Ambulatory surgery center efficiency is important, but there are several challenges for today's centers. Arvind Movva, MD, CEO of Regional SurgiCenter in Moline, Ill., discusses how his center is rising to the occasion and preparing for success in the future.
EHR implementation
Electronic health records and automated practice management systems are becoming more common to collect data, record patient information and comply with data reporting regulations. However, the EHR doesn't always make the care process more efficient upfront.
"The EHR does slow us down somewhat in our admission process," says Dr. Movva. "We've tried to streamline as much as we can by using forms and eliminating repetitive processes. Everyone is cross-trained to move people through our admissions process more quickly."
The EHR slows down several aspects of medicine, and if the information input is inaccurate it could harm patients. The input is slower than dictation or simply writing in many cases, but it does become more legible with the EHR system.
"We have kept with transcription only for operative reports," says Dr. Movva. "Our surgeons provide the indications and pertinent positives and negatives, so staff can transcribe using the templates that the surgeon provides to the staff outlining their preferred standard language. This allows us to turnover rooms quickly and keeps the surgeon efficient."
By the time the patient is in recovery, Dr. Movva has his dictations in-hand and ready to discuss with the patient and their family. "That speeds things up a great deal and eliminates the workflow problem," says Dr. Movva.
Maximized scheduling
Another challenge for the surgery center is scheduling multiple types of procedures. The facility recently added a urology division and plans to begin otolaryngology procedures soon. Adding these specialties to the center where gastroenterology, general surgery, plastics and pain procedures are already performed is challenging.
"There are many different procedures and they all require different resources and room times," says Dr. Movva. "Scheduling and turning rooms over efficiently is challenging. We have a better result when we try to fit the smaller cases in between larger cases. When we've blocked our rooms out for cases, there are procedures that go over or under and cause downtime for the staff and OR. But we've found the blend of big and small useful for fitting in the gaps."
However, maintaining a blended schedule takes considerable maintenance and staff dedication to analyze and improve the system. The center's on-the-ground processes are consistently monitored to avoid mistakes. The physicians are also responsible for accurate estimations about case time.
"We need to be realistic about case procedure time when we are scheduling," says Dr. Movva. "If we think the case will be take more time, we have to consistently log the actual time. If everyone says they're doing procedures in 30 minutes but it really takes an hour, the administrative staff might not see that because it's always recorded as 30 minutes. "
Case mix profitability
Profitable cases — both efficient and cost-effective cases — make the ASC a success. Colonoscopies have been the bread-and-butter for Dr. Movva's center, but pain procedures including implantable stimulators and trial stimulators have been successful as well. Finally, urology procedures like cystoscopies and prostatectomies have efficient turnover times and a financial upside.
"Most of the ENT procedures are very quick and reimburse well," says Dr. Movva. "We have found some centers avoid procedures that can be done at low margins or even a loss, but we find offering those procedures keeps our physicians in the ASC and keeps them efficient."
The implant-driven or disposables-driven procedures are more costly and require favorable payer contracts to turn a profit. But they can keep physicians at the center and potentially bring in more cases.
High-deductible health plans
Patients are coming in with higher deductible health plans today, and they're more cost-aware than in the past. "There still seems to be a lack of knowledge about the economic benefits to the consumer and employer for using an ASC over the hospital or HOPD setting," says Dr. Movva. "We are seeing some consumers become more aware and that poses challenges to people who have more skin in the game when it comes to the actual procedure."
Providers are becoming savvier about the patients' expectations and communicating to set reasonable goals post-operation. This way ASCs can be ready for increased volume in the future.
"We are expecting the cost and quality pressures to drive more cases to the ASC," says Dr. Movva. "Insurance companies are looking at hospital systems consolidating and seeing them direct patients strongly within their own facilities. That poses a threat to ASCs and it's not clear how it will shake out. We'll have to stay tuned and position ourselves to be ready for what comes next."