Mike Madewell, administrator of Panama City (Fla.) Surgery Center, a Nueterra facility, cites seven lax habits of surgeons who are otherwise highly effective in an ambulatory surgery center, and he suggests ways to help improve their performance.
1. Slow in sending over patient information. A physician's office may delay sending patient information to the surgery center in preparation for a case. "This means we don't have time to call the payor and verify benefits and can't call patients to tell them how much they will have to pay and make sure they have a means to pay for it," Mr. Madewell says. Create a good relationship with schedulers and explain to them the importance of sending the information over as soon as possible.
2. Some outpatient surgery goes elsewhere. A surgeon may get into the habit of scheduling some outpatient cases at the hospital. For example, if he has three inpatient cases at the hospital, he might schedule his only outpatient case of the day there too because it's convenient. "When the surgeon does this routinely, it can add up to a substantial amount of lost cases for the ASC," Mr. Madewell says. Request data on inpatient cases from the physician's office, print a report showing his total volume of outpatient cases at the hospital and present it to the physician. The report can be a powerful tool because physicians often don't realize how many cases have been diverted to the hospital.
3. Putting off dictation past the day of surgery. If the operative note is not dictated on the day of surgery, the physician may forget for weeks to do it. "Out of sight, out of mind," Mr. Madewell says. This can be a problem particularly when the physician uses the ASC just once or twice a month. Delaying dictation may mean the physician forgets crucial details for more CPT codes and that means lost income for the ASC. Also, if the delay is more than 45 days, some insurers won't pay the claim. Encourage physicians to dictate their operative report on the day of surgery. Allowing dictation over the phone or by computer make it easier, although when the physician is at another, he may not have access to the ASC's patient record to jog his memory.
4. Arriving late for surgery. If the first physician of the day arrives late, the anesthesiology team who was waiting for him typically can bill the center anyway, which is a high price to pay for unproductive time. One solution is to make to the physician pay this charge by taking it out of his distribution check. "When physicians lose money, they get the message right away," Mr. Madewell says.
5. Ordering expensive devices. Expensive devices can make all the difference between making and losing money. In an orthopedics case paid by Medicare, for example, higher costs can turn a barely profitable case into money-losing one for the ASC. Show physicians breakdowns of case-costs and encourage them to use devices that bring the ASC a discount.
6. Scheduling money-losing cases at the ASC. If the ASC would lose money on a particular case, physicians should be encouraged to bring the case to the hospital. Paid a higher rate, the hospital could actually make money on the case. "It would be a win-win situation for the hospital and the ASC if the case goes to the hospital," Mr. Madewell says.
7. Not enough detail in the operative report. The physician's operative report does not have enough detail to capture all the charges that could be billed to the insurer. The physician may need to undergo training with a coder to learn how to tell the full story of the case for billing purposes.
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Read more ideas for ASC improvement:
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- How to Banish Bad Customer Service at an Ambulatory Surgery Center