Staffing is the top cost for many ASCs, meaning staffing models and salary rates must be tailored carefully to fit the needs of the center. Mary Sturm, RN, director of patient care services for Surgical Management Professionals, discusses six ways to cut staffing costs in your ASC.
1. Set clear expectations with staff. Many ASCs recruit employees directly from the hospital setting, meaning potential employees may be used to a set schedule and pre-determined hours. During the interview process, Ms. Sturm recommends you let candidates know that working at an ASC means accepting a flexible schedule. "They need to understand there are rarely guaranteed hour situations, and even full-time people are asked to either not come in or leave early on a slow day," she says.
Honesty and clarity is essential during the interview process to prevent hostility later on, she says. If you let candidates know about your staffing policy, you will probably end up hiring people who understand the financial constraints of an ASC. She says this up-front attitude is even more important in the current economy, when candidates are often looking for full-time employment.
2. Employ a mix of full- and part-time staff. According to Ms. Sturm, the most successful ASC staffing models include a mix of full-time and part-time staff. "You need a cadre of part-time or casual staff that you can call upon to work when volumes are higher and back off when volumes are lower," she says. Part-time staff should be expected to fill these unpredictable shifts, while full-time employees might be more reticent. "If you only have full-time staff, they expect to show up for work every day, and you can't clone them to be an extra staffer on an extremely busy day," she says. "So you want some full-time staff to provide that consistency for patients and surgeons, but part-time staff can be a good asset."
She says full-time and part-time staff should be employed for every position to create a "safety net" in every area of the ASC. The ratio of full-time to part-time staff will depend on your number and type of specialties and the size of your surgery center.
3. Benchmark salary data against local facilities. Your center must compete in its own market, Ms. Sturm says. This means that while national data on employee salaries can be a helpful tool, local market data is essential to ensuring competitive salaries for regional candidates. "We have several centers in the Minneapolis metropolitan market which have a very urban wage scale," she says. "What we determined to be the [Minneapolis metropolitan] wage scale is very different from a smaller Iowa community," she says.
She says this data can be acquired from national surveys that break down data into regions, but the best source may be the candidates themselves. "You get general information about what various categories in your community are getting paid just from the candidates in front of you," she says. "You will find out what they're requiring and demanding." Set your salaries at a competitive rate to ensure employee attraction and retention. During the interview process, you will probably find out quickly if your proposed salary rate is too low.
4. Make exceptions for hard-to-fill positions during salary freezes. Negative reimbursement changes and a down economy can push ASCs toward salary freezes, decreases and even layoffs. Ms. Sturm says the first step in affecting employee salaries because of financial downturn should be a salary freeze, meaning salaries will not increase for a certain amount of time. However, ASCs should be careful about freezing salaries across the board. It can actually cost more money to lose a valuable employee, then find and hire a new employee who may demand more money, than to give a small raise to ensure retention.
"If there are any job shortages where recruitment of a specific job category is difficult, that's an area you would not freeze and would want to remain competitive in, "she says. "You don't want to shoot yourself in the root in a way that doesn't allow you to recruit or retain job categories that are much more difficult to employ." This exception might apply to positions where qualified staffers are scarce, such as certified coders or ASC-specific IT professionals.
5. Cross-train staff. If your ASC successfully cross-trains its staff, you can end up with a group of employees who can each fill several critical positions. This means less money spent on new employees and less time spent adjusting schedules. "Particularly in the RN area, [it's very valuable if] a nurse can work in a few different departments, such as admissions, surgery and PACU," she says. "It also provides a lot of job satisfaction and job security for the nurse because of the flexibility and versatility of [his or her] skill set."
6. Use software to track labor expense per case. Ms. Sturm says a quality software program can help an ASC track labor expense. ASC staff members can enter information on direct and indirect patient caregiver wages into the program and track labor spending over time. The software can then compare wages based on procedure, specialty, time of day and a variety of other factors, giving the ASC information on the most labor-expensive cases. "Without that information, all you can look at is aggregate labor expenses," she says. "If your volume goes up, you assume that labor expense goes up too, but you can [ideally] have volume go up and still maintain flat labor expenses. You need to have a measurement tool that tracks that data."
She says because certain specialties are more labor-intensive, this data will give your center a good idea of where you spend money and where to cut costs first.
Learn more about Surgical Management Professionals.
1. Set clear expectations with staff. Many ASCs recruit employees directly from the hospital setting, meaning potential employees may be used to a set schedule and pre-determined hours. During the interview process, Ms. Sturm recommends you let candidates know that working at an ASC means accepting a flexible schedule. "They need to understand there are rarely guaranteed hour situations, and even full-time people are asked to either not come in or leave early on a slow day," she says.
Honesty and clarity is essential during the interview process to prevent hostility later on, she says. If you let candidates know about your staffing policy, you will probably end up hiring people who understand the financial constraints of an ASC. She says this up-front attitude is even more important in the current economy, when candidates are often looking for full-time employment.
2. Employ a mix of full- and part-time staff. According to Ms. Sturm, the most successful ASC staffing models include a mix of full-time and part-time staff. "You need a cadre of part-time or casual staff that you can call upon to work when volumes are higher and back off when volumes are lower," she says. Part-time staff should be expected to fill these unpredictable shifts, while full-time employees might be more reticent. "If you only have full-time staff, they expect to show up for work every day, and you can't clone them to be an extra staffer on an extremely busy day," she says. "So you want some full-time staff to provide that consistency for patients and surgeons, but part-time staff can be a good asset."
She says full-time and part-time staff should be employed for every position to create a "safety net" in every area of the ASC. The ratio of full-time to part-time staff will depend on your number and type of specialties and the size of your surgery center.
3. Benchmark salary data against local facilities. Your center must compete in its own market, Ms. Sturm says. This means that while national data on employee salaries can be a helpful tool, local market data is essential to ensuring competitive salaries for regional candidates. "We have several centers in the Minneapolis metropolitan market which have a very urban wage scale," she says. "What we determined to be the [Minneapolis metropolitan] wage scale is very different from a smaller Iowa community," she says.
She says this data can be acquired from national surveys that break down data into regions, but the best source may be the candidates themselves. "You get general information about what various categories in your community are getting paid just from the candidates in front of you," she says. "You will find out what they're requiring and demanding." Set your salaries at a competitive rate to ensure employee attraction and retention. During the interview process, you will probably find out quickly if your proposed salary rate is too low.
4. Make exceptions for hard-to-fill positions during salary freezes. Negative reimbursement changes and a down economy can push ASCs toward salary freezes, decreases and even layoffs. Ms. Sturm says the first step in affecting employee salaries because of financial downturn should be a salary freeze, meaning salaries will not increase for a certain amount of time. However, ASCs should be careful about freezing salaries across the board. It can actually cost more money to lose a valuable employee, then find and hire a new employee who may demand more money, than to give a small raise to ensure retention.
"If there are any job shortages where recruitment of a specific job category is difficult, that's an area you would not freeze and would want to remain competitive in, "she says. "You don't want to shoot yourself in the root in a way that doesn't allow you to recruit or retain job categories that are much more difficult to employ." This exception might apply to positions where qualified staffers are scarce, such as certified coders or ASC-specific IT professionals.
5. Cross-train staff. If your ASC successfully cross-trains its staff, you can end up with a group of employees who can each fill several critical positions. This means less money spent on new employees and less time spent adjusting schedules. "Particularly in the RN area, [it's very valuable if] a nurse can work in a few different departments, such as admissions, surgery and PACU," she says. "It also provides a lot of job satisfaction and job security for the nurse because of the flexibility and versatility of [his or her] skill set."
6. Use software to track labor expense per case. Ms. Sturm says a quality software program can help an ASC track labor expense. ASC staff members can enter information on direct and indirect patient caregiver wages into the program and track labor spending over time. The software can then compare wages based on procedure, specialty, time of day and a variety of other factors, giving the ASC information on the most labor-expensive cases. "Without that information, all you can look at is aggregate labor expenses," she says. "If your volume goes up, you assume that labor expense goes up too, but you can [ideally] have volume go up and still maintain flat labor expenses. You need to have a measurement tool that tracks that data."
She says because certain specialties are more labor-intensive, this data will give your center a good idea of where you spend money and where to cut costs first.
Learn more about Surgical Management Professionals.