Five ASC administrators weigh in on what they wish they had known at the start of their careers in the outpatient arena.
Question: What are some things you wish you had known when you began your career in the ASC industry that you know now?
Gary A. Richberg, RN, BSN, CMPE, CASC, Administrator, Pacific Rim Outpatient Surgery Center, Bellingham, Wash.: One of the major things I wish I had known was the value of attending the conferences that focused on dealing with insurance companies and reimbursements. I had no idea about the complexities of rate negotiations in the beginning of my career. I also learned that high case volumes did not always translate into higher revenues.
After noticing early in my career that my profit benchmarks were falling short in some months, I focused on both reviewing my payer mix and reimbursement rates to increase my profits as well as whether or not to perform certain cases based on case costing.
I listened to various teaching sessions in the early 2000s from Brent Lambert from Ambulatory Surgical Centers of America and Tom Mallon from Regent Surgical Health, and those sessions helped me to develop a mindset that was beneficial in my early development as a business-focused administrator that complemented my nursing background.
To opine, the value of networking with professionals with proven track records is such a valuable tool in the development and growth of any career.
Benita Tapia RN, CASC, Administrator, Precision Ambulatory Surgery Center & 90210 Surgery Medical Center, Beverly Hills, Calif.: That not only should there be an emergency crash cart in an ASC but there should always be an emergency bottle of wine, ready for the administrator for those stressful days — just kidding!
Seriously though, I came from a clinical background as did a lot of administrators. I wish that starting on this path I had more of a business/marketing background. Nursing taught me a lot about patient safety, compliance and dealing with different personalities. But part of my job is marketing and very much business related.
Also, having a better understanding of one's strengths and weaknesses, and realizing that a good administrator also pulls on the strengths and knowledge of a team is also essential. Understanding that you can't do everything yourself and delegation is a part of the job. I think starting in the ASC as an administrator, I thought I needed to do everything myself. Learning to delegate is part of my job and balance in life, in general, is good. All that comes with experience.
Becky Zeigler-Otis, Administrator, ASC of Stevens Point (Wis.): I wish I had known more about the amount of regulation and standards by which an ASC and its staff have to abide. You really have to learn from a variety of resources and stay up-to-date with regulations required of ASCs. Most of those resources, like ours, are small and you have no large departments to go to that can assist you with keeping on top of all of the regulations.
I also wish I had known more about financials. This is something you really have to focus on to keep your company agile and profitable.
Susan L. Carocari, BSN, RN, CAPA, Administrator, River Valley Ambulatory Surgery Center, Norwich, Conn.: Gosh, that's a tough question, so many answers! I had no previous experience with ASCs, since my entire 32 years in nursing had previously been in a hospital setting. Our facility started from scratch when I came on board. This meant I had to learn everything from how a surgery center is built to regulations and facilities requirements to Accreditation Association for Ambulatory Health Care standards and business office functions. The best guide to these items was probably the AAAHC standards manual as well as their Achieving Accreditation conference.
When I first read my job description I was overwhelmed but I have had terrific support from my managing partners as well as the physicians.
I wish I had known that we had to build our EMR from a blank template. This was extremely time consuming initially but has paid off down the road. All EMRs are challenging so I'm not sure ours is any more difficult than others but it can be frustrating when it has issues. I also wish I had known we are essentially our own on site IT managing the system and its numerous problems.
Daron Pealock, RN, Administrator/Director of Nursing, Cedar Orthopaedic Surgery Center, Cedar City, Utah: I wish I known more about the insurance industry and how to work on insurance contract negotiations.
I wish I had known or understood the cutthroat aspect of the hospital industry especially when that entity could cause us to lose insurance contracts via politics and pressure from there own contracts with insurance companies.