8 Things an ASC Can Do to Improve Operations and Drive Stronger Results

Managing an ASC is more challenging than ever, given uncertainties about future reimbursements, a dearth of unaffiliated surgeons to recruit and increasing competition from hospitals. Several industry experts weigh in on what they believe to be the most important actions ASC operators can take to enhance their chances of succeeding in this environment.

1. Adopt a sense of urgency. Waiting around before taking action does not make problems go away. "Do not wait to investigate any opportunity to build your business or re-engineer internal structures to reduce costs," says Cassandra T. Speier, senior vice president of operations at NovaMed. "A day lost on either avenue can translate into real dollars."

2. Partner with a hospital. Hospital partnerships have proved to be an unexpected pattern of success for ASC operator Regent Surgical Health, according to Tom Mallon, Regent's co-founder and CEO.  "When there are no doctors to recruit or we find ourselves in a highly-concentrated payor market, we have successfully partnered with local health systems to contract for us," he says. "We do this by negotiating an operating agreement that allows for the physicians to control the clinical and many of the business issues of the facility."

Under these arrangements, the hospital has supermajority powers and is subject to a dispute resolution mechanism — although Regent has never needed to use it, Mr. Mallon says. In return, Regent manages the facility, which removes the hospital from being in the "hot seat" with the physicians, he says. These partnerships benefit the hospital, which gains a closer relationship with physicians, as well as the ASC, which can enjoy improved contracts with the major payors in the market. "Over half of our centers now have hospital partners, and we appreciate their contributions," Mr. Mallon says.  

3. Adopt a customer-service attitude. Ritz-Carlton hotels keep files on their frequent guests that note their room preferences down to even the smallest details, says Ms. Speier. Staff members also greet each guest by name. ASCs should be no different. "Become the Ritz-Carlton of ASCs," Ms. Speier says. "From the first interaction, the patient should feel it is your privilege to have them in your facility instead of the other way around."

This customer-service attitude should also apply to physicians. Staff should greet physicians with a smile and keep their preferences in mind. One orthopedist Ms. Speier knows likes to have frozen Snickers bars on hand for snacks between cases. They are always stocked in the PACU refrigerator. "It is often the small details that will align and build loyalty," Ms. Speier says.

4. Be actively involved in state ASC associations. Bobby Hillert, the executive director of the Texas ASC Society, says that because healthcare is one of the most regulated industries in the nation, it is critical for ASCs to work with their trade associations to learn about how state and federal policy decisions will affect them. "In Texas, we have a lot of data reporting required by the state," he says. "ASCs have been given an opportunity to have a stakeholder voice in the process. It's important for them to not only be a stakeholder but also to be aware of what's coming rather than waiting until the last minute and getting fined for not meeting the reporting deadlines."

Ms. Speier highlights this area too, noting that the state associations are an invaluable source of information on legislative and regulatory issues and help teach lawmakers about the real value ASCs provide. "Your state association needs your support in order for our voice to be heard," she says.

5. Get to know your commercial payors. It is important for ASCs to be proactive when it comes to familiarizing themselves with the commercial insurers in their area, and knowing who is responsible for setting rates for contracts. "If they don't hear from you, then they're not getting first-hand insight into what happens in an ASC," Mr. Hillert explains.

6. Understand your costs. Case-costing is an extremely valuable exercise, says Ms. Speier. As reimbursements from payors shrink, ASCs that do not keep track of costs down to the smallest details might not know when they are losing money on a case. "Be sure your case-costing outcomes are shared with your staff and physicians, including anesthesia," she says.

7. Standardize supplies. Surgeons might be resistant to standardization, but everything from implants to sutures to gloves should be examined. "Don't force changes, but engage — especially the difficult ones — the surgeons in the process," says Ms. Speier. "Everyone likes to be asked their opinion and be on the team that makes decisions."

8. Establish a guiding vision. This falls into the category of management that drives outstanding business results, says Ms. Speier. Great managers will be both responsible and accountable and will lead by example, she explains. They will also commit to clear, concise and frequent communication. "Embrace change — it is your friend," she says. "Never compromise your values."

Contact Barbara Kirchheimer at barbara@beckersasc.com