Whether you base your benchmarking on data from local ASCs, national surveys or your own data history, benchmarking can give you a good idea of where you stand in comparison to your competitors, the national average and yourself. Sandy Berreth, administrator of Brainerd Lakes Surgical Center in Baxter, Minn., discusses 15 processes she benchmarks for different clinical and staff members in her facility. She recommends every ASC use a combination of national, local and internal for benchmarking, as not every process will be benchmarked through a national survey.
Physicians
1. OR utilization. While Ms. Berreth benchmarks time spent in the OR, she says she doesn't find it particularly useful because different surgeons will always take different amounts of time to perform procedures. Instead, she benchmarks OR utilization. "I look at how the different doctors use their block times, and the expectation is that they use 86 percent of their block time," she says. "We want to know if the OR is utilized, and if it's utilized correctly."
ASC chief financial officer
2. Timeliness of accounts payable. Ms. Berreth says benchmarking should not stop with clinical staff and front desk members. She benchmarks her administrative team, including her chief financial officer, to ensure optimal performance. She says the CFO is benchmarked on the timeliness of her accounts payable, as well as how many delinquent payables the ASC experiences on a regular basis. Benchmarking the timeliness of accounts payable gives Ms. Berreth a better idea of how the CFO performs over time, as well as compared to other facilities, and ensures more prompt payment to suppliers over time.
ASC administrator
3. ASC budget. Ms. Berreth keeps track of how closely she stays on budget every year to determine how her budgeting skills change over time. She says her governing board expects her to stay within 3 percent plus or minus to meet the budget standard, though she tries to exceed that expectation.
4. Increases in third-party payor contracts. In order for Ms. Berreth to keep center revenues high, she must negotiate regular increases in third-party payor contracts. Every few years, she benchmarks increases in payor contracts to determine whether the ASC is gaining leverage over time. "2011 is my year for negotiating, so one of my benchmarks will be on my ability to negotiate an increase of at least 5 percent," she says.
5. Rate of terminations and resignations. One of the best ways to determine staff satisfaction in an ASC is to look at the rate of turnover, Ms. Berreth says. She benchmarks the rate of terminations and resignations to tell whether the ASC is losing more people than in previous years.
6. Number of staff educational sessions. If your ASC administrator is expected to provide regular educational sessions, you should benchmark the amount of education provided against your history, as well as other ASCs, if you can attain that information. Ms. Berreth benchmarks education to ensure that she provides at least one educational session every month and one annual education day. "I have to make sure that the staff are being updated — not just business-wise, but education-wise," she says.
Billing and coding team
7. Percentage of denials. Ms. Berreth says she tracks the percentage of denials in her ASC to better understand why claims are denied and how often errors occur. Since your ASC would ideally submit clean claims all the time, you need to know how often claims are submitted incorrectly and causing delays in payment for your center. Once you know whether your ASC receives an unusually high number of denials, Ms. Berreth says you can start to "dig deeper" to investigate the root cause. "Was the claim denied because the code was inappropriate and not able to be paid in an ASC?" she says.
8. Turnaround on claims. Ms. Berreth says her ASC also benchmarks how long it takes for claims to be processed and paid. If your ASC takes a long time to receive payment, you should obviously seek out the problem and determine whether the lag exists in your center or with the payor.
Schedulers
9. Average number of days to fulfill a request. According to Ms. Berreth, ASCs should benchmark the average number of days between a patient requesting a procedure to the date of procedure. At Brainerd Lakes Surgical Center, she says she documents the time it takes the scheduler to schedule an injection, as well as how long it takes the scheduler to book a physical at the local clinic. "If you're having back pain, you certainly don't want to wait two weeks," she says. Comparing the average wait time for an appointment to other centers, as well as the ASC's history, can help ensure patients are seen in a timely manner, which increases patient satisfaction.
Ms. Berreth adds that this benchmarking practice is particularly important if your ASC relies on one scheduler. If one staff member is responsible for scheduling, delays or oversights in scheduling might be overlooked or forgotten. Your center should also benchmark against other centers' scheduling turnaround time to ensure you don't lose patients to competitors who can provide appointments more quickly.
Nurses
10. IV starts. Ms. Berreth says her ASC benchmarks how many tries it takes each ASC nurse to complete an IV stick, as well as whether the nurse prepares the skin properly and where his or her technique lies on a quality spectrum. "I think most ASCs go with the standard that a nurse is a nurse is a nurse, and every nurse should be able to start an IV because they're trained to do it," she says. "But if I have nurses who start IVs on their very first stick. As for that outlier who takes five sticks — maybe he or she shouldn't be starting IVs."
11. Hand-washing. Hand-washing may seem like a relatively simple practice, but many ASC administrators agree that their staff members are often unaware of how — and how long — to wash their hands. According to Jane Kirk MSN, RN, CIC, clinical specialist and adviser for GOJO Industries, staff should wash their hands with soap and water for 15 seconds — about the amount of time it takes to sing "Happy Birthday." Ms. Berreth says she uses her patient care coordinator for the pre/post-operative area to document hand-washing. "If [as an administrator], I went out and just hung around the nurse's station, it would be really odd," she says. "So I have my patient care coordinator take data sheets on every one of the staff and mark down whether they're washing their hands appropriately."
12. Time-outs. Brainerd Lakes Surgical Center also benchmarks how often time-outs are performed appropriately prior to an incision. Ms. Berreth says benchmarking time-outs is critical to ensure compliance with federal and accreditation body regulations. "We have a data sheet that my clinical coordinator for the OR takes to every room, and nobody thinks, 'What are you doing?' because she's in the rooms all the time anyway," Ms. Berreth says. "She does three or four different cases on every circulating RN."
Front desk staff
13. Timing of pre-op telephone calls. Ms. Berreth says benchmarking the timing of pre-op telephone calls can also contribute to patient satisfaction, as well as efficiency. "We try not to call too many days out in advance," she says. "We look at the timeframe from when the patient is scheduled to when the patient is called and all the information is on the chart, ready to go for the surgery," she says.
14. Length of registration. Benchmarking the time it takes to register a patient can give your ASC an idea of why patients may be dissatisfied with the initial registration process, as well as which ASC members can complete registration in a timely fashion. "The whole thing can fall apart if you have 40 patients and somebody who doesn't know how to use the computer system," she says.
15. Patient understanding of information. A patient who arrives at your ASC confused and disoriented may be less likely to have a good experience, so benchmarking the patient experience prior to arrival is essential. Ms. Berreth distributes a questionnaire to patients that asks them to evaluate the difficulty of finding the center, then reviews those questionnaires every month to determine how many patients are getting lost. Over time, she uses that information to improve pre-operative telephone calls or the map distributed to patients.
Read more about benchmarking:
-6 Steps to Reduce Transfer Rates Through Benchmarking
-Critical ASC Mistake: Benchmarking Externally But Not Internally
Physicians
1. OR utilization. While Ms. Berreth benchmarks time spent in the OR, she says she doesn't find it particularly useful because different surgeons will always take different amounts of time to perform procedures. Instead, she benchmarks OR utilization. "I look at how the different doctors use their block times, and the expectation is that they use 86 percent of their block time," she says. "We want to know if the OR is utilized, and if it's utilized correctly."
ASC chief financial officer
2. Timeliness of accounts payable. Ms. Berreth says benchmarking should not stop with clinical staff and front desk members. She benchmarks her administrative team, including her chief financial officer, to ensure optimal performance. She says the CFO is benchmarked on the timeliness of her accounts payable, as well as how many delinquent payables the ASC experiences on a regular basis. Benchmarking the timeliness of accounts payable gives Ms. Berreth a better idea of how the CFO performs over time, as well as compared to other facilities, and ensures more prompt payment to suppliers over time.
ASC administrator
3. ASC budget. Ms. Berreth keeps track of how closely she stays on budget every year to determine how her budgeting skills change over time. She says her governing board expects her to stay within 3 percent plus or minus to meet the budget standard, though she tries to exceed that expectation.
4. Increases in third-party payor contracts. In order for Ms. Berreth to keep center revenues high, she must negotiate regular increases in third-party payor contracts. Every few years, she benchmarks increases in payor contracts to determine whether the ASC is gaining leverage over time. "2011 is my year for negotiating, so one of my benchmarks will be on my ability to negotiate an increase of at least 5 percent," she says.
5. Rate of terminations and resignations. One of the best ways to determine staff satisfaction in an ASC is to look at the rate of turnover, Ms. Berreth says. She benchmarks the rate of terminations and resignations to tell whether the ASC is losing more people than in previous years.
6. Number of staff educational sessions. If your ASC administrator is expected to provide regular educational sessions, you should benchmark the amount of education provided against your history, as well as other ASCs, if you can attain that information. Ms. Berreth benchmarks education to ensure that she provides at least one educational session every month and one annual education day. "I have to make sure that the staff are being updated — not just business-wise, but education-wise," she says.
Billing and coding team
7. Percentage of denials. Ms. Berreth says she tracks the percentage of denials in her ASC to better understand why claims are denied and how often errors occur. Since your ASC would ideally submit clean claims all the time, you need to know how often claims are submitted incorrectly and causing delays in payment for your center. Once you know whether your ASC receives an unusually high number of denials, Ms. Berreth says you can start to "dig deeper" to investigate the root cause. "Was the claim denied because the code was inappropriate and not able to be paid in an ASC?" she says.
8. Turnaround on claims. Ms. Berreth says her ASC also benchmarks how long it takes for claims to be processed and paid. If your ASC takes a long time to receive payment, you should obviously seek out the problem and determine whether the lag exists in your center or with the payor.
Schedulers
9. Average number of days to fulfill a request. According to Ms. Berreth, ASCs should benchmark the average number of days between a patient requesting a procedure to the date of procedure. At Brainerd Lakes Surgical Center, she says she documents the time it takes the scheduler to schedule an injection, as well as how long it takes the scheduler to book a physical at the local clinic. "If you're having back pain, you certainly don't want to wait two weeks," she says. Comparing the average wait time for an appointment to other centers, as well as the ASC's history, can help ensure patients are seen in a timely manner, which increases patient satisfaction.
Ms. Berreth adds that this benchmarking practice is particularly important if your ASC relies on one scheduler. If one staff member is responsible for scheduling, delays or oversights in scheduling might be overlooked or forgotten. Your center should also benchmark against other centers' scheduling turnaround time to ensure you don't lose patients to competitors who can provide appointments more quickly.
Nurses
10. IV starts. Ms. Berreth says her ASC benchmarks how many tries it takes each ASC nurse to complete an IV stick, as well as whether the nurse prepares the skin properly and where his or her technique lies on a quality spectrum. "I think most ASCs go with the standard that a nurse is a nurse is a nurse, and every nurse should be able to start an IV because they're trained to do it," she says. "But if I have nurses who start IVs on their very first stick. As for that outlier who takes five sticks — maybe he or she shouldn't be starting IVs."
11. Hand-washing. Hand-washing may seem like a relatively simple practice, but many ASC administrators agree that their staff members are often unaware of how — and how long — to wash their hands. According to Jane Kirk MSN, RN, CIC, clinical specialist and adviser for GOJO Industries, staff should wash their hands with soap and water for 15 seconds — about the amount of time it takes to sing "Happy Birthday." Ms. Berreth says she uses her patient care coordinator for the pre/post-operative area to document hand-washing. "If [as an administrator], I went out and just hung around the nurse's station, it would be really odd," she says. "So I have my patient care coordinator take data sheets on every one of the staff and mark down whether they're washing their hands appropriately."
12. Time-outs. Brainerd Lakes Surgical Center also benchmarks how often time-outs are performed appropriately prior to an incision. Ms. Berreth says benchmarking time-outs is critical to ensure compliance with federal and accreditation body regulations. "We have a data sheet that my clinical coordinator for the OR takes to every room, and nobody thinks, 'What are you doing?' because she's in the rooms all the time anyway," Ms. Berreth says. "She does three or four different cases on every circulating RN."
Front desk staff
13. Timing of pre-op telephone calls. Ms. Berreth says benchmarking the timing of pre-op telephone calls can also contribute to patient satisfaction, as well as efficiency. "We try not to call too many days out in advance," she says. "We look at the timeframe from when the patient is scheduled to when the patient is called and all the information is on the chart, ready to go for the surgery," she says.
14. Length of registration. Benchmarking the time it takes to register a patient can give your ASC an idea of why patients may be dissatisfied with the initial registration process, as well as which ASC members can complete registration in a timely fashion. "The whole thing can fall apart if you have 40 patients and somebody who doesn't know how to use the computer system," she says.
15. Patient understanding of information. A patient who arrives at your ASC confused and disoriented may be less likely to have a good experience, so benchmarking the patient experience prior to arrival is essential. Ms. Berreth distributes a questionnaire to patients that asks them to evaluate the difficulty of finding the center, then reviews those questionnaires every month to determine how many patients are getting lost. Over time, she uses that information to improve pre-operative telephone calls or the map distributed to patients.
Read more about benchmarking:
-6 Steps to Reduce Transfer Rates Through Benchmarking
-Critical ASC Mistake: Benchmarking Externally But Not Internally