So you've been hired as ASC administrator, now what? In an established center, policies and procedures are likely developed, credentialing is set, payer contracts negotiated and vendors contracted. As the new administrator, your role is to review everything and become familiar with that information. But what if you've been hired into a new center?
For many ASC administrators, it is a sink-or-swim situation when they are brought on board to manage a new center. There is so much information they need to know, yet very little in the way of resources. As a result, many administrators are left wondering where they can go for help.
The following is an overview of the various areas administrators must know well to be effective. Whether a veteran administrator, or someone new to the job, this information should serve as a primer to success.
Financial management: To learn about finances, start by shadowing the business office team. Sit down with each person and ask about his/her role within the team. Remember names and establish connections because each team member owns a part of the knowledge base. Additional tips include: take an entry-level accounting course, learn your accounting software (QuickBooks is preferred by many centers), consider taking AORN ASC Administrator's Boot Camp, call your software vendor and learn your system's billing module. If you don't have the needed financial background, and cannot take a course, consider outsourcing billing.
Accreditation and regulations: CMS reserves the right to conduct an unannounced validation survey, to confirm the first survey's results, any time after a deemed status survey is conducted. Unannounced surveys can be more difficult if a center takes part in an early option CMS deemed status survey. Early option surveys are designed for new centers wishing to perform cases and bill Medicare. The process can be lengthy, and Medicare cannot be billed in the meantime. While awaiting a Medicare number it is important to consider the available cash you will need.
If a center expects to bill Medicare, it all starts with the 855B application. Study the CMS ASC regulations and Interpretive Guidelines, which are available online. When preparing for a survey, conduct an infection control survey to ensure the center is compliant.
Supply chain management: Review the processes and available reports pertaining to inventory; this includes learning about group purchasing organizations. A center can join a GPO at no cost and receive benefits regardless of ownership. It is also important to identify distributors. Understand up front what reports will be available; how the distributor can help the center; how often they deliver (once a week, twice a week?); and do they drive their own trucks, or do they deliver by commercial trucks?
Preference cards, building inventory and purchasing contracts: Loading updated preference cards into a center's software system will help with tracking costs. As a center builds the inventory process, it is essential to establish strict guidelines regarding contracts and payment requirements.
Medical records management: Every state has its own set of requirements for retention and destruction of medical records. When dealing with children, record retention is especially critical as records must be retained until the infant has reached age of maturity, which is 18 or 21, plus a certain number of years. OSHA records for employees must be kept for 30 years.
Designate a medical records employee (typically someone in the business office), though this may be the administrator, it is not advised. Because the administrator has too many other obligations, this responsibility should be delegated.
Additionally, medical records must be locked up after the center closes and tracked at all times. If a medical record leaves the medical records' area and is simply taken to another area, the new location must be known.
Facilities management/requirements: Facilities management is an area that is often overlooked by administrators. Due diligence must be done as the administrator should be able to easily answer the following questions about the building such as: What signs must be displayed? What safety checks are required? How are medical gas cylinders stored and maintained? What are the requirements for the emergency call system? What are your temperature and humidity standards? Are the logs readily available?
Board of managers: The Board of Managers controls a center and has corporate liability. In relating to the Board of Managers, an administrator must carry out a variety of tasks, including developing an agenda template for meetings and keeping detailed minutes, reporting on the financials, quality, infection control and committee minutes and achieving accreditation requirements for the frequency of the meetings. If bylaws specify quarterly meetings, then examiners will look for verification that these occurred; for bylaws and operating agreements, work with a healthcare attorney.
Quality management: Many administrators struggle with developing meaningful quality improvement studies. The following resources will greatly help with quality management efforts: ASC Quality Collaboration, AAAHC Institute for Quality Improvement and AORN Ambulatory Administrator Boot Camp.
There are many additional resources available to administrators including the complimentary e-book, Admin 101: What Every New ASC Administrator Needs to Know, available at www.sourcemed.net/7353. This comprehensive e-book walks readers through the complicated role of ASC administrator. Additional help can be found by visiting: Association of Ambulatory Surgery Centers, ASC Quality Collaboration and AORN (Association of Perioperative Registered Nurses).