Though the fourth financial quarter is in full swing, it is not too late to for ambulatory surgery centers to set attainable goals to complete before the year's end.
Jessica Nantz, president of Outpatient Healthcare Strategies, and Regina Boore, RN, principal and CEO of Progressive Surgical Solutions, have several practical tips for ASC administrators to implement to boost this year's productivity and prepare for a successful start of 2013.
"To end the year on a high note, you need to focus on removing inefficiencies, identifying areas for improvement and working to make 2013 even better than 2012," Ms. Nantz says.
Here are Ms. Nantz and Ms. Boore's six 6 goals for ASCs for the remainder of 2012.
1. Align with staffing benchmarks. Staffing is one of the most important benchmarks for ASCs to stay on track with, and the fall is an optimal time to ensure you're not over- spending on staff. Your ASC should be staying but are staying within benchmark ratios, Ms. Nantz says.
"Your supply costs and staffing are the two expenses that impact your bottom line the most," Ms. Nantz says. She recommends making tough decisions now to align with your goals so you can go into 2013 with control of your expenses.
Volumes may increase near year's end, but don't be tempted to over-spend on staff. "It is critical to keep a close eye on your staffing costs or you're not going to have that influx of revenue fall to the bottom line," she says. "Just because you see a spike in volume doesn't mean you can take your eye off of controlling expenses."
Also check your staff for competency and consistency indicators, Ms. Boore says. "We need consistency across the board, and it can be hard to maintain consistency with per-diem staff," she says.
2. Prepare for annual inventory. It may not yet be time to complete annual inventory, but ASCs can set a goal to better prepare for inventory to make the process smoother and less time consuming than in year's past.
"Almost all organizations do an end-of-the-year inventory," Ms. Boore says. "You need to know how much cash is on the shelf. If you don't have account sheets and inventory itemized by location, that is something to get working on to make the process a lot more efficient.
Be prepared to bring an accountant in and set dates for your upcoming inventory. "Make sure staff members are educated on what is needed from them," to avoid any holdups in the process, Ms. Nantz says. "Ensure everything on your shelves is priced accurately and counted," she says. "This will give you an accurate number, dollar-wise, of what is on your shelves starting in 2013."
This is the time to look at supplies and identify items which that may not be used because of the types of cases scheduled through the end of the year. If any expire, you may be able to exchange them or receive a credit.
"But I would not advise an ASC to wait until the end of the year to check inventory, as the expiration dates for most supplies do not correlate with the end of a year," Ms. Nantz says.
3. Fix any accounts receivable problems. Examining accounts receivable now can give you time to get back on track if any receivables are sliding or bills are uncollected. Often one issue can impact your entire revenue stream. Ms. Boore recommends taking the following steps to ensure a healthy A/R:
• Accurately perform insurance verification in advance of surgery every time
• Collect all patient out-of-pocket collectables before surgery
• Assign someone to work accounts receivable, drop claims on time and monitor denied/rejected claims
"Are you making sure you are 100 percent of time accurately doing insurance verification in advance of surgery?" Ms. Boore says. "Are you collecting all patient out-of-pocket collectables before surgery? Do you have someone working accounts receivable, dropping claims on time and monitoring denied or rejected claims for trends? Identify one thing that can have a ripple effect and you can rectify the majority of problems," she says. ."
Improper coding can also be an issue that's missed during the first half of the year. But coding mistakes will carry over to the next year and should be addressed completely.
"Ensure your ASC has had a coding audit performed by a third party," Ms. Nantz says. "You should do that from a compliance standpoint as well as from a revenue perspective."
Though the end of 2012 is near, time still remains to get revenue back on track. Work your budget thoroughly to identify all weaknesses. "It's our last chance once we've worked our budget to actual numbers to make adjustments before end of the year," Ms. Boore says.
4. Analyze payor contracts. If your contact negotiations begin shortly after the start of 2013, now is the time to do front-end research. This research will help you know if your current rates are adequate or if renegotiations will be necessary.
"If you have payor contracts that are going to need to be renewed in the first quarter of 2013, you should make sure that during this final quarter you analyze your case costing, look at your volumes, gather all of your data together and have it ready to renegotiate your contracts after the New Year," Ms. Nantz says.
Fee schedules should be reassessed now as well. Surgery centers often neglect third- party contracts, she says, so reevaluation can often show often reveal payors that are not fulfilling their contracted terms. Before you go into negotiations, "really evaluate those contracts," she says. "Make sure you are paid at the negotiated rate, that the rates are in line with your cost reports and that it's still a reasonably profitable contract."
While ASCs should have monthly collections goals, administrators can seek to improve collections by adding additional resources to collecting more payments on the front end, especially on self-pay patient accounts.
Overall, Ms. Nantz says, look for ways to get back on track with improved habits for next year. "You have the opportunity to re-bill and work to capture lost revenue," she says, "although this revenue may not reach your facility before the end of the year."
5. Address compliance. Accreditation requirements change throughout the year, so ASCs should set a goal of evaluating their current compliance now to start 2013 in line with standards.
"As you're approaching the final few months of the year," Ms. Nantz says, "if you've missed any federal, state or accreditation requirements that require your ASC to conduct [some task or survey] annually, make sure to address these annual requirements."
Medicare standards can be particularly complex, and it is easy for ASCs to develop gaps in compliance without noticing. "On a practical level, whenever you do periodic assessment on your operational compliance, you will find gaps," Ms. Boore says. "You may find gaps that weren’t there before or a gap that now is the time to address."
She said these can include gaps in physician behaviors, such as improperly discarding masks, which may require ongoing monitoring and reinforcement. Starting now rather than waiting will to establish these compliant behaviors.
Mandatory quality reporting also begins Oct. 1. "If you haven’t educated your staff as to the quality reporting requirements, you need to do as soon as possible," she says. "All surgeons and staff need to know what their role is in capturing data and getting it to coders and billers in a timely manner."
6. Assess physician satisfaction. Both Ms. Nantz and Ms. Boore agree that surveying physician satisfaction should take place now.
"Complete at least one physician satisfaction survey for the year, if you haven't conducted one already," Ms. Nantz says. "If the results of the survey indicate you have unhappy physicians, institute changes by the end of the year to put you on track for a good start to 2013."
Ms. Boore recommends doing surveys on a regular basis to properly assess your center's situation and help meet physicians' needs.
"A regular physician survey, as well as an employee survey, is good idea," she says. "You end up investing lot in staff with training and development. It costs a lot when we lose them. By making sure your OR is operating in a way that attracts and retains quality medical and facility staff benefits any organization."
More Articles on Improving Performance:
8 Points on How Narrowing Payor Networks Impacts Surgery Centers
Evolving Strategies for Surgery Centers to Reach Savvy Healthcare Consumers: Q&A With Dr. Arvind Movva, CEO of Regional SurgiCenter
8 Steps to Cut Cost Per Case in Surgery Centers
Jessica Nantz, president of Outpatient Healthcare Strategies, and Regina Boore, RN, principal and CEO of Progressive Surgical Solutions, have several practical tips for ASC administrators to implement to boost this year's productivity and prepare for a successful start of 2013.
"To end the year on a high note, you need to focus on removing inefficiencies, identifying areas for improvement and working to make 2013 even better than 2012," Ms. Nantz says.
Here are Ms. Nantz and Ms. Boore's six 6 goals for ASCs for the remainder of 2012.
1. Align with staffing benchmarks. Staffing is one of the most important benchmarks for ASCs to stay on track with, and the fall is an optimal time to ensure you're not over- spending on staff. Your ASC should be staying but are staying within benchmark ratios, Ms. Nantz says.
"Your supply costs and staffing are the two expenses that impact your bottom line the most," Ms. Nantz says. She recommends making tough decisions now to align with your goals so you can go into 2013 with control of your expenses.
Volumes may increase near year's end, but don't be tempted to over-spend on staff. "It is critical to keep a close eye on your staffing costs or you're not going to have that influx of revenue fall to the bottom line," she says. "Just because you see a spike in volume doesn't mean you can take your eye off of controlling expenses."
Also check your staff for competency and consistency indicators, Ms. Boore says. "We need consistency across the board, and it can be hard to maintain consistency with per-diem staff," she says.
2. Prepare for annual inventory. It may not yet be time to complete annual inventory, but ASCs can set a goal to better prepare for inventory to make the process smoother and less time consuming than in year's past.
"Almost all organizations do an end-of-the-year inventory," Ms. Boore says. "You need to know how much cash is on the shelf. If you don't have account sheets and inventory itemized by location, that is something to get working on to make the process a lot more efficient.
Be prepared to bring an accountant in and set dates for your upcoming inventory. "Make sure staff members are educated on what is needed from them," to avoid any holdups in the process, Ms. Nantz says. "Ensure everything on your shelves is priced accurately and counted," she says. "This will give you an accurate number, dollar-wise, of what is on your shelves starting in 2013."
This is the time to look at supplies and identify items which that may not be used because of the types of cases scheduled through the end of the year. If any expire, you may be able to exchange them or receive a credit.
"But I would not advise an ASC to wait until the end of the year to check inventory, as the expiration dates for most supplies do not correlate with the end of a year," Ms. Nantz says.
3. Fix any accounts receivable problems. Examining accounts receivable now can give you time to get back on track if any receivables are sliding or bills are uncollected. Often one issue can impact your entire revenue stream. Ms. Boore recommends taking the following steps to ensure a healthy A/R:
• Accurately perform insurance verification in advance of surgery every time
• Collect all patient out-of-pocket collectables before surgery
• Assign someone to work accounts receivable, drop claims on time and monitor denied/rejected claims
"Are you making sure you are 100 percent of time accurately doing insurance verification in advance of surgery?" Ms. Boore says. "Are you collecting all patient out-of-pocket collectables before surgery? Do you have someone working accounts receivable, dropping claims on time and monitoring denied or rejected claims for trends? Identify one thing that can have a ripple effect and you can rectify the majority of problems," she says. ."
Improper coding can also be an issue that's missed during the first half of the year. But coding mistakes will carry over to the next year and should be addressed completely.
"Ensure your ASC has had a coding audit performed by a third party," Ms. Nantz says. "You should do that from a compliance standpoint as well as from a revenue perspective."
Though the end of 2012 is near, time still remains to get revenue back on track. Work your budget thoroughly to identify all weaknesses. "It's our last chance once we've worked our budget to actual numbers to make adjustments before end of the year," Ms. Boore says.
4. Analyze payor contracts. If your contact negotiations begin shortly after the start of 2013, now is the time to do front-end research. This research will help you know if your current rates are adequate or if renegotiations will be necessary.
"If you have payor contracts that are going to need to be renewed in the first quarter of 2013, you should make sure that during this final quarter you analyze your case costing, look at your volumes, gather all of your data together and have it ready to renegotiate your contracts after the New Year," Ms. Nantz says.
Fee schedules should be reassessed now as well. Surgery centers often neglect third- party contracts, she says, so reevaluation can often show often reveal payors that are not fulfilling their contracted terms. Before you go into negotiations, "really evaluate those contracts," she says. "Make sure you are paid at the negotiated rate, that the rates are in line with your cost reports and that it's still a reasonably profitable contract."
While ASCs should have monthly collections goals, administrators can seek to improve collections by adding additional resources to collecting more payments on the front end, especially on self-pay patient accounts.
Overall, Ms. Nantz says, look for ways to get back on track with improved habits for next year. "You have the opportunity to re-bill and work to capture lost revenue," she says, "although this revenue may not reach your facility before the end of the year."
5. Address compliance. Accreditation requirements change throughout the year, so ASCs should set a goal of evaluating their current compliance now to start 2013 in line with standards.
"As you're approaching the final few months of the year," Ms. Nantz says, "if you've missed any federal, state or accreditation requirements that require your ASC to conduct [some task or survey] annually, make sure to address these annual requirements."
Medicare standards can be particularly complex, and it is easy for ASCs to develop gaps in compliance without noticing. "On a practical level, whenever you do periodic assessment on your operational compliance, you will find gaps," Ms. Boore says. "You may find gaps that weren’t there before or a gap that now is the time to address."
She said these can include gaps in physician behaviors, such as improperly discarding masks, which may require ongoing monitoring and reinforcement. Starting now rather than waiting will to establish these compliant behaviors.
Mandatory quality reporting also begins Oct. 1. "If you haven’t educated your staff as to the quality reporting requirements, you need to do as soon as possible," she says. "All surgeons and staff need to know what their role is in capturing data and getting it to coders and billers in a timely manner."
6. Assess physician satisfaction. Both Ms. Nantz and Ms. Boore agree that surveying physician satisfaction should take place now.
"Complete at least one physician satisfaction survey for the year, if you haven't conducted one already," Ms. Nantz says. "If the results of the survey indicate you have unhappy physicians, institute changes by the end of the year to put you on track for a good start to 2013."
Ms. Boore recommends doing surveys on a regular basis to properly assess your center's situation and help meet physicians' needs.
"A regular physician survey, as well as an employee survey, is good idea," she says. "You end up investing lot in staff with training and development. It costs a lot when we lose them. By making sure your OR is operating in a way that attracts and retains quality medical and facility staff benefits any organization."
More Articles on Improving Performance:
8 Points on How Narrowing Payor Networks Impacts Surgery Centers
Evolving Strategies for Surgery Centers to Reach Savvy Healthcare Consumers: Q&A With Dr. Arvind Movva, CEO of Regional SurgiCenter
8 Steps to Cut Cost Per Case in Surgery Centers