From contracts to cost containment, eight ASC leaders joined Becker's to discuss smart leadership.
Question: What are smart ASC leaders doing right now?
Editor's note: These responses were edited lightly for brevity and clarity.
Michelle Eilander, RN. Administrative Director of Ankeny (Iowa) Medical Park Surgery Center: Being flexible with staffing arrangements and showing staff appreciation. Staffing can be a struggle at times, and the new generation that is entering or has recently entered the working world want flexibility. Also, ASC leaders need to know case-costing specifics to be able to make sure that the procedures that are being performed are actual procedures that are profitable. In addition, the utilization of block time is very important and can be tweaked by using reports that show actual times for primary procedures and adjusting times as needed. If the actual procedure times are scheduled correctly, it can decrease patient wait times and prevent staff working overtime, which can lead to burnout; or on the other hand, it might result in the physician waiting for the patient to be ready in the pre-op area, which is wasting his utilization time. It is best to be as accurate as possible when scheduling the procedures so that neither the patient nor the physician are waiting and it does not go past operating room time frames, resulting in overtime pay for staff.
Michelle Fischer. Administrator of Christus Surgery Center-Stone Oak (San Antonio): We are actively looking for creative ways to counteract our rising labor and supply expenses while keeping our employees and physicians engaged and happy. We continue to actively recruit physicians and stay current with industry trends for new service lines that can possibly be added to our facility.
Melissa Hermanson, MSN, RN. Administrator of Ambulatory Care Center (Vineland, N.J.): Smart ASC leaders are monitoring the market and analyzing reimbursement data against rising costs. Although, on the whole, ASCs received a boost in rates this year, it isn't nearly enough to match inflation rates and several procedures took hits. Anesthesia reimbursements are also changing and could affect the ASCs bottom line. Finally, commercial payers have begun using the Medicare fee schedule as a guide for contract discussions. Sharpen up those negotiation skills.
Liliana Lehmann. President of Axis HealthCare Partners (Fort Lauderdale, Fla.):
The current environment can be disruptive to the organization's strategic planning. Leaders must take a step back and analyze the current structure of the organization they are running to make sure it is properly set to grow and expand. We need to understand that we are facing very different times post pandemic and must react accordingly. For example:
- Efficient and effective staffing has always been essential to the success of the ASC. Leaders need to look for creative ways, besides wage increases, to keep and retain strong talent. ASCs are fighting against hospitals and travel agencies for a very limited pool of candidates. Leaders must realize that a revolving door cannot only be disruptive, but extremely costly.
- Control of the healthcare supply chain is imperative at a time when payers' reimbursements are mostly flat. Streamlining and automating a significant portion of the entire procurement process is an investment well worth it.
- Analyzing ASC specific value-based models mostly in the form of bundled payments as part of the organization's strategic plan.
- Understanding private equity groups acquisitions of not only ASCs but medical practices and how it affects your current ASC environment.
Michael Powers. Administrator of Children's West Surgery Center (Knoxville, Tenn.): Strategically thinking about where are the current and future opportunities. … Is it renegotiating payer contracts for fee increases based upon solid data to their surgical mix/profitability? Is it in reviewing physician succession planning or recruitment of specific specialties that fit best into their center again with greatest profitability. Is it ensuring competitive salary and benefits to maintain and recruit staff. Or constant review of supply costs and looking for opportunities for savings. Lastly, the goal should be filling the operating room schedule with as many of the most profitable cases as possible every day. This must be considered in advance and not a few days before. The smartest leaders know their business, understand their opportunities and strategically plan tactics to accomplish the necessary goals. All too common for ASC leaders get pulled into the day-to-day operations and do not have the time to focus strategically.
Marietha Silvers, RN. Administrator of The Surgery Center of Cleveland (Tenn.): Preparing for the future. Thinking outside the box. Investigating potential procedures that could and have been performed in an outpatient setting safely in anticipation of said procedures being performed in your ASC. We must constantly evolve and re-create what we are.
Merle Smith. Administrator of Pueblo (Colo.) Surgery Center: Controlling costs best they can and staffing correctly.
Mark Spina. Director of Operations at the Endoscopy Center of Connecticut (Hamden): Smart ASC leaders now are recruiting and hiring enough staff, particularly registered nurses, to effectively run their ASCs. With nursing shortages continuing to plague the market, ASCs must constantly recruit new RN staff members. Even if fully staffed, it only takes one RN to resign or go out on medical leave to result in a short staffing situation.