Here are 10 tried-and-true strategies for building a successful GI/endoscopy-driven ASC.
1. Beware of and prepare for impending forces that will impact gastroenterology. The new healthcare reform law and American Recovery and Reinvestment Act will inevitably change the way gastroenterology has been traditionally practiced. In conjunction with all the political commotion that will impact healthcare, ASCs across the country have had to face the challenge of reduced patient volumes due to a slow economic turnaround as well as decreased Medicare reimbursements. A crucial step to building on your GI/endoscopy-driven ASC's success is keeping up with current trends and how these changes will affect the industry so that your ASC can react accordingly.
From: 6 Ways Healthcare Reform and ARRA Will Impact Gastroenterology and 6 Ways GI/Endoscopy-Driven ASCs Will Chance in the Next Five Years.
2. Cut costs wherever possible. Karen Smith, nursing director at Central Illinois Endoscopy Center, says her ASC clamped down on costs related to medical waste, which was costing the facility approximately $800 on a monthly basis. Because her endoscopy center was building case volume, she quickly got to work by conducting audits of what her staff members and physicians were throwing into the medical waste bags. After finding materials that in the medical waste bags that did not belong — such as cups, gloves, IV tubing, band-aids, wrappers and straw wrappers — she re-educated the staff on what was and was not appropriate to throw away in medical waste bags.
"I told the staff and physicians that they needed to watch what they were putting in the red bags. Two months later, I did an audit and found that it was even worse," Ms. Smith says. "Since that wasn't working, what I ended up doing was putting up big stickers on top of the garbage cans that said "For medical waste only" and wrote exactly what was supposed to be in there, basically anything saturated in blood or body fluid. That helped enormously."
3. Compensate for lack of Medicare reimbursements by working with other payors. Jim Stilley, CEO of Northwest Michigan Surgery Center in Traverse City, Mich., says reaching out and working with other insurance carriers can help make up for the loss in profits. He says the biggest selling point when negotiating contracts with other payors is the fact that the cost to perform surgeries in an ASC setting is much less than the cost to perform the same surgeries in the hospital setting.
"If we do a colonoscopy, the price to do it here is half that at a hospital, plus we don't have to provide some of the things that a hospital might have to," he says. "So because our costs are so much lower than a hospital's to perform any one surgery, we have more leverage with BlueCross, Aetna and other payors to make more, so you have to use those opportunities to make up for the losses with Medicare."
4. Adopt best practices for purchasing equipment. Becky Johnson, clinical director of Lincoln (Neb.) Endoscopy Center, says one of the things GI/endoscopy-driven ASCs can do to achieve greater success is adopt excellent purchasing practices that will lead to increased savings without compromising quality care. Some best practices include carefully sifting through physicians' suggestions and conducting competitive cost analyses of various supplies and equipment.
Networking with others in the industry also helps recover costs from purchasing equipment. Ms. Johnson goes to at least one large conference every year focusing on GI to glean better practices in ordering supplies and keep up with advancing technology in the industry. Going to these conferences helps to gather ideas on buying supplies or get leverage for contracting and pricing on products from different vendors, she says.
5. Strategize number of cases by payor per day. Limiting or expanding the number of patients of a certain payor per day is one strategy for ASCs to consider. To stay profitable, Mr. Stilley says surgery centers may have to cap the number of visits by patients covered by Medicare.
"If I have room to see 16 GI patients each day, I might have to cap the number of Medicare patients each day to seven or eight patients," he says. "We can only afford to operate with that many Medicare beneficiaries, and it's unfortunate we have to close that enrollment group, but we have to make room for other payors. Otherwise we won't be profitable. Our facility has the physical capacity to take more patients but not the financial capacity."
6. Expand your schedule to allow more patient visits. Extending hours of operation at Berks Center has allowed more patients to come in later in the day. Additional weekend hours have been made available to patients in the past to accommodate schedules, and that is an option that will continue to be made available on occasion in the future, says John Gleason, administrative director at Berks Center for Digestive Health in Wyomissing, Pa.
"We started out with a schedule that went from approximately 7:30 a.m. to 3 p.m. Monday through Friday, with the last case finishing around 3 p.m. In order to accommodate more cases, we added hours to the end of the day so that cases ended around 5 p.m.," Mr. Gleason says. "Our cases are scheduled every half hour, so this added an additional four patients per room to the schedule. An additional four procedures per room in three rooms over the course of a year adds approximately 3,000 cases to the center."
7. Increase efficiency. Efficiency is a fundamental element to building a successful ASC and should be a goal in every aspect of operations at your GI/endoscopy-driven ASC. This one success factor could potentially increase your patient volume, increase physician, staff and patient satisfaction as well as positively impact your facility's bottom line. Dianne Wallace, executive director of Menomonee Falls (Wis.) Ambulatory Surgery Center, suggests multi-specialty ASCs create a separate patient flow through the facility for just the GI specialty.
"As we grew the GI specialty, we realized admitting GI patients with the general population was going to compromise the quality of care and patient satisfaction," Ms. Wallace says. "GI cases can be anywhere from 15-30 minutes, and recovery is approximately 45 minutes. Other procedures, such as orthopedics or podiatry, can be as long as one hour, with recovery being as long as 1-2 hours. Those cases take much longer to perform and recover from than a colonoscopy and EGD, which are the two main procedures for GI. "
8. Recruit the best-of-the-best GI physicians. Recruiting GI physicians is not a task that should be taken lightly. Since recruiting GI physicians ultimately means higher case volumes, it is important GI/endoscopy-driven ASCs diligently reach out to GI physicians with a proven track record of success based on background and experience and who also fit well with the culture of your ASC. This can be done by aggressively marketing your own ASC's track records and successes to potential candidates.
"ASCs will have to sell themselves based on the quality of their equipment and whether they have a skilled staff who understands GI," says Ms. Wallace. "Physicians are going to look to see who provides the best quality care and has the best staff and equipment, like scopes and video equipment for GI procedures. ASCs have to prove to physicians it is worth their while to join their facility."
9. Build a cohesive team around your top-notch physicians. Building a truly cohesive unit of GI physicians and staff members will make all the difference in delivering the most excellent clinical outcomes with the widest profit margins. Employing a cohesive team will also help your GI/endoscopy-driven ASC operate at optimal efficiency. Philip Grossman, MD, CEO, medical director and chairman of the board at Kendall Endoscopy and Surgery Center in Miami, suggests creating social opportunities for physicians and staff to get to know each other and foster stronger relationships.
"Every year, we hold a nice holiday party where we invite the entire staff and their spouse or significant other," Dr. Grossman says. "Some of the employees have commented to me that not only do they appreciate the party, the food and the music, but also the fact that the physician partners and their spouses gave up an evening to be with them. It gives everyone a chance to find out what their peers are like as people."
10. Strive for excellent patient care and satisfaction. Focusing on providing high quality care for each patient not only ensures patients receive the care they need to recover any GI-related conditions but also gives them a reason to come back.
"I have patients come back to this facility because of the nurses and physicians that I have," says Connie Casey, administrator at Northpoint Surgery Center in West Palm Beach, Fla. "Everyone puts forth exceptional effort for all the patients, including the scheduling department, billing and collecting, nurses in the OR or recovery room and so on. I have letters that come in every week from patients saying they have never met a more professional staff that is so kind and courteous."
1. Beware of and prepare for impending forces that will impact gastroenterology. The new healthcare reform law and American Recovery and Reinvestment Act will inevitably change the way gastroenterology has been traditionally practiced. In conjunction with all the political commotion that will impact healthcare, ASCs across the country have had to face the challenge of reduced patient volumes due to a slow economic turnaround as well as decreased Medicare reimbursements. A crucial step to building on your GI/endoscopy-driven ASC's success is keeping up with current trends and how these changes will affect the industry so that your ASC can react accordingly.
From: 6 Ways Healthcare Reform and ARRA Will Impact Gastroenterology and 6 Ways GI/Endoscopy-Driven ASCs Will Chance in the Next Five Years.
2. Cut costs wherever possible. Karen Smith, nursing director at Central Illinois Endoscopy Center, says her ASC clamped down on costs related to medical waste, which was costing the facility approximately $800 on a monthly basis. Because her endoscopy center was building case volume, she quickly got to work by conducting audits of what her staff members and physicians were throwing into the medical waste bags. After finding materials that in the medical waste bags that did not belong — such as cups, gloves, IV tubing, band-aids, wrappers and straw wrappers — she re-educated the staff on what was and was not appropriate to throw away in medical waste bags.
"I told the staff and physicians that they needed to watch what they were putting in the red bags. Two months later, I did an audit and found that it was even worse," Ms. Smith says. "Since that wasn't working, what I ended up doing was putting up big stickers on top of the garbage cans that said "For medical waste only" and wrote exactly what was supposed to be in there, basically anything saturated in blood or body fluid. That helped enormously."
3. Compensate for lack of Medicare reimbursements by working with other payors. Jim Stilley, CEO of Northwest Michigan Surgery Center in Traverse City, Mich., says reaching out and working with other insurance carriers can help make up for the loss in profits. He says the biggest selling point when negotiating contracts with other payors is the fact that the cost to perform surgeries in an ASC setting is much less than the cost to perform the same surgeries in the hospital setting.
"If we do a colonoscopy, the price to do it here is half that at a hospital, plus we don't have to provide some of the things that a hospital might have to," he says. "So because our costs are so much lower than a hospital's to perform any one surgery, we have more leverage with BlueCross, Aetna and other payors to make more, so you have to use those opportunities to make up for the losses with Medicare."
4. Adopt best practices for purchasing equipment. Becky Johnson, clinical director of Lincoln (Neb.) Endoscopy Center, says one of the things GI/endoscopy-driven ASCs can do to achieve greater success is adopt excellent purchasing practices that will lead to increased savings without compromising quality care. Some best practices include carefully sifting through physicians' suggestions and conducting competitive cost analyses of various supplies and equipment.
Networking with others in the industry also helps recover costs from purchasing equipment. Ms. Johnson goes to at least one large conference every year focusing on GI to glean better practices in ordering supplies and keep up with advancing technology in the industry. Going to these conferences helps to gather ideas on buying supplies or get leverage for contracting and pricing on products from different vendors, she says.
5. Strategize number of cases by payor per day. Limiting or expanding the number of patients of a certain payor per day is one strategy for ASCs to consider. To stay profitable, Mr. Stilley says surgery centers may have to cap the number of visits by patients covered by Medicare.
"If I have room to see 16 GI patients each day, I might have to cap the number of Medicare patients each day to seven or eight patients," he says. "We can only afford to operate with that many Medicare beneficiaries, and it's unfortunate we have to close that enrollment group, but we have to make room for other payors. Otherwise we won't be profitable. Our facility has the physical capacity to take more patients but not the financial capacity."
6. Expand your schedule to allow more patient visits. Extending hours of operation at Berks Center has allowed more patients to come in later in the day. Additional weekend hours have been made available to patients in the past to accommodate schedules, and that is an option that will continue to be made available on occasion in the future, says John Gleason, administrative director at Berks Center for Digestive Health in Wyomissing, Pa.
"We started out with a schedule that went from approximately 7:30 a.m. to 3 p.m. Monday through Friday, with the last case finishing around 3 p.m. In order to accommodate more cases, we added hours to the end of the day so that cases ended around 5 p.m.," Mr. Gleason says. "Our cases are scheduled every half hour, so this added an additional four patients per room to the schedule. An additional four procedures per room in three rooms over the course of a year adds approximately 3,000 cases to the center."
7. Increase efficiency. Efficiency is a fundamental element to building a successful ASC and should be a goal in every aspect of operations at your GI/endoscopy-driven ASC. This one success factor could potentially increase your patient volume, increase physician, staff and patient satisfaction as well as positively impact your facility's bottom line. Dianne Wallace, executive director of Menomonee Falls (Wis.) Ambulatory Surgery Center, suggests multi-specialty ASCs create a separate patient flow through the facility for just the GI specialty.
"As we grew the GI specialty, we realized admitting GI patients with the general population was going to compromise the quality of care and patient satisfaction," Ms. Wallace says. "GI cases can be anywhere from 15-30 minutes, and recovery is approximately 45 minutes. Other procedures, such as orthopedics or podiatry, can be as long as one hour, with recovery being as long as 1-2 hours. Those cases take much longer to perform and recover from than a colonoscopy and EGD, which are the two main procedures for GI. "
8. Recruit the best-of-the-best GI physicians. Recruiting GI physicians is not a task that should be taken lightly. Since recruiting GI physicians ultimately means higher case volumes, it is important GI/endoscopy-driven ASCs diligently reach out to GI physicians with a proven track record of success based on background and experience and who also fit well with the culture of your ASC. This can be done by aggressively marketing your own ASC's track records and successes to potential candidates.
"ASCs will have to sell themselves based on the quality of their equipment and whether they have a skilled staff who understands GI," says Ms. Wallace. "Physicians are going to look to see who provides the best quality care and has the best staff and equipment, like scopes and video equipment for GI procedures. ASCs have to prove to physicians it is worth their while to join their facility."
9. Build a cohesive team around your top-notch physicians. Building a truly cohesive unit of GI physicians and staff members will make all the difference in delivering the most excellent clinical outcomes with the widest profit margins. Employing a cohesive team will also help your GI/endoscopy-driven ASC operate at optimal efficiency. Philip Grossman, MD, CEO, medical director and chairman of the board at Kendall Endoscopy and Surgery Center in Miami, suggests creating social opportunities for physicians and staff to get to know each other and foster stronger relationships.
"Every year, we hold a nice holiday party where we invite the entire staff and their spouse or significant other," Dr. Grossman says. "Some of the employees have commented to me that not only do they appreciate the party, the food and the music, but also the fact that the physician partners and their spouses gave up an evening to be with them. It gives everyone a chance to find out what their peers are like as people."
10. Strive for excellent patient care and satisfaction. Focusing on providing high quality care for each patient not only ensures patients receive the care they need to recover any GI-related conditions but also gives them a reason to come back.
"I have patients come back to this facility because of the nurses and physicians that I have," says Connie Casey, administrator at Northpoint Surgery Center in West Palm Beach, Fla. "Everyone puts forth exceptional effort for all the patients, including the scheduling department, billing and collecting, nurses in the OR or recovery room and so on. I have letters that come in every week from patients saying they have never met a more professional staff that is so kind and courteous."