"You can't manage what you don't measure" — words to live by, according to many ASC administrators. Aaron Murski, senior manager at VMG Health discusses 10 statistics every ASC should track and how frequently they should be tracked to ensure financial health and high quality of care.
1. Adverse events. As health reform increases the focus on tracking quality measures, Mr. Murski recommends ASCs track adverse events and look at each event individually. "Some ASCs are really lacking in [tracking quality], and quality is huge in healthcare reform," he says. "If you don't have the infrastructure to track adverse events and prove that you're delivering on quality measures, you're going to be [behind]." He says ASCs should keep records on every adverse event — patient falls, infections, wrong-site surgery and others — and examine those events to determine why they happened and what could have been done differently to prevent them.
2. Staffing costs per case. ASC administrators should look at staff costs per case on a weekly basis, especially if the ASC has a dramatically changing volume, says Mr. Murski. Looking at staffing costs per case should include examining hours spent per case, as well as staffing trends over time. "With centers that have plastics, for example, plastic/cosmetic surgeons can assume quite a bit of time in the OR and destroy the profitability of a case really quickly," Mr. Murski says. "You should understanding staffing costs on a per case and per hour basis."
3. Revenue. Mr. Murski recommends looking at your income statement, including days in A/R and reimbursements from different payors, once a month. "It depends on the comfort level of the physician partners [how often you examine revenue]," he says. "Some physicians want a higher touch and want to see a report weekly, but all ASCs should look at those key indicators of revenue once a month." He says ASCs should aim to increase A/R turnover and decrease days outstanding over time, and looking at revenue on a regular basis should help administrators understand where money is being lost and how to fix it.
4. Patient satisfaction. Looking at patient satisfaction scores on a monthly basis may not be necessary if your ASC has consistently received very high satisfaction scores, Mr. Murski says, but other centers should definitely look at surveys regularly. "Most surgery centers give exit surveys to patients and their families, and those can be compiled on a monthly basis," he says. Addressing problems as they arise will help correct poor behavior by physicians and staff members, he says. If you wait until many months or a year after a bad patient experience occurs, your staff members will not remember the event and may be less likely to learn from it.
5. Physician satisfaction. Tracking physician satisfaction will differ depending on the ASC, Mr. Murski says. "Some ASCs have five utilizers, and they've all invested, and they've had the same staff for 10 years," he says. "In that case, physician satisfaction isn't as much of an issue." On the other hand, he says ASCs with more casual utilizers should aim to address physician satisfaction at monthly board meetings. "Keeping physicians happy is just as important as patient satisfaction," he says. "If the ASC caters to the casual or non-invested utilizer or they have a very large utilization base, they should be looking at those scores once a month."
6. Supply costs per case. Especially with surgical specialties like orthopedics, where supplies can be expensive, your ASC should track your supply costs per case and make sure they're "trending down over time," says Mr. Murski. Looking at supply costs per case can also give you an idea of which specialties, physicians, staff members and times of day mean more money spent on supplies. Once you know where you're losing money on supplies, you can target specific physicians or staff members with education about how to use supplies without wasting money.
7. Number of vendors. Mr. Murski recommends examining the number of vendors used for supplies on a quarterly basis. Surgery centers can easily waste money by failing to standardize their products, he says. "I saw a surgery center that used ENT wands for procedures, and each physician was using a different supplier," he says. "The administrator finally had enough and got them to use one supplier, and now the ASC is a volume buyer and they're able to cut that cost way down." He says because most ASCs can't drastically affect their reimbursements, they should instead focus on cutting expenses as a way to make more money.
8. Concentration of revenue among specialties. According to Mr. Murski, if you run a multi-specialty ASC, you need to know "what your revenue is made of." If you keep track of how much revenue each specialty brings in, you can make better informed decisions during contract negotiations. "It's important to see the direction of your case mix," he says. "It's not necessarily something you can have control over, but you can definitely brace for something if you know it's coming." For example, he says if you know that Medicare reimbursements for GI are being tied to hospital outpatient department rates, you can use the information to budget for the coming years based on your concentration of GI cases.
9. Business risk. On a quarterly basis, Mr. Murski recommends ASCs look at the risk of their business and determine whether the loss of one physician would be a major detriment to the center. "If you've got one person doing all the volume, and — heaven forbid — something happens to [him or her], that's a much riskier business than if you've got a well-diversified and productive physician base," he says. He says ASCs should avoid having one or two physicians performing a heavy concentration of the cases. "It's a 'what if' situation," he says. "If you're planning for the worst, you've got to know where your risks are."
10. Staff satisfaction. Examining staff satisfaction rates can coincide neatly with your ASC's biannual or annual review process, Mr. Murski says. During reviews, your administrator should ask questions about staff satisfaction, discussing the workplace environment, ASC leadership, relationships between staff members and the future of the center. If you want to track staff satisfaction on a more regular basis, Mr. Murski recommends an old stand-by — the employee suggestion box. "It sounds pretty simple, but having a comments box can help you track staff satisfaction between performance reviews," he says.
Read more insights from the team at VMG Health:
-10 ASC Benchmarking Statistics on Case Revenue
-Critical ASC Mistake: Accepting Highest Bidder But Not Best Long-Term Partner
Daily
1. Adverse events. As health reform increases the focus on tracking quality measures, Mr. Murski recommends ASCs track adverse events and look at each event individually. "Some ASCs are really lacking in [tracking quality], and quality is huge in healthcare reform," he says. "If you don't have the infrastructure to track adverse events and prove that you're delivering on quality measures, you're going to be [behind]." He says ASCs should keep records on every adverse event — patient falls, infections, wrong-site surgery and others — and examine those events to determine why they happened and what could have been done differently to prevent them.
Weekly
2. Staffing costs per case. ASC administrators should look at staff costs per case on a weekly basis, especially if the ASC has a dramatically changing volume, says Mr. Murski. Looking at staffing costs per case should include examining hours spent per case, as well as staffing trends over time. "With centers that have plastics, for example, plastic/cosmetic surgeons can assume quite a bit of time in the OR and destroy the profitability of a case really quickly," Mr. Murski says. "You should understanding staffing costs on a per case and per hour basis."
Monthly
3. Revenue. Mr. Murski recommends looking at your income statement, including days in A/R and reimbursements from different payors, once a month. "It depends on the comfort level of the physician partners [how often you examine revenue]," he says. "Some physicians want a higher touch and want to see a report weekly, but all ASCs should look at those key indicators of revenue once a month." He says ASCs should aim to increase A/R turnover and decrease days outstanding over time, and looking at revenue on a regular basis should help administrators understand where money is being lost and how to fix it.
4. Patient satisfaction. Looking at patient satisfaction scores on a monthly basis may not be necessary if your ASC has consistently received very high satisfaction scores, Mr. Murski says, but other centers should definitely look at surveys regularly. "Most surgery centers give exit surveys to patients and their families, and those can be compiled on a monthly basis," he says. Addressing problems as they arise will help correct poor behavior by physicians and staff members, he says. If you wait until many months or a year after a bad patient experience occurs, your staff members will not remember the event and may be less likely to learn from it.
5. Physician satisfaction. Tracking physician satisfaction will differ depending on the ASC, Mr. Murski says. "Some ASCs have five utilizers, and they've all invested, and they've had the same staff for 10 years," he says. "In that case, physician satisfaction isn't as much of an issue." On the other hand, he says ASCs with more casual utilizers should aim to address physician satisfaction at monthly board meetings. "Keeping physicians happy is just as important as patient satisfaction," he says. "If the ASC caters to the casual or non-invested utilizer or they have a very large utilization base, they should be looking at those scores once a month."
6. Supply costs per case. Especially with surgical specialties like orthopedics, where supplies can be expensive, your ASC should track your supply costs per case and make sure they're "trending down over time," says Mr. Murski. Looking at supply costs per case can also give you an idea of which specialties, physicians, staff members and times of day mean more money spent on supplies. Once you know where you're losing money on supplies, you can target specific physicians or staff members with education about how to use supplies without wasting money.
Quarterly
7. Number of vendors. Mr. Murski recommends examining the number of vendors used for supplies on a quarterly basis. Surgery centers can easily waste money by failing to standardize their products, he says. "I saw a surgery center that used ENT wands for procedures, and each physician was using a different supplier," he says. "The administrator finally had enough and got them to use one supplier, and now the ASC is a volume buyer and they're able to cut that cost way down." He says because most ASCs can't drastically affect their reimbursements, they should instead focus on cutting expenses as a way to make more money.
8. Concentration of revenue among specialties. According to Mr. Murski, if you run a multi-specialty ASC, you need to know "what your revenue is made of." If you keep track of how much revenue each specialty brings in, you can make better informed decisions during contract negotiations. "It's important to see the direction of your case mix," he says. "It's not necessarily something you can have control over, but you can definitely brace for something if you know it's coming." For example, he says if you know that Medicare reimbursements for GI are being tied to hospital outpatient department rates, you can use the information to budget for the coming years based on your concentration of GI cases.
9. Business risk. On a quarterly basis, Mr. Murski recommends ASCs look at the risk of their business and determine whether the loss of one physician would be a major detriment to the center. "If you've got one person doing all the volume, and — heaven forbid — something happens to [him or her], that's a much riskier business than if you've got a well-diversified and productive physician base," he says. He says ASCs should avoid having one or two physicians performing a heavy concentration of the cases. "It's a 'what if' situation," he says. "If you're planning for the worst, you've got to know where your risks are."
Annually
10. Staff satisfaction. Examining staff satisfaction rates can coincide neatly with your ASC's biannual or annual review process, Mr. Murski says. During reviews, your administrator should ask questions about staff satisfaction, discussing the workplace environment, ASC leadership, relationships between staff members and the future of the center. If you want to track staff satisfaction on a more regular basis, Mr. Murski recommends an old stand-by — the employee suggestion box. "It sounds pretty simple, but having a comments box can help you track staff satisfaction between performance reviews," he says.
Read more insights from the team at VMG Health:
-10 ASC Benchmarking Statistics on Case Revenue
-Critical ASC Mistake: Accepting Highest Bidder But Not Best Long-Term Partner