Every year new technologies and techniques are introduced in the healthcare landscape. Ambulatory surgery center owners and operators must make prudent decisions for technological upgrades that will ensure their facility remains on the cutting-edge of patient care.
Four ASC administrators discuss the upgrades recently made at their centers and how they impacted operations.
Question: What are some recent upgrades you made at your center?
Robin Amos, Administrator, Mallard Creek Surgery Center (Charlotte, N.C.): We just celebrated our one-year anniversary. We purchased some additional equipment to add spine procedures and total joint replacement procedures. We added TJR procedures launched in September and spine in October. When opened the center, we wanted to make sure our operating rooms were as large as we could make them. We also needed adequate storage space and we needed processing space that could meet the demands of orthopedic instruments. So we kept these requirements in mind during construction.
Andrea Marsh, Administrator, Orthopaedic South Surgical Center (Morrow, Ga.): We implemented online assessment using One Medical Passport and our corporate office recently upgraded our servers, which increased speed and efficiency.
Andrew Cash, MD, Owner, Minimally Invasive Center of Excellence (Las Vegas): Our Minimally Invasive Center of Excellence was established primarily to treat spinal conditions with minimally invasive spine surgery and with diagnostic/therapeutic injections. As we have grown to include orthopedic conditions, we had to upgrade our center with regard to orthopedic tables, arthroscopy towers and equipment. We had to prognosticate a timeline in which the additional services would a cover the new expenses.
Julie Tonsager, OR Team Leader, St. Cloud (Minn.) Surgery Center: We purchased an ultraviolet light, and as a matter of fact six months later we purchased a second light. We had a 'name the robot' contest at the center and have named both of our UV lights. They are: DORA, Disinfecting Operating Room Apparatus, and GUS, Give Us Sterility. Both of these lights are working full-time for us, and we have even expanded their use to waiting rooms and bathrooms. They are so important to us that we have center-wide goals set around their use.
Q: Why did you decide to make these upgrades?
RA: We wanted to be a full-fledged orthopedic surgery center that was a one-stop shop for our group. All the physicians from the group wanted to provide some type of surgical care here and so we wanted to add the TJR and spine options as well as sports medicine services.
AC: Supplementing our amubulatory services with orthopedic cases improved our service line, negotiating power and value to patients.
AM: A number of reasons, including cost efficiency, improving patient outcomes and satisfaction as well as reducing cancellations.
JT: We had been looking at these devices over the past several years. We were in the process of gearing up to do some outpatient total joint cases. The surgeon involved wanted us to look at a UV light and purchase one so we could decrease our potential for infection.
Q: How has it affected ASC operations since implementation/addition? Have you seen a return on investment as yet?
RA: With celebrating our one-year anniversary, we have seen our volumes steadily increase, especially after adding the TJR program and spine services. These have added to our monthly stats and have been very useful in growing volume.
AC: Our orthopedic services became available less than a year ago, and we have not recuperated the capital outlay; however, we remain optimistic through the utilization of more surgeons and augmented case volume.
AM: It has increased efficiency, patient satisfaction, quality of assessment — that is thorough assessment — as well as improved communication and cost savings because we were able to shift the pre-assessment nurse to assist with lunch coverage, among other changes. Approximate savings for us is $24,000 per year. The upgrades have also resulted in increased employee satisfaction and decreased stress because the staff no longer has to worry about tracking the patient down or playing phone tag.
JT: We are proud to announce that since last October we have done 33 total joint cases with no infections. We have seen a return on investment and we are doing cases that we would not have been able to do if we did not have the UV light. Plus we are using the light in other areas of the center and this decreases the risk of infection for all patients. Saving one infection is an awesome return on investment in my estimation!
Q: What are some considerations for ASCs thinking about an upgrade?
RA: I think an electronic medical record system is extremely important for efficiency. We did not start our facility with an EMR, but implementing one is a target of ours for the future. An EMR helps drive your statistical data and it allows us to ensure that we are performing at our best. It's a huge productivity tool. Also, another consideration is making sure you are getting the best price on supplies with your GPO.
AM: Make sure you partner with a reliable company and product. Do your homework. Look at the product from a patient standpoint. Ask questions like: "Does the system save or timeout and lose data? Can the patient access information to make changes?"
AC: Any upgrade to the center falls under the same scrutiny, even more so for expensive technologies like the O-arm and robotic-assisted surgery; higher expense equates to higher financial risk. I feel that a conservative approach to return on investment is the most prudent. By definition, there is a built-in margin of error for anticipated case volume, payer reimbursement and unforeseen expenses. While financial deliberations are integral, they will always be secondary to the paramount considerations of patient outcomes, satisfaction and safety.
Q: What are some common mistakes to avoid when deciding on and implementing an upgrade?
RA: Not shopping around enough for supplies and products is a common mistake. There are a lot of suppliers and great products that are refurbished and can be bought at good prices. It pays to be educated and to do your homework.
AC: Balanced comparison shopping. Too few comparisons risks inadvertent selection of the most expensive and least practical, while too many comparisons leads to analysis paralysis, wasted time, prolonged decision-making and greater likelihood of buyer's remorse.
AM: Don't go with the bells and whistles if it is not necessary. You want to meet your needs for present and future, but some may only be options and will dissipate your savings.
JT: The need to research the item you are looking at. In most instances there is more than one company carrying this item and of course they want you to buy theirs. You need to look at what best suits your needs. In our instance, we needed a machine that not only worked, but also did so efficiently and in a small time footprint and thus the Xenex UV light. Time is money in an operating room.
Q: Are there any other investments/upgrades you're considering for the future?
RA: Getting an EMR is our next big goal and we hope to have it in place within 24 months.
AC: We are investigating non-orthopedic subspecialist equipment. We will have to manage the utilization of operating rooms with anticipated financial and storage constraints.
AM: Hoping to pilot an electronic health record for our management company, USPI, which will improve other areas for us. Hopefully this time next year, we can have this same interview regarding how an EHR has affected our ASC! We were given the opportunity to pilot the One Medical Passport and never looked back.
JT: We have moved ahead with two robotic systems for our total joint replacements. We have the BlueBelt Navio robotic for partial knee replacement, and we have the MAKOplasty robotic arm for partial knee resurfacing and hip replacement.