your cost-cutting efforts.
4. Bring the information to your decision-making group. Take your data — and the conclusions you drew from it — to your quality committee, or your board of directors. Ask them for suggestions or permission to implement an action plan.
5. Make an action plan for improvement. Decide how you will improve costs per case for the next six months. In order to assess the efficacy of your methods, use one method of improvement per benchmarking period. For example, ask your nurses to be hyper-vigilant about not opening packs until the surgeon asks for a supply, and see how that action affects costs per case.
6. Implement the plan. Implement the plan and ensure that everyone understands and is compliant with the change
7. Evaluate your plan's success by re-measuring, then re-tweak as needed. Using the same method as before, re-measure costs per case for the second six-month period and compare to your first benchmarking period. Look to see if your new process still has gaps that could be closed and address them.
It is important to revisit the issue at pre-determined intervals to make sure you are holding the gains you have made.
Learn more about Regent Surgical Health.
Related Articles on ASC Turnarounds:
8 Points of Survival for Surgery Centers After ACOs
8 Surgery Centers in Small Towns
How to Improve Your ASC in 2013: 5 Goals From Arise Healthcare's Jared Leger
1. Employee and physician satisfaction. Ms. O'Neill says many surgery centers neglect employee satisfaction surveys, which can help immensely in keeping valuable employees at your ASC. She says employee satisfaction should be benchmarked internally, meaning that you compare your results to the ASC's history, rather than to other surgery centers in your market. Joyce Thomas, senior vice president for Regent Surgical Health recommended forming an "employee relations council" that takes the data from the survey every year and looks for areas of improvement. "The council is run by the employees, and you let them address the issues and come up with solutions," she says. "The council would have a representative from each patient care area — a surgical tech, an RN, a sterile processing employee and some front office and business office staff."
She says employees on the council may come up with "quick fixes" that contribute a lot to satisfaction with little effort or money. For example, the ASC might institute regular staff meetings to communicate what's going on in the organization, if employees respond on the survey that they don't talk enough with administration.
She says while the employee council is intended to concentrate on employee satisfaction, it could also branch into physician satisfaction. "Gather your employees together with your medical directors, and brainstorm how to make the experience better for physicians," she says. She recommends asking questions about why the physicians chose the facility in the first place; how competent ASC staff members are; whether the facility's physical plant is sufficient; how easy the physician finds scheduling a case; and how patients respond to their experience at the ASC.
She says both surveys — physician and employee — should include "general questions" that leave enough space for feedback and comments.
2. Turnover of supplies. Ms. O'Neill recommends looking at how frequently your surgery center orders supplies to determine whether you're wasting money on shipping charges — or wasting money on supplies that you never use. "Ideally you would achieve a just-in-time inventory, and how you do that is benchmarking against yourself," she says "If you're ordering supplies twice a week, you may be spending money on shipping and handling that you don't need to." She says your ASC may be able to save money by ordering supplies once every two weeks.
She recommends looking ahead to the number of cases scheduled in a given week and ordering supplies based on that case volume, rather than placing rush orders because you don't have enough supplies or ordering in bulk so far in advance that you don't know whether you'll need what you're buying. "If you have a supply that you only use four times a year, you don't want to have 15 sitting on a shelf, but if you have something you use every single case, you need to know that you have two weeks' worth," she says.
3. Type of procedures performed at the ASC. Ms. O'Neill says some ASCs don't keep up with the type of procedures that can be performed in the ASC setting. CMS keeps a list of Medicare allowable procedures for the ASC setting on its website, and surgery center administrators should check the list at least annually to determine whether any new procedures have been approved. Private insurance companies will also provide updated lists of ASC allowable procedures.
"If you're not keeping up with your competitors in terms of what payors will allow, you're using opportunities for revenue," she says. Look externally to your competitors to determine whether other centers and your local hospital outpatient departments are performing procedures that you could add to your surgery center. Evaluate the reimbursement potential and if it makes financial and logistical sense, start the conversations with your providers.
4. Staff compensation. Ms. O'Neill says surgery center leaders should always benchmark staff compensation, to ensure they're competitive within their local market fostering recruitment and retention of talented employees. She says the website Salary.com is a useful tool in benchmarking salaries; you can enter a wide range of job descriptions and filter the results by zip code. While the methodology is proprietary, Salary.com uses employer-reported data as a primary source in its calculations. While other salary surveys frequently organize salary data by region — "northeast," for example — Salary.com dissects your area to the lowest level (down to a zip code), giving you a good idea of what the local facilities would pay your nurses.
Once you have an idea of the average salary for a particular position in your area, Ms. O'Neill recommends creating one to three wage ranges for each position in your ASC, depending on skill sets required. For example, an entry-level nurse might make a minimum of $30/hour and a maximum of $45/hour. The wage ranges have to be competitive with the basic market and correspond to the individual's contributions to your center.
Decide which attributes demand more money. In this case, a nurse who can work two different patient care areas (e.g. the pre-op and the PACU) might be in the entry level range, and a nurse who competently works in three patient care areas (e.g. pre-op, OR, and PACU) may be moved into a higher salary range. "It establishes incentive for people wanting to contribute more," she says. "When you implement an objective system, your salaries across the board don't become skewed and your staff feels fairly compensated." If someone hits the maximum wage level in their range, there should be an opportunity for them to earn more if they are willing to contribute more. Some lesser skilled positions only require one wage range to be competitive
She says compensation should also be part of your employee satisfaction surveys. On an annual basis, ask your employees how they feel about salary and benefits, and welcome suggestions for improvement or change.
5. How to benchmark:
Ms. O'Neill offers the following steps for accurate and successful benchmarking in an ambulatory surgery center. These are very much like the steps in "nursing process," "project management" or any "performance improvement" methodology.
1. Identify and describe where there is a gap within your organization that needs addressing
2. Determine what data you need to collect and your method of collection. For example, you might track costs per case for a specific specialty for six months. Make sure you're comparing "apples to apples." Don't track costs per case for GI and put the data into the same bucket as costs per case for orthopedics. When you take the average of the two costs, you will end up with a number that isn't as useful because of the vast discrepancy in cost.
3. Analyze where you are and how you compare. After six months, take your average cost per case for your specific specialty and compare it to data from industry surveys or peer ASCs in your area. Determine how well you're doing or, conversely, how drastically you need to overhaul your cost-cutting efforts.
4. Bring the information to your decision-making group. Take your data — and the conclusions you drew from it — to your quality committee, or your board of directors. Ask them for suggestions or permission to implement an action plan.
5. Make an action plan for improvement. Decide how you will improve costs per case for the next six months. In order to assess the efficacy of your methods, use one method of improvement per benchmarking period. For example, ask your nurses to be hyper-vigilant about not opening packs until the surgeon asks for a supply, and see how that action affects costs per case.
6. Implement the plan. Implement the plan and ensure that everyone understands and is compliant with the change
7. Evaluate your plan's success by re-measuring, then re-tweak as needed. Using the same method as before, re-measure costs per case for the second six-month period and compare to your first benchmarking period. Look to see if your new process still has gaps that could be closed and address them.
It is important to revisit the issue at pre-determined intervals to make sure you are holding the gains you have made.
Learn more about Regent Surgical Health.
Related Articles on ASC Turnarounds:
8 Points of Survival for Surgery Centers After ACOs
8 Surgery Centers in Small Towns
How to Improve Your ASC in 2013: 5 Goals From Arise Healthcare's Jared Leger