With all the challenges ASCs are currently facing — decreased Medicare reimbursement, a struggling economy and increased competition — it has become more important than ever that ASCs work to increase profits by saving every dollar and avoiding monetary waste. Here are five proactive measures ASCs can take to avoid leaving money on the table.
1. Closely monitor and strategize scheduling. Sue Leveque, RN, administrator at Central California Endoscopy Center in Fresno, Calif., says it is absolutely essential ASCs monitor staffing schedules and scheduled procedures very closely. At Central California Endoscopy, schedulers are charged with watching block time by confirming physicians' schedules two months ahead of time, which gives the scheduler a clear view of expected vacation times and can more effectively schedule procedures accordingly.
"Schedulers start calling around and ask each of our 14 physicians to give them dates they would like off for vacation and fax it to the front office, so if physicians need two weeks for vacation we can more easily fill their open block times," Ms. Leveque says. "Doing it this way, we can fill those blocks 80 percent of the time, but if we find out only a week before, we have lost that time and, more importantly, lost that revenue."
Ms. Leveque adds providing pay-for-performance bonuses give schedulers an incentive to keep a closer watch on schedules. "We work really hard with the schedulers and incentivize them if they demonstrate staying on top of it by providing Starbucks giftcards and organizing big luncheons for them with the physicians. It's important to keep good relationships with the schedulers," she says.
2. Closely manage prices on smaller supplies and drugs. Hiring someone responsible for keeping a close eye on the prices of pharmaceuticals and smaller supplies, such as gauze sponges, is just as essential to preventing monetary waste as close monitoring of schedules. Ms. Leveque says prices on drugs and smaller supplies, such as syringe needles and bite locks, can vary tremendously on a week-to-week basis. As a result, Central California Endoscopy has appointed a materials manager who is responsible for keeping track of prices on all supplies ordered for the surgery center.
"You can't keep ordering supplies from the same vendor anymore and assume the prices are going to stay the same. Our materials staff member checks the prices on all our items all the time to make sure we always have the best price, and if we don't have the best price, that person makes a call to make sure we get it," Ms. Leveque says. "The materials manager has to be actively engaged and do the homework. One time, a sale representative came in offering what we thought was a great price on a bite lock, but when we went back to compare that to what we were paying, he was quoting us at $1.50 more than what we were already paying."
3. Change staffing according to the caseload flow. With staffing costs as one of the top overhead expenses of any ASC, it is critical to ensure staff members are scheduled to work according to how many cases are booked. Ms. Leveque emphasizes the need to have the number of staff members ebb and flow according to the number of cases scheduled for the day.
"The clinical staff's hours should flow with the caseload, so if the number of cases drops you should be seeing your staffing and hours drop, too," she says. "Our clinical manager is ultimately responsible for the clinical staff, so they are always working with the schedulers to see case loads. For example, if the scheduler sees open block time next Tuesday and isn't able to fill that space, she should be speaking with our clinical manager to cancel the per diem staff."
4. Analyze hidden costs of purchasing new equipment or technology. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says ASCs often make the mistake of overlooking the hidden costs associated with buying new equipment or technology. Hidden costs may vary from training staff to learn how to use the new equipment to insurance companies denying coverage," he says.
"The idea is to get an accurate picture of all the costs from the most expensive option to the least expensive option because people's anatomies are different, and a different implant may be needed at the time of surgery. You'll want to have all this information before you negotiate coverage with insurance companies," he says.
5. Strategize how to collect money in a more timely and efficient manner. Dr. Dooley says in light of increasing patient copays and deductibles, it is now common practice for the ASC to collect more money up-front and learn the accurate cost of service so a payment plan can be arranged, if necessary.
"In order to accurately nail the cost of services on a prospective basis, it's not only important to have information from the surgeon about what procedure is being done but also what other things might be used because of that procedure," he says. "For example, if a patient comes in for an ACL repair, you want to note the cost of repairing a torn meniscus as well as the cost of implants. If you don't know let the patient know ahead of time, you'll have a very unhappy customer, which makes them less likely to pay."
Dr. Dooley says this also requires ASCs to work closely with payors on a regular basis, ensuring ASCs knows exactly what kind of coverage patients have. "You have to have the exact ID number, network and know what contract that patient is under. This resulted in us now having to develop a position on staff where they are responsible for all the pre-certification functions and essentially gathers all the accurate information, check it and arranges a payment plan for the patient ahead of time."
Learn more about Central California Endoscopy Center.
Learn more about Mississippi Valley Surgery Center.
1. Closely monitor and strategize scheduling. Sue Leveque, RN, administrator at Central California Endoscopy Center in Fresno, Calif., says it is absolutely essential ASCs monitor staffing schedules and scheduled procedures very closely. At Central California Endoscopy, schedulers are charged with watching block time by confirming physicians' schedules two months ahead of time, which gives the scheduler a clear view of expected vacation times and can more effectively schedule procedures accordingly.
"Schedulers start calling around and ask each of our 14 physicians to give them dates they would like off for vacation and fax it to the front office, so if physicians need two weeks for vacation we can more easily fill their open block times," Ms. Leveque says. "Doing it this way, we can fill those blocks 80 percent of the time, but if we find out only a week before, we have lost that time and, more importantly, lost that revenue."
Ms. Leveque adds providing pay-for-performance bonuses give schedulers an incentive to keep a closer watch on schedules. "We work really hard with the schedulers and incentivize them if they demonstrate staying on top of it by providing Starbucks giftcards and organizing big luncheons for them with the physicians. It's important to keep good relationships with the schedulers," she says.
2. Closely manage prices on smaller supplies and drugs. Hiring someone responsible for keeping a close eye on the prices of pharmaceuticals and smaller supplies, such as gauze sponges, is just as essential to preventing monetary waste as close monitoring of schedules. Ms. Leveque says prices on drugs and smaller supplies, such as syringe needles and bite locks, can vary tremendously on a week-to-week basis. As a result, Central California Endoscopy has appointed a materials manager who is responsible for keeping track of prices on all supplies ordered for the surgery center.
"You can't keep ordering supplies from the same vendor anymore and assume the prices are going to stay the same. Our materials staff member checks the prices on all our items all the time to make sure we always have the best price, and if we don't have the best price, that person makes a call to make sure we get it," Ms. Leveque says. "The materials manager has to be actively engaged and do the homework. One time, a sale representative came in offering what we thought was a great price on a bite lock, but when we went back to compare that to what we were paying, he was quoting us at $1.50 more than what we were already paying."
3. Change staffing according to the caseload flow. With staffing costs as one of the top overhead expenses of any ASC, it is critical to ensure staff members are scheduled to work according to how many cases are booked. Ms. Leveque emphasizes the need to have the number of staff members ebb and flow according to the number of cases scheduled for the day.
"The clinical staff's hours should flow with the caseload, so if the number of cases drops you should be seeing your staffing and hours drop, too," she says. "Our clinical manager is ultimately responsible for the clinical staff, so they are always working with the schedulers to see case loads. For example, if the scheduler sees open block time next Tuesday and isn't able to fill that space, she should be speaking with our clinical manager to cancel the per diem staff."
4. Analyze hidden costs of purchasing new equipment or technology. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says ASCs often make the mistake of overlooking the hidden costs associated with buying new equipment or technology. Hidden costs may vary from training staff to learn how to use the new equipment to insurance companies denying coverage," he says.
"The idea is to get an accurate picture of all the costs from the most expensive option to the least expensive option because people's anatomies are different, and a different implant may be needed at the time of surgery. You'll want to have all this information before you negotiate coverage with insurance companies," he says.
5. Strategize how to collect money in a more timely and efficient manner. Dr. Dooley says in light of increasing patient copays and deductibles, it is now common practice for the ASC to collect more money up-front and learn the accurate cost of service so a payment plan can be arranged, if necessary.
"In order to accurately nail the cost of services on a prospective basis, it's not only important to have information from the surgeon about what procedure is being done but also what other things might be used because of that procedure," he says. "For example, if a patient comes in for an ACL repair, you want to note the cost of repairing a torn meniscus as well as the cost of implants. If you don't know let the patient know ahead of time, you'll have a very unhappy customer, which makes them less likely to pay."
Dr. Dooley says this also requires ASCs to work closely with payors on a regular basis, ensuring ASCs knows exactly what kind of coverage patients have. "You have to have the exact ID number, network and know what contract that patient is under. This resulted in us now having to develop a position on staff where they are responsible for all the pre-certification functions and essentially gathers all the accurate information, check it and arranges a payment plan for the patient ahead of time."
Learn more about Central California Endoscopy Center.
Learn more about Mississippi Valley Surgery Center.