In Aug. 2011, North Memorial Ambulatory Surgery Center in Maple Grove, Minn., integrated over 400 endoscopy cases per month from a center that closed within the same building. These 400 cases account for over 50 percent of total volume performed at the center today. Reed Martin, chief operating officer for Surgical Management Professionals, which manages the center, discusses how the company helped the ASC integrate the new cases and ramp up volume in a short time period.
1. Determine whether the surgery center can handle more cases. When Surgical Management Professionals heard from their physician partners that another surgery center was closing, they looked into the possibility of integrating cases from the closed ASC into their existing center. "We had excess capacity so we thought we might be able to do it," Mr. Martin says. SMP and Traci Albers, the facility executive director, analyzed the facility capacity and determined the surgery center would be able to double its case volume without overwhelming the center.
2. Explain financial and operational benefits to the ASC board. A surgery center board will likely have some reservations when considering integrating cases from a closed center. Mr. Martin says the most common concerns with his board were whether the ASC could handle the extra patient flow and double the case volume. "Any board would say, 'Can our reception area handle it, and are we ready in all areas for that volume increase?'" he says.
SMP and the executive director developed financial models of the additional volume and explained to the board that the addition of the endoscopy cases would benefit the surgery center financially and increase physician distributions. The additional cases would also use the extra time available in the surgery center's schedule and take advantage of staff already working at the facility.
3. Analyze equipment needs. Mr. Martin says SMP and the executive director worked with the physicians at the closing center to make sure they were comfortable with the equipment at the existing facility. The physicians said they were happy with their current equipment, so the surgery center opted to buy it and incorporate it into the existing center. "We did the same thing with supplies," he says. "We asked physicians and staff, 'Are these the supplies that best served you and the patients?'" He says the equipment and supplies were purchased at fair market value.
4. Look at surgery center processes and make changes as necessary. Before the physicians joined the new center, Mr. Martin says SMP and the facility leadership had to determine how they would best utilize the facility for the additional cases. ASC leadership decided the physicians could use some of the center's operating rooms and that the center would require modifications for scope processing. The ASC eventually decided to do some physical plant modifications to create a space for scope processing.
The surgery center also decided to utilize one end of the pre-operative area for endoscopy cases, with surgical cases at the opposite end. "Endo cases have different requirements than surgery cases, and this way we could keep them both separate and together," Mr. Martin says. He says the same was true for post-operative care; endoscopy patients were treated in the opposite end of the center's "phase two" area.
5. Bring on staff from the old center if possible. Mr. Martin says the surgery center brought on staff from the old center that understood the physicians' needs and could participate in the transition. He says the clinical areas were not the only areas in need of extra staff when the extra cases came in; the surgery center also had to add staff in reception and scheduling to make sure the ASC could handle the additional patient flow. "The new staff were very helpful in describing their processes to us and how best to incorporate them," he says. "We built some good teamwork with those discussions."
6. Integrate new physicians into the center and culture. Integrating physicians from another center can be challenging, as the physicians have to transition to working in a new space and sharing the facility with a new set of providers. Mr. Martin says SMP and the surgery center leadership team helped integrate the new physicians by involving them in discussions around ASC processes, equipment and supplies. “We also made an effort to give the physicians frequent access to the center's executive director during the transition.”
"They were used to a separate dictation area, and we were able to provide that area adjacent to the executive director's office," he says. "In addition, there are some creature comforts that make an environment more pleasant, such as special coffee or a separate refrigerator." He says the physicians were accustomed to those comforts in the old facility, so they incorporated them at the ASC to make them feel at home.
7. Emphasize efficiency to help cases run smoothly. SMP emphasizes efficiency to increase surgery center profitability, Mr. Martin says, and that culture needed to be communicated to the new physicians to make sure they wasted no time in the OR. He said it was quite simple to get them "on board" with SMP and the surgery center's attitude towards efficiency.
"We just showed them that our staff can handle the patients and described how we were going to do it," he says. "One of the physicians was really excited to see he could do 17-18 colonoscopies between 7:30 a.m. and 3:00 p.m. I think the proof is in the pudding once you show them how it's going to work."
Related Articles on ASC Case Volume:
What Surgery Centers Should Expect in 2012: 15 ASC Market Trends
30 ASCs Performing More Than 10,000 Procedures a Year
16 New Statistics on Orthopedic Case Revenue
1. Determine whether the surgery center can handle more cases. When Surgical Management Professionals heard from their physician partners that another surgery center was closing, they looked into the possibility of integrating cases from the closed ASC into their existing center. "We had excess capacity so we thought we might be able to do it," Mr. Martin says. SMP and Traci Albers, the facility executive director, analyzed the facility capacity and determined the surgery center would be able to double its case volume without overwhelming the center.
2. Explain financial and operational benefits to the ASC board. A surgery center board will likely have some reservations when considering integrating cases from a closed center. Mr. Martin says the most common concerns with his board were whether the ASC could handle the extra patient flow and double the case volume. "Any board would say, 'Can our reception area handle it, and are we ready in all areas for that volume increase?'" he says.
SMP and the executive director developed financial models of the additional volume and explained to the board that the addition of the endoscopy cases would benefit the surgery center financially and increase physician distributions. The additional cases would also use the extra time available in the surgery center's schedule and take advantage of staff already working at the facility.
3. Analyze equipment needs. Mr. Martin says SMP and the executive director worked with the physicians at the closing center to make sure they were comfortable with the equipment at the existing facility. The physicians said they were happy with their current equipment, so the surgery center opted to buy it and incorporate it into the existing center. "We did the same thing with supplies," he says. "We asked physicians and staff, 'Are these the supplies that best served you and the patients?'" He says the equipment and supplies were purchased at fair market value.
4. Look at surgery center processes and make changes as necessary. Before the physicians joined the new center, Mr. Martin says SMP and the facility leadership had to determine how they would best utilize the facility for the additional cases. ASC leadership decided the physicians could use some of the center's operating rooms and that the center would require modifications for scope processing. The ASC eventually decided to do some physical plant modifications to create a space for scope processing.
The surgery center also decided to utilize one end of the pre-operative area for endoscopy cases, with surgical cases at the opposite end. "Endo cases have different requirements than surgery cases, and this way we could keep them both separate and together," Mr. Martin says. He says the same was true for post-operative care; endoscopy patients were treated in the opposite end of the center's "phase two" area.
5. Bring on staff from the old center if possible. Mr. Martin says the surgery center brought on staff from the old center that understood the physicians' needs and could participate in the transition. He says the clinical areas were not the only areas in need of extra staff when the extra cases came in; the surgery center also had to add staff in reception and scheduling to make sure the ASC could handle the additional patient flow. "The new staff were very helpful in describing their processes to us and how best to incorporate them," he says. "We built some good teamwork with those discussions."
6. Integrate new physicians into the center and culture. Integrating physicians from another center can be challenging, as the physicians have to transition to working in a new space and sharing the facility with a new set of providers. Mr. Martin says SMP and the surgery center leadership team helped integrate the new physicians by involving them in discussions around ASC processes, equipment and supplies. “We also made an effort to give the physicians frequent access to the center's executive director during the transition.”
"They were used to a separate dictation area, and we were able to provide that area adjacent to the executive director's office," he says. "In addition, there are some creature comforts that make an environment more pleasant, such as special coffee or a separate refrigerator." He says the physicians were accustomed to those comforts in the old facility, so they incorporated them at the ASC to make them feel at home.
7. Emphasize efficiency to help cases run smoothly. SMP emphasizes efficiency to increase surgery center profitability, Mr. Martin says, and that culture needed to be communicated to the new physicians to make sure they wasted no time in the OR. He said it was quite simple to get them "on board" with SMP and the surgery center's attitude towards efficiency.
"We just showed them that our staff can handle the patients and described how we were going to do it," he says. "One of the physicians was really excited to see he could do 17-18 colonoscopies between 7:30 a.m. and 3:00 p.m. I think the proof is in the pudding once you show them how it's going to work."
Related Articles on ASC Case Volume:
What Surgery Centers Should Expect in 2012: 15 ASC Market Trends
30 ASCs Performing More Than 10,000 Procedures a Year
16 New Statistics on Orthopedic Case Revenue