Physician recruitment is essential to surgery center profitability — but in this day and age, finding eligible providers is becoming more and more difficult. As hospital employment and non-compete contracts prevent physicians from joining surgery centers, ASC administrators must offer physicians competitive advantages to working at the local hospital or competing ASCs. Here, surgery center experts discuss seven traits that make your facility stand out in a crowd.
1. Attentive administrator. An attentive administrator can make all the difference in how much case volume a physician contributes to an ASC. Administrators agree that ASC leaders who notice physician preferences — whether that means the brand of coffee they enjoy, their preferred case start time or their favorite staff members — are more likely to keep loyal providers. Vicki Edelman, administrator of Blue Bell (Pa.) Surgery Center, says administrators should notice and react accordingly if a particular physician has stopped scheduling his or her usual number of cases.
"If he's on vacation, we can tell the other doctors, 'We need more cases that day, or we're going to have to move that day's scheduled cases to another day,'" she says. On the other hand, if a physician is disgruntled, you will be able to fix the problem more quickly if you follow up and express concern than if you let them drop off the radar for weeks.
2. Control over staffing. ASC physicians benefit tremendously by controlling who works in the operating room with them, says Anthony Coletta, MD. "I no longer have to introduce myself to the nurses or anesthesiologists before surgery," he says. "The contrast with hospitals, where surgeons have little or no control over staffing (or scheduling or post-op care, for that matter), could not be greater." He says the ability to know every person in the OR makes every surgery more enjoyable and efficient — and more importantly, safer.
To this end, make sure you notice which staff members your surgeons prefer. If a surgeon always requests or compliments a particular nurse, try to schedule the nurse during the physician's block time. If you're hiring a new staff member, ask physicians to sit in on the interview process and provide input on the new employee. Even if physicians turn down the opportunity to contribute, they'll appreciate the offer.
3. Prompt, effective solutions to physician problems. Sandra Jones, executive vice president of ASD Management, says physician satisfaction can be tied to how quickly an administrator responds to complaints or issues in the ASC. When a physician comes forward with a problem, she recommends asking questions to determine the root of the problem. For example, maybe a physician feels undervalued or financially burdened. You won't be able to fix the problem until you find out what really brought about the complaint.
Sometimes physicians will come to you with problems that can be fixed, and sometimes there will be no immediate solution. Ms. Jones says it's important for administrators to differentiate between the two situations and explain the difference to physicians. "They may complain because they want a different type of instrument or a newer technology, and your resources just aren't going to allow that because of continuous cutbacks on reimbursement," she says. "It's tough to have the latest and greatest in everything." She says part of that resource allocation is just working with physicians to help them understand that every physician has to operate for the benefit of the whole facility.
4. Control of the revenue stream. Allen Hord, MD, a physician at West Paces ASC in Atlanta, an Interventional Management Services partner center, says surgery center physicians have often shied away from hospital relationships because of the level of control the hospital expects over revenue issues. "In two previous experience in hospital-contracted (although not employed) groups, I found that hospitals rarely acted in the economic best interests of their doctors," he says. "They want to control the revenue stream and reap all the benefits."
In order to attract physician-investors to your center, make it clear that they will have substantial input on the strategic direction and operational decisions at the center if they desire. Make it clear you are open to accepting their cases — as long as they are profitable to the ASC — and you will work to cut costs to ensure their distributions remain high.
5. Lack of bureaucratic obstacles. Physicians want to be able to take care of patients without any hassle, says Kris Sabo, administrator of Pend Oreille Surgery Center in Ponderay, Idaho. "On the provider side, they're focused on that patient, and they don't want to have to worry about what's next," she says. This means administrators need to anticipate physician needs as much as possible.
A good example of this is keeping physician preference cards updated. You don't need to bother physicians to update their preference card; instead, talk to a trusted member of their office staff and find out which supplies are no longer appropriate to stock. While a physician may not notice the updates, he or she will appreciate the fact that each piece of equipment is correct without having to ask.
6. Efficient case turnover. Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich., says many physicians open or join surgery centers for the added efficiency, so short waiting times and prompt case turnover is essential. "We came from a hospital that wasn't necessarily as efficient as we wanted, and the ability to balance cases has been a nice change from that situation," he says.
If possible, the ASC should use a "floating team" to keep an eye on each room while physicians are working. If you're running multiple ORs, you should staff a charge person or assistant to watch the proceedings in each room and notice which staff members will be finished with turnover first. New infection control guidelines also require more in-depth cleaning, so surgery center staff may need to allow for 10 minutes to prepare a room for the next case.
7. No case cancellations due to inadequate screening. David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, a Health Inventures facility, says physicians will become easily frustrated if the ASC has to cancel cases due to inadequate patient screening. Case cancellation hurts patient satisfaction, revenue and it disrupts the physician's schedule, so it should be avoided whenever possible. At Mr. Kelly's surgery center, the anesthesiologists provide the guidelines for preoperative phone calls, and staff members follow those guidelines to catch any patients at increased risk of complications. This could mean patients who are overweight, suffer from sleep apnea or respiratory problems or have a history of adverse reactions to anesthesia.
"If they're over a certain age or have a history of heart disease, they may need an EKG ahead of time," he says. Preoperative phone call staff should ask clear, direct questions that get to the root of the patient's history and current medication use. Additionally, leveraging technology, like an online pre-op assessment tool where patients enter personal health history at their leisure and own pace, is a great way to obtain complete information.
Related Articles on ASC Operations:
Which Are the Most Common Surgery Center Specialties?
5 Tips for Updating a GI Center's Technology
50 Benchmarks on Surgery Center Finances
1. Attentive administrator. An attentive administrator can make all the difference in how much case volume a physician contributes to an ASC. Administrators agree that ASC leaders who notice physician preferences — whether that means the brand of coffee they enjoy, their preferred case start time or their favorite staff members — are more likely to keep loyal providers. Vicki Edelman, administrator of Blue Bell (Pa.) Surgery Center, says administrators should notice and react accordingly if a particular physician has stopped scheduling his or her usual number of cases.
"If he's on vacation, we can tell the other doctors, 'We need more cases that day, or we're going to have to move that day's scheduled cases to another day,'" she says. On the other hand, if a physician is disgruntled, you will be able to fix the problem more quickly if you follow up and express concern than if you let them drop off the radar for weeks.
2. Control over staffing. ASC physicians benefit tremendously by controlling who works in the operating room with them, says Anthony Coletta, MD. "I no longer have to introduce myself to the nurses or anesthesiologists before surgery," he says. "The contrast with hospitals, where surgeons have little or no control over staffing (or scheduling or post-op care, for that matter), could not be greater." He says the ability to know every person in the OR makes every surgery more enjoyable and efficient — and more importantly, safer.
To this end, make sure you notice which staff members your surgeons prefer. If a surgeon always requests or compliments a particular nurse, try to schedule the nurse during the physician's block time. If you're hiring a new staff member, ask physicians to sit in on the interview process and provide input on the new employee. Even if physicians turn down the opportunity to contribute, they'll appreciate the offer.
3. Prompt, effective solutions to physician problems. Sandra Jones, executive vice president of ASD Management, says physician satisfaction can be tied to how quickly an administrator responds to complaints or issues in the ASC. When a physician comes forward with a problem, she recommends asking questions to determine the root of the problem. For example, maybe a physician feels undervalued or financially burdened. You won't be able to fix the problem until you find out what really brought about the complaint.
Sometimes physicians will come to you with problems that can be fixed, and sometimes there will be no immediate solution. Ms. Jones says it's important for administrators to differentiate between the two situations and explain the difference to physicians. "They may complain because they want a different type of instrument or a newer technology, and your resources just aren't going to allow that because of continuous cutbacks on reimbursement," she says. "It's tough to have the latest and greatest in everything." She says part of that resource allocation is just working with physicians to help them understand that every physician has to operate for the benefit of the whole facility.
4. Control of the revenue stream. Allen Hord, MD, a physician at West Paces ASC in Atlanta, an Interventional Management Services partner center, says surgery center physicians have often shied away from hospital relationships because of the level of control the hospital expects over revenue issues. "In two previous experience in hospital-contracted (although not employed) groups, I found that hospitals rarely acted in the economic best interests of their doctors," he says. "They want to control the revenue stream and reap all the benefits."
In order to attract physician-investors to your center, make it clear that they will have substantial input on the strategic direction and operational decisions at the center if they desire. Make it clear you are open to accepting their cases — as long as they are profitable to the ASC — and you will work to cut costs to ensure their distributions remain high.
5. Lack of bureaucratic obstacles. Physicians want to be able to take care of patients without any hassle, says Kris Sabo, administrator of Pend Oreille Surgery Center in Ponderay, Idaho. "On the provider side, they're focused on that patient, and they don't want to have to worry about what's next," she says. This means administrators need to anticipate physician needs as much as possible.
A good example of this is keeping physician preference cards updated. You don't need to bother physicians to update their preference card; instead, talk to a trusted member of their office staff and find out which supplies are no longer appropriate to stock. While a physician may not notice the updates, he or she will appreciate the fact that each piece of equipment is correct without having to ask.
6. Efficient case turnover. Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich., says many physicians open or join surgery centers for the added efficiency, so short waiting times and prompt case turnover is essential. "We came from a hospital that wasn't necessarily as efficient as we wanted, and the ability to balance cases has been a nice change from that situation," he says.
If possible, the ASC should use a "floating team" to keep an eye on each room while physicians are working. If you're running multiple ORs, you should staff a charge person or assistant to watch the proceedings in each room and notice which staff members will be finished with turnover first. New infection control guidelines also require more in-depth cleaning, so surgery center staff may need to allow for 10 minutes to prepare a room for the next case.
7. No case cancellations due to inadequate screening. David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, a Health Inventures facility, says physicians will become easily frustrated if the ASC has to cancel cases due to inadequate patient screening. Case cancellation hurts patient satisfaction, revenue and it disrupts the physician's schedule, so it should be avoided whenever possible. At Mr. Kelly's surgery center, the anesthesiologists provide the guidelines for preoperative phone calls, and staff members follow those guidelines to catch any patients at increased risk of complications. This could mean patients who are overweight, suffer from sleep apnea or respiratory problems or have a history of adverse reactions to anesthesia.
"If they're over a certain age or have a history of heart disease, they may need an EKG ahead of time," he says. Preoperative phone call staff should ask clear, direct questions that get to the root of the patient's history and current medication use. Additionally, leveraging technology, like an online pre-op assessment tool where patients enter personal health history at their leisure and own pace, is a great way to obtain complete information.
Related Articles on ASC Operations:
Which Are the Most Common Surgery Center Specialties?
5 Tips for Updating a GI Center's Technology
50 Benchmarks on Surgery Center Finances