Three ASC administrators offer advice on cutting costs and increasing profits on gastroenterology in an ambulatory surgery center.
1. Find out why your cases are cancelled. According to Bunny Twiford, RN, president of Twiford Consulting in Warminster, Pa., GI/endoscopy-driven ASCs should benchmark reasons patients are cancelled on the day of the scheduled procedure. If ASCs categorized the reasons for case cancellations, they could take steps to prevent cancellations and save on staffing costs. Ms. Twiford says poor bowel prep is one of the causes of sudden GI procedure cancellations. Non-adherence to "nothing by mouth" or NPO instructions or a patient with cold or flu symptoms might be other reasons for a cancellation. "For example, ASCs don't want to find out at 7 a.m. that the patient stopped their bowel prep," Ms. Twiford says. "Let's say my GI/endoscopy-driven ASC had 14 cancellations in November, and I go back to find 10 of those were bowel prep-related. I have to go back and find out what difficulties or challenges around bowel prep caused the cancellations. Maybe patients aren't understanding the bowel prep procedure or they encountered problems with the bowel prep in the evening when the ASC was closed."
2. Reduce the cost of scopes. In order to save money on scopes, ASC administrators should take time to research pricing and maintenance fees. Felix Mariani, administrator of Allegheny Regional Endoscopy Center, says his center spent more than a year researching scope prices from three major manufacturers. "We spent well over a year researching various factors, such as which scope is best suited for our physicians, which scope is the most cost-effective, which one is the easiest to use and offers the highest quality of images and so on," he says. "In addition, throughout this process we had monthly meetings involving all of the physicians and myself. These meetings allowed physicians the critical input into the selection process." ASCs should also make an effort to control costs related to scope maintenance, he says. This may necessitate negotiating with the vendor to see how maintenance and repair costs can be reduced.
3. Work with primary care physicians to increase colorectal screenings. Most ASCs rely on their physicians to bring cases to the center, but primary care physicians in your community may also be a valuable source of referrals. GI centers should talk to primary care physicians about the importance of colon cancer screenings and your center's availability. If primary care physicians are aware that your center performs screenings, they may recommend colon cancer screenings to their patients and then send them your way. "We do a lot of work in just educating the [physician] community, talking to primary care physicians, OB/GYNs and other specialists about colon cancer," says Nancy Nikolovski of Physicians Endoscopy Center in Houston, Texas. "They're still the gatekeepers, and they really do direct patients' care, so they are instrumental in making sure patients get screened."
4. Look for a 60 percent return on investment on new equipment. When her ASC considers adding new equipment, Ms. Nikolovski says she spends at least six months researching, looking at data, talking to other centers and doing cost-benefit analysis and prediction of the return on investment. "We have to be able to present the new revenue stream and demonstrate that it is going to add value to our centers," she says. "We typically look for returns on investment of at least 55-60 percent and choose to add equipment that will be profitable."
Read more on GI:
-Microcameras May Lead to Disposable Endoscopes
-Pillcam SB Capsule Receives FDA Approval
-AGA: Increased Access Needed for Colorectal Cancer Screenings
1. Find out why your cases are cancelled. According to Bunny Twiford, RN, president of Twiford Consulting in Warminster, Pa., GI/endoscopy-driven ASCs should benchmark reasons patients are cancelled on the day of the scheduled procedure. If ASCs categorized the reasons for case cancellations, they could take steps to prevent cancellations and save on staffing costs. Ms. Twiford says poor bowel prep is one of the causes of sudden GI procedure cancellations. Non-adherence to "nothing by mouth" or NPO instructions or a patient with cold or flu symptoms might be other reasons for a cancellation. "For example, ASCs don't want to find out at 7 a.m. that the patient stopped their bowel prep," Ms. Twiford says. "Let's say my GI/endoscopy-driven ASC had 14 cancellations in November, and I go back to find 10 of those were bowel prep-related. I have to go back and find out what difficulties or challenges around bowel prep caused the cancellations. Maybe patients aren't understanding the bowel prep procedure or they encountered problems with the bowel prep in the evening when the ASC was closed."
2. Reduce the cost of scopes. In order to save money on scopes, ASC administrators should take time to research pricing and maintenance fees. Felix Mariani, administrator of Allegheny Regional Endoscopy Center, says his center spent more than a year researching scope prices from three major manufacturers. "We spent well over a year researching various factors, such as which scope is best suited for our physicians, which scope is the most cost-effective, which one is the easiest to use and offers the highest quality of images and so on," he says. "In addition, throughout this process we had monthly meetings involving all of the physicians and myself. These meetings allowed physicians the critical input into the selection process." ASCs should also make an effort to control costs related to scope maintenance, he says. This may necessitate negotiating with the vendor to see how maintenance and repair costs can be reduced.
3. Work with primary care physicians to increase colorectal screenings. Most ASCs rely on their physicians to bring cases to the center, but primary care physicians in your community may also be a valuable source of referrals. GI centers should talk to primary care physicians about the importance of colon cancer screenings and your center's availability. If primary care physicians are aware that your center performs screenings, they may recommend colon cancer screenings to their patients and then send them your way. "We do a lot of work in just educating the [physician] community, talking to primary care physicians, OB/GYNs and other specialists about colon cancer," says Nancy Nikolovski of Physicians Endoscopy Center in Houston, Texas. "They're still the gatekeepers, and they really do direct patients' care, so they are instrumental in making sure patients get screened."
4. Look for a 60 percent return on investment on new equipment. When her ASC considers adding new equipment, Ms. Nikolovski says she spends at least six months researching, looking at data, talking to other centers and doing cost-benefit analysis and prediction of the return on investment. "We have to be able to present the new revenue stream and demonstrate that it is going to add value to our centers," she says. "We typically look for returns on investment of at least 55-60 percent and choose to add equipment that will be profitable."
Read more on GI:
-Microcameras May Lead to Disposable Endoscopes
-Pillcam SB Capsule Receives FDA Approval
-AGA: Increased Access Needed for Colorectal Cancer Screenings