Identifying Your ASC as "High Performance" to Generate Results

Everyone wants higher reimbursement, but is your surgical center making the investment to identify itself as a "high performing" facility that can demand a reimbursement premium?

The reimbursement landscape for ambulatory surgical centers, and for healthcare providers in general, continues to change dramatically. Today's reality includes increasing market competition, pay-for-performance, risk management, regulatory complexities, the emergence of Accountable Care Organizations and numerous operational challenges. To be successful, ASCs must effectively and efficiently combine five core competencies:

•    Operational management
•    Financial management
•    Regulatory compliance
•    Quality measurements
•    Patient (customer) satisfaction

Providers that can demonstrate (and prove) these competencies will be identified as high performing. They can recognize tangible benefits from payors, patients, physicians and staff. Payors will value that they are contracting with a financially stable, quality provider. Patients will be comfortable that the facility exceeds standards. Physicians will be confident in their facility, increasing utilization that drives revenue. Staff will take pride in their center, improving patient care and physician interactions while reducing staff turnover.

1. High performance and reimbursement. Will "high performance" lead to increased reimbursements? It already does: Medicare reduces payments to centers that are not reporting on the five quality measures, and as of last January, ASCs are required to use the safe surgery checklist to avoid financial penalties. All major payors (Blue Cross, Blue Shield, Aetna, Cigna, United Healthcare) are in discussions related to "pay-for-performance" contracts. Your ASC has the ability to define and demonstrate "high performance" within industry guidelines. You can modify the five core competencies mentioned above to differentiate yourself.

2. "Above normal" clinical quality. You can demonstrate your high performance in clinical quality by:

• Documenting your reporting requirements for CMS Quality Indicators
• Documenting peer review on a regular and consistent basis to ensure that your physicians are qualified and competent.
• Ensure that all physicians and staff meet continuing education requirements.
• Have complete charts and forms for all patient encounters.

3. Absolute regulatory compliance. You can demonstrate that you maintain absolute regulatory compliance by maintaining your accreditation through AAAHC, AAAASF, Joint Commission or other credible agencies. Using a program such as AccredAbility (www.mmxhealthcare.com), your facility can maintain absolute records and tracking of everything from OR temperature to generator readiness to credentialing and privileges. If you maintain paper records, your binders must be accurate and up-to-date. You must always be ready for your next inspection.

4. Outstanding patient satisfaction. A high performing center puts a premium on outstanding patient satisfaction and can share results with payers. Physicians and staff must agree that patient satisfaction goes hand-in-hand with clinical quality. All centers will collect, analyze and report on patient satisfaction data quarterly. A high performing center will work to get 100% satisfaction, make survey results available and deal with any problems or complaints in a patient-centric, transparent manner.

5. Profitable financial management. A high performing center will demonstrate financial stability to a payer through its profit & loss statement, its balance sheet, and through key performance metrics. This center will know its case reimbursement by payer and have a complete understanding of its cost/case. Using a program such as ManageMyASC (also at www.mmxhealthcare.com), a center can quickly and easily communicate its financial acumen.

6. Proven operational competence. A high performing center can prove operational competence that corresponds to profitable financial management and outstanding patient satisfaction. What makes our center special? What is your case capacity? What are the average "door-to-door" times for your most common procedures? Can you describe in a positive way your patient flow from scheduling to post-op follow up calls?

Summary
Delivering on these five competencies and being able to demonstrate (prove) them doesn't just happen. It is an investment of time and money. It is a culture that you can create. Doing these things — identifying yourself as a high performing surgical center – positions you to attain maximum reimbursement from your payers and allows you to recruit and retain the best physicians and staff.