Tim Shannon, vice president of operations for Blue Chip Surgical Center Partners, discusses 10 ways surgery centers can profit from ENT while improving patient safety and satisfaction.
1. Ensure robust volume. ENT does not have the reimbursement power of specialties such as orthopedics or spine, but it can be profitable for surgery centers if the facility can guarantee volume. Mr. Shannon says depending on contracts, ENT physicians should be expected to bring approximately 250 cases to the center each year to offset the cost of expenses and initial start-up fees. Because revenue for ENT cases is limited, volume is key to ensuring profitability. "Reimbursement isn't great, but if you have good volume, you can certainly make it beneficial," he says.
2. Plan for $100,000 per ENT room. A multi-specialty ASC looking to add ENT should plan on spending approximately $100,000 per ENT room. This would cover equipment and supplies, including a microscope, sinus shavers, rigid scopes and instrument trays. "If you have volume to support additional rooms, you can take that number and multiply it by the number of rooms," Mr. Shannon says.
3. Negotiate strong contracts. While ENT does not have the same implant considerations as other specialties, robust payor contracts are still essential to profitability. Mr. Shannon estimates that ASCs can expect to see anywhere from $300-$700 in per-case reimbursement after expenses, but the number depends heavily on negotiation. Make sure your contract manager is familiar with the cost of each procedure and the savings to the insurance company.
4. Focus on profitable procedures. The best ENT cases for surgery centers are those that are quick and easy to perform — namely tonsils, adenoids and tubes. While most ENT surgeries, with the exception of larger thyroid procedures, are appropriate for ASCs, those that require more time may be less profitable due to reimbursement issues.
5. Plan a sizable waiting and recovery area. ENT-driven surgery centers will see a lot of pediatric patients, meaning both the waiting and recovery areas must be large enough to accommodate family members. "ENT tends to come with a lot of extra volume in terms of people," Mr. Shannon says. "Make sure you have enough room to support the family when they come in, because it's very important to the child that there are familiar faces around when they wake up."
6. Decrease turnover times. Efficiency is the name of the game in ENT, and thus short turnover times are essential to keep cases moving. Mr. Shannon estimates that turnover for tubes will take approximately five minutes, while turnover for tonsils and adenoids will take around 10-12 minutes. These numbers obviously vary based on the physician and staff members, but ASCs should make sure to have enough supporting supplies and equipment to perform consecutive procedures.
7. Dedicate a nurse to each pediatric patient. ASCs that focus strictly on adult patients may use one nurse to cover multiple patients in the recovery area. The nurse can move back and forth from patient to patient as they wake up and recover from anesthesia. Because ENT cases are often performed on children, however, ASCs should be prepared to dedicate one nurse to each child in the recovery area. "With pediatrics you want to have more nurse staffing to make sure you're covered," Mr. Shannon says. "When a child wakes up, you don't know if it will be nice and easy or if the child will [panic] in unfamiliar territory."
8. Find providers with PALS certification. ASCs that perform ENT should find staff members with Pediatric Advanced Life Support certification. While pediatric anesthesiologists will have PALS certification, at least one other staff member should also hold the certification in case anesthesia is not able to be in the recovery room.
9. Pair ENT with a specialty that performs longer cases. ENT can work well in a multi-specialty ASC when paired with other specialties that require more case time. "That way, you can have ENT in one room doing short cases, and another specialty, like general surgery, spine or orthopedics, working in the other room on longer cases," Mr. Shannon says. "The specialties are not competing for the same recovery room beds."
10. Tout ASC efficiency to local ENT physicians. Physician recruitment is a challenge for most surgery centers, and ENT is so surgery center-appropriate that some markets may have saturated the local physician population. However, Mr. Shannon says surgery centers have an advantage in ENT physician recruitment because of the specialty's natural efficiency. "Doctors like ASCs because they're quick and easy, and in hospitals, they get bogged down due to emergency procedures," he says. Talk to providers about your ASC's case times and turnover times to demonstrate the benefits of performing ENT in a surgery center.
Learn more about Blue Chip Surgical Center Partners.
Related Articles on Surgery Center Specialties:
How to Bring Spine to a Surgery Center: Q&A With Chris Bishop of Blue Chip Surgical Partners
50 Benchmarks of 5 Top ASC Specialties
Ophthalmologist Compensation: 10 Statistics to Know
1. Ensure robust volume. ENT does not have the reimbursement power of specialties such as orthopedics or spine, but it can be profitable for surgery centers if the facility can guarantee volume. Mr. Shannon says depending on contracts, ENT physicians should be expected to bring approximately 250 cases to the center each year to offset the cost of expenses and initial start-up fees. Because revenue for ENT cases is limited, volume is key to ensuring profitability. "Reimbursement isn't great, but if you have good volume, you can certainly make it beneficial," he says.
2. Plan for $100,000 per ENT room. A multi-specialty ASC looking to add ENT should plan on spending approximately $100,000 per ENT room. This would cover equipment and supplies, including a microscope, sinus shavers, rigid scopes and instrument trays. "If you have volume to support additional rooms, you can take that number and multiply it by the number of rooms," Mr. Shannon says.
3. Negotiate strong contracts. While ENT does not have the same implant considerations as other specialties, robust payor contracts are still essential to profitability. Mr. Shannon estimates that ASCs can expect to see anywhere from $300-$700 in per-case reimbursement after expenses, but the number depends heavily on negotiation. Make sure your contract manager is familiar with the cost of each procedure and the savings to the insurance company.
4. Focus on profitable procedures. The best ENT cases for surgery centers are those that are quick and easy to perform — namely tonsils, adenoids and tubes. While most ENT surgeries, with the exception of larger thyroid procedures, are appropriate for ASCs, those that require more time may be less profitable due to reimbursement issues.
5. Plan a sizable waiting and recovery area. ENT-driven surgery centers will see a lot of pediatric patients, meaning both the waiting and recovery areas must be large enough to accommodate family members. "ENT tends to come with a lot of extra volume in terms of people," Mr. Shannon says. "Make sure you have enough room to support the family when they come in, because it's very important to the child that there are familiar faces around when they wake up."
6. Decrease turnover times. Efficiency is the name of the game in ENT, and thus short turnover times are essential to keep cases moving. Mr. Shannon estimates that turnover for tubes will take approximately five minutes, while turnover for tonsils and adenoids will take around 10-12 minutes. These numbers obviously vary based on the physician and staff members, but ASCs should make sure to have enough supporting supplies and equipment to perform consecutive procedures.
7. Dedicate a nurse to each pediatric patient. ASCs that focus strictly on adult patients may use one nurse to cover multiple patients in the recovery area. The nurse can move back and forth from patient to patient as they wake up and recover from anesthesia. Because ENT cases are often performed on children, however, ASCs should be prepared to dedicate one nurse to each child in the recovery area. "With pediatrics you want to have more nurse staffing to make sure you're covered," Mr. Shannon says. "When a child wakes up, you don't know if it will be nice and easy or if the child will [panic] in unfamiliar territory."
8. Find providers with PALS certification. ASCs that perform ENT should find staff members with Pediatric Advanced Life Support certification. While pediatric anesthesiologists will have PALS certification, at least one other staff member should also hold the certification in case anesthesia is not able to be in the recovery room.
9. Pair ENT with a specialty that performs longer cases. ENT can work well in a multi-specialty ASC when paired with other specialties that require more case time. "That way, you can have ENT in one room doing short cases, and another specialty, like general surgery, spine or orthopedics, working in the other room on longer cases," Mr. Shannon says. "The specialties are not competing for the same recovery room beds."
10. Tout ASC efficiency to local ENT physicians. Physician recruitment is a challenge for most surgery centers, and ENT is so surgery center-appropriate that some markets may have saturated the local physician population. However, Mr. Shannon says surgery centers have an advantage in ENT physician recruitment because of the specialty's natural efficiency. "Doctors like ASCs because they're quick and easy, and in hospitals, they get bogged down due to emergency procedures," he says. Talk to providers about your ASC's case times and turnover times to demonstrate the benefits of performing ENT in a surgery center.
Learn more about Blue Chip Surgical Center Partners.
Related Articles on Surgery Center Specialties:
How to Bring Spine to a Surgery Center: Q&A With Chris Bishop of Blue Chip Surgical Partners
50 Benchmarks of 5 Top ASC Specialties
Ophthalmologist Compensation: 10 Statistics to Know