Don't go into the next year without some robust goals for your surgery center. Setting goals now will empower employees to offer suggestions for change and get your ASC off to a good start in 2013. Here Jared Leger, CEO of Arise Healthcare, shares five goals surgery centers can pursue over the next year.
1. Try to go in-network. Many experts agree that out-of-network — once a lucrative reimbursement strategy for surgery centers — is a dying strategy in many markets. Mr. Leger says if possible, surgery centers should think about moving in-network with their regional payors.
"It's becoming more difficult to get paid at full reimbursement rates through out-of-network insurance carriers," he says. "Higher out-of-network deductibles and co-insurances, increased HMO-only insurance products being sold to employers, and reasonable and customary fee schedule payment maximums will continue to make the out-of-network model difficult."
Instead of relying on out-of-network to stabilize over the next few years, talk to your payors and determine whether an in-network contact could keep your center profitable and build relationships with insurance companies.
2. Grow outpatient volume. More and more cases are moving into the outpatient setting; spine is one specialty that has seen tremendous growth in surgery centers due to the advent of minimally invasive techniques. While these procedures are not fully embraced by payors or physicians at this time, Mr. Leger encourages centers to look into procedures with outpatient potential.
"Try to look for cases that are routinely performed in an inpatient setting, and work to eliminate the barriers preventing them from being safely performed in an outpatient setting," he says. There may be capital expenditures associated with the addition of a new specialty, but Mr. Leger says this isn't necessarily a dealbreaker. "Sometimes it's a matter of purchasing equipment that ends up paying for itself with increased volume," he says.
3. Look to JV with a hospital. Hospital/physician ASC joint ventures are becoming more popular, as ASCs seek contracting clout and hospitals attempt to build physician relationships and grow market share. Mr. Leger says surgery centers should at least consider the possibility of a hospital partner — even if it turns out to be impractical.
"This goal is not applicable in all markets, but I would at least look at a hospital joint venture," he says. "It would eliminate any out-of-network issues, if you are facing challenges with the out-of-network model." Hospital partnership can also often improve ASC contracting rates by 15-20 percent. "It likely provides for better reimbursement rates on the same book of business," Mr. Leger says.
4. Cut costs. No matter the year, surgery centers are always going to have to look at costs. Mr. Leger says this should be a critical step for ASCs in 2013, especially if they have "low-hanging fruit" that hasn't been tackled in the past. He sets a clear goal for centers: "Start with your 20 top expenses by dollar amount, [and] work to reduce those costs by five percent."
5. Reduce turnover and turnaround time. Efficiency is key, especially in centers that perform specialties with a high case volume and quick case time, such as ophthalmology and gastroenterology. He says this should be an easy one: Simply measure turnover time and then incentive your staff to beat the current turnover time.
You can even post your current "best time" on the wall along with your goal. "Engage employees to offer solutions on how to become more efficient," Mr. Leger says. Most likely, your front-line workers — nurses and techs — will understand the issues that cause delays.
Learn more about Arise Healthcare.
1. Try to go in-network. Many experts agree that out-of-network — once a lucrative reimbursement strategy for surgery centers — is a dying strategy in many markets. Mr. Leger says if possible, surgery centers should think about moving in-network with their regional payors.
"It's becoming more difficult to get paid at full reimbursement rates through out-of-network insurance carriers," he says. "Higher out-of-network deductibles and co-insurances, increased HMO-only insurance products being sold to employers, and reasonable and customary fee schedule payment maximums will continue to make the out-of-network model difficult."
Instead of relying on out-of-network to stabilize over the next few years, talk to your payors and determine whether an in-network contact could keep your center profitable and build relationships with insurance companies.
2. Grow outpatient volume. More and more cases are moving into the outpatient setting; spine is one specialty that has seen tremendous growth in surgery centers due to the advent of minimally invasive techniques. While these procedures are not fully embraced by payors or physicians at this time, Mr. Leger encourages centers to look into procedures with outpatient potential.
"Try to look for cases that are routinely performed in an inpatient setting, and work to eliminate the barriers preventing them from being safely performed in an outpatient setting," he says. There may be capital expenditures associated with the addition of a new specialty, but Mr. Leger says this isn't necessarily a dealbreaker. "Sometimes it's a matter of purchasing equipment that ends up paying for itself with increased volume," he says.
3. Look to JV with a hospital. Hospital/physician ASC joint ventures are becoming more popular, as ASCs seek contracting clout and hospitals attempt to build physician relationships and grow market share. Mr. Leger says surgery centers should at least consider the possibility of a hospital partner — even if it turns out to be impractical.
"This goal is not applicable in all markets, but I would at least look at a hospital joint venture," he says. "It would eliminate any out-of-network issues, if you are facing challenges with the out-of-network model." Hospital partnership can also often improve ASC contracting rates by 15-20 percent. "It likely provides for better reimbursement rates on the same book of business," Mr. Leger says.
4. Cut costs. No matter the year, surgery centers are always going to have to look at costs. Mr. Leger says this should be a critical step for ASCs in 2013, especially if they have "low-hanging fruit" that hasn't been tackled in the past. He sets a clear goal for centers: "Start with your 20 top expenses by dollar amount, [and] work to reduce those costs by five percent."
5. Reduce turnover and turnaround time. Efficiency is key, especially in centers that perform specialties with a high case volume and quick case time, such as ophthalmology and gastroenterology. He says this should be an easy one: Simply measure turnover time and then incentive your staff to beat the current turnover time.
You can even post your current "best time" on the wall along with your goal. "Engage employees to offer solutions on how to become more efficient," Mr. Leger says. Most likely, your front-line workers — nurses and techs — will understand the issues that cause delays.
Learn more about Arise Healthcare.