Excessive staff hours per case can have a big negative impact on surgery center income. Founding Partner of ASD Management Joe Zasa talks about this impact and how to make sure surgery centers hit their staffing time per case benchmarks while providing high quality patient care.
1. Stick to the benchmarks. A multi specialty ASC doing in excess of 300 cases per month should have no more than 10 to 11 hours worked per patient depending on the type of cases performed at the center. Staffing costs have a big impact on the ASC's bottom line.
"The conclusion is that 12.5 hours worked versus 11.0 seems innocuous enough, but it costs $250,000 of net income per year for your center and the investors without any slip in quality of care," says Mr. Zasa. An overstaffed center looks very similar to a properly staffed center; thus, use benchmarks to identify potential areas where there are problems, and ask questions. Ultimately, a team approach to staffing is the best way rather than relying on one person to determine staffing patterns.
"The collaborative approach is the best because it creates checks and balances and allows input to hone the correct staffing for your center," says Mr. Zasa.
This benchmark is for productive work hours, which includes patient care prior to, during and after surgery. The preadmission process and postoperative calls, staff education, staff meetings and employees working at the center are all included in the benchmark. The benchmark does not include non-productive paid work hours, vacation, sick leave or jury duty.
2. Embrace the working manager role. ASC administrators should manage the center efficiently but also work to fill in other roles where needed; the manager just can't delegate to other employees. There must be a balance between clinical and administrative duties. Remember, the manager should not hire people to do their job. If so, the result is an $80,000 reduction in income per employee.
"Cross training is an obvious way to effectively reduce your costs," says Mr. Zasa. "We believe [staffing goals] are easily achievable if our administrators embrace the working manager model instead of hiring additional employees."
3. Don't hire another nurse unless it's necessary. Really dig deep into the data and surgery center processes to make sure everyone is running as efficiently as possible before hiring another nurse. The additional nurse will cost around $80,000 per annum at $30 per hour plus 25 percent benefits and a typical bonus.
"Quality of care is of paramount importance," says Mr. Zasa. "So under the assumption that there is good quality of care, a surgery center doing more than 300 cases per month should run around 10 hours of staffing per patient, based on our experience. If you are not in that range, there should be a good reason you aren't there."
4. Bring in a third party to evaluate staffing at the center. If your center can't consistently record appropriate staffing hours per case, bring in a third party to examine your processes and suggest improvements. The manager should understand how to flex their staff and cross train to meet the needs of a lean surgery center. The cost of doing this is small compared to the potential savings generated
"These evaluations should look at the benchmarks to act as a diagnostic to tell us where there might be issues," says Mr. Zasa. "We don't run surgery centers off spreadsheets, but the numbers don't lie. They show us where to look and which questions to ask."
The third party evaluators can work with your center to find constructive ways to reduce those staffing hours per patient.
5. Work with the governing body to make necessary changes. When your center goes beyond the benchmarks, bring the physician investors and entire governing body together to discuss strategies for reduction. This could mean more compact scheduling, part-time employees, flex hours or process changes at the ASC.
"It's great to have a bunch of employees at the ASC, but when each additional employee costs $80,000 out of the physician's pocket, it's time to pay more attention to staffing," says Mr. Zasa. "Embrace a collaborative approach to staffing with proper checks and balances, use benchmarks and set realistic goals for managers. These strategies allow you center to be more efficient without diminishing the quality of care."
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