Opening a new ambulatory surgery center is always a challenge, but The Surgery Center of Central PA hit a few unique speed bumps when it started operations in 2003. A few months prior to the opening of the ASC, a senior partner was killed, immediately eliminating up to 35 percent of the center's surgical volume. "You get strapped down trying to open the surgery center to begin with, and when 34 percent of the business is gone and you and your staff are grieving, it makes [the process much more difficult]," says Robert Lamont, the center's CEO.
In the first stage of operations, the center struggled to keep afloat financially. "Our bank account was drawn all the way down, and we weren't sure if we were going to hit payroll," Mr. Lamont says. "Then vendors stopped sending us products because we couldn't pay our bills." Finally, the center received its first check from Medicare, and the administrative team starting "filling the financial hole back in."
He says it might sound cliché, but the key to boosting surgical volume was ensuring and promoting quality outcomes and patient satisfaction. "You do go out and talk to physicians about what's happening inside your center," he says. "We let them know we were continuing to take great care of the patients in spite of everything that's going on." He says another key to overcoming the considerable challenges was keeping staff focused on the ultimate goal: great patient care.
Initial Challenges: Competition and Payor Woes
In its early days, The Surgery Center of Central PA faced severe competition from other healthcare facilities in the area. Possibly in retaliation to the construction of a new center, a local hospital hired its own ophthalmologist to compete with the surgery center's eye procedures. The center was surprised by an unannounced visit from Medicare after an anonymous source filed a complaint against the center for improper credentialing and other allegations, all of which were determined to be unfounded by the inspections.
The surgery center surgeons who had previously been partners with another surgery center were kicked out of their ownership status with the other center. "The surgery center that was partially owned by the hospital went out and recruited its own ophthalmologist from a competing medical center," he says. "Then, to take it one step further, [the center] made appointments with local optometrists, asking them to refer patients back to their surgery center instead of ours." To counter the competitive strike, Mr. Lamont says his surgery center reached out to physicians in the area and publicized his center's outcomes and patient satisfaction.
He says the center also faced hardship when it came to negotiating contracts with payors. "Some of the payors didn't want to work with us and wouldn't negotiate fair reimbursement because of the relationships they had with hospitals," he says. "Some of the payors required us to be accredited and didn't require hospitals to be accredited, so they were holding surgery centers to a higher standard." He says the only possible response was "no": The Surgery Center of Central PA refused to work with payors who offered insubstantial reimbursement. "Eventually you get them to come back to the table because of the quality of care you're providing and the amount of volume you're generating," he says.
The Surgery Center of PA has a significant success story to tell, especially in light of the challenges it faced early on. Mr. Lamont outlines several practices that have helped the ASC stay solvent and sound:
1. Implement EHR in stages. Mr. Lamont's surgery center recently implemented an electronic health record, a process he says has improved patient care and pleased ASC staff. He says the key to successfully installing the EHR was to stage the implementation to give the center time to customize and learn the system. He says prior to go-live, ASC staff came in on weekends to customize the system and train themselves on using it. "We made a clear decision to not go 100 percent EMR from day one," he says. "We might have a surgical day where we had 20 cases, and we would pick [eight of them]. We'd do two in the morning, two in the late morning, two after lunch and two at the end of the day, which staggered [the install] and let people get used to it." He says it took time for staff members to develop confidence with the EHR, but implementing in stages helped wary team members pick up the system over time.
2. Find an anesthesia provider who really wants to practice at the ASC. Living in rural Pennsylvania poses a challenge when it comes to recruiting an anesthesia provider, Mr. Lamont says. Having a consistent anesthesiologist is important to the center's staff and means better patient care because the anesthesia provider and ASC nurses and physicians are used to working with each other. "It's difficult for staff to deal with because anesthesiologists have different ways of doing things just like surgeons do, and it's challenging to be constantly running a new anesthesiologist routine," he says.
To solve the problem, he says the ASC found an anesthesia provider who came to the center after years of working in the hospital. The anesthesiologist had worked in a high-stress, fast-paced environment and was looking for a change. "It's rare that we operate into the late afternoon, and that's very appealing for an anesthesiologist who's used to working from 6 a.m. to 6 p.m. and being mentally and physically exhausted," he says. While the center used to use independent contractors, it now staffs one full-time anesthesiologist who really loves the ASC environment.
3. Let your staff plan your daily schedule. With reimbursement and case volume down, Mr. Lamont says the best way to improve finances is to cut staffing costs. He says the staff at his center "owns" the surgery schedule, from pre-admission testing to pre-op to the OR. "They completely plan the day, and they're motivated to not be standing around," he says. "They want to get out of here just like everyone else." He says letting the staff plan the schedule has empowered them to take control of staffing inefficiencies. "We've also had team leaders in each specific area look at the day in advance and decide what staff needs to be aware of," he says. "Do we need to call some people off, or do we need to tell the flex staff not to come in?"
Read more successful ASC case studies:
-Successful ASC Case Study: Q&A With Neal Maerki of Bend Surgery Center
-Successful ASC Case Study: Northpoint Surgery and Laser Center
In the first stage of operations, the center struggled to keep afloat financially. "Our bank account was drawn all the way down, and we weren't sure if we were going to hit payroll," Mr. Lamont says. "Then vendors stopped sending us products because we couldn't pay our bills." Finally, the center received its first check from Medicare, and the administrative team starting "filling the financial hole back in."
He says it might sound cliché, but the key to boosting surgical volume was ensuring and promoting quality outcomes and patient satisfaction. "You do go out and talk to physicians about what's happening inside your center," he says. "We let them know we were continuing to take great care of the patients in spite of everything that's going on." He says another key to overcoming the considerable challenges was keeping staff focused on the ultimate goal: great patient care.
Initial Challenges: Competition and Payor Woes
In its early days, The Surgery Center of Central PA faced severe competition from other healthcare facilities in the area. Possibly in retaliation to the construction of a new center, a local hospital hired its own ophthalmologist to compete with the surgery center's eye procedures. The center was surprised by an unannounced visit from Medicare after an anonymous source filed a complaint against the center for improper credentialing and other allegations, all of which were determined to be unfounded by the inspections.
The surgery center surgeons who had previously been partners with another surgery center were kicked out of their ownership status with the other center. "The surgery center that was partially owned by the hospital went out and recruited its own ophthalmologist from a competing medical center," he says. "Then, to take it one step further, [the center] made appointments with local optometrists, asking them to refer patients back to their surgery center instead of ours." To counter the competitive strike, Mr. Lamont says his surgery center reached out to physicians in the area and publicized his center's outcomes and patient satisfaction.
He says the center also faced hardship when it came to negotiating contracts with payors. "Some of the payors didn't want to work with us and wouldn't negotiate fair reimbursement because of the relationships they had with hospitals," he says. "Some of the payors required us to be accredited and didn't require hospitals to be accredited, so they were holding surgery centers to a higher standard." He says the only possible response was "no": The Surgery Center of Central PA refused to work with payors who offered insubstantial reimbursement. "Eventually you get them to come back to the table because of the quality of care you're providing and the amount of volume you're generating," he says.
The Surgery Center of PA has a significant success story to tell, especially in light of the challenges it faced early on. Mr. Lamont outlines several practices that have helped the ASC stay solvent and sound:
1. Implement EHR in stages. Mr. Lamont's surgery center recently implemented an electronic health record, a process he says has improved patient care and pleased ASC staff. He says the key to successfully installing the EHR was to stage the implementation to give the center time to customize and learn the system. He says prior to go-live, ASC staff came in on weekends to customize the system and train themselves on using it. "We made a clear decision to not go 100 percent EMR from day one," he says. "We might have a surgical day where we had 20 cases, and we would pick [eight of them]. We'd do two in the morning, two in the late morning, two after lunch and two at the end of the day, which staggered [the install] and let people get used to it." He says it took time for staff members to develop confidence with the EHR, but implementing in stages helped wary team members pick up the system over time.
2. Find an anesthesia provider who really wants to practice at the ASC. Living in rural Pennsylvania poses a challenge when it comes to recruiting an anesthesia provider, Mr. Lamont says. Having a consistent anesthesiologist is important to the center's staff and means better patient care because the anesthesia provider and ASC nurses and physicians are used to working with each other. "It's difficult for staff to deal with because anesthesiologists have different ways of doing things just like surgeons do, and it's challenging to be constantly running a new anesthesiologist routine," he says.
To solve the problem, he says the ASC found an anesthesia provider who came to the center after years of working in the hospital. The anesthesiologist had worked in a high-stress, fast-paced environment and was looking for a change. "It's rare that we operate into the late afternoon, and that's very appealing for an anesthesiologist who's used to working from 6 a.m. to 6 p.m. and being mentally and physically exhausted," he says. While the center used to use independent contractors, it now staffs one full-time anesthesiologist who really loves the ASC environment.
3. Let your staff plan your daily schedule. With reimbursement and case volume down, Mr. Lamont says the best way to improve finances is to cut staffing costs. He says the staff at his center "owns" the surgery schedule, from pre-admission testing to pre-op to the OR. "They completely plan the day, and they're motivated to not be standing around," he says. "They want to get out of here just like everyone else." He says letting the staff plan the schedule has empowered them to take control of staffing inefficiencies. "We've also had team leaders in each specific area look at the day in advance and decide what staff needs to be aware of," he says. "Do we need to call some people off, or do we need to tell the flex staff not to come in?"
Read more successful ASC case studies:
-Successful ASC Case Study: Q&A With Neal Maerki of Bend Surgery Center
-Successful ASC Case Study: Northpoint Surgery and Laser Center