With ambulatory surgery centers continuing to grow in popularity as they secure their place as the preferred location for elective surgery, many ASCs — both hospital-physician joint-venture and physician-owned centers — are currently in development or the planning stages.
For these de novo ASCs, the COVID-19 pandemic may have temporarily delayed progress, but now that all states are reopening, projects are getting back on track. When they finally open their doors, there should be plenty of case volume. Industry experts predict that services of existing and new ASCs will be in high demand and well-positioned to fill a growing, critical need going forward, particularly post-COVID-19.
With that said, the pandemic-caused pause in our economy and the ASC industry has illuminated the need for changes in how healthcare — including elective surgery — is practiced. Three of the reasons for such changes are addressed below and include suggested solutions that may require de novo ASCs to take a different approach to their development as they proceed toward completion. If you are amid building an ASC or planning to do so in the near future, read on.
Reason #1: Safety guidelines/requirements
COVID-19 has brought about new safety measures which may require design plan changes. The need for social distancing in patient care areas, including the waiting room, will require an increase in square footage dedicated to these spaces. If your ASC has not broken ground and you have sufficient land space, consider whether to change your plans to include building a larger center with more spacious preoperative and postoperative areas, a larger waiting room, and perhaps temporary space for pre-admission virus screening and/or testing. If land size or budget restraints do not permit you to enlarge your original plan, or if your ASC is already under construction, you may need to work with your architect to redesign the existing space to better meet these necessary spacing guidelines.
In either scenario, when considering where to "find" this additional space, you can reduce the size of your business office by outsourcing some of its functions, such as revenue cycle management and information technology (IT) services.
Reason #2: Volume surge and continued migration of outpatient surgery
Industry experts predict that while surgical volume will likely take some time to return to normal as ASCs continue to navigate the challenges of operating in the midst of a pandemic, what will follow the end of this health crisis is a sharp increase in cases. With an estimated four million U.S. elective surgeries cancelled during the height of the pandemic, there is an enormous backlog awaiting rescheduling, which is also forcing a delay in scheduling new procedures.
As the pandemic continues, many hospitals will remain largely focused on COVID-19 and more emergent care, thus limiting their ability to perform elective surgeries at normal capacity. Third-party payers are increasingly directing surgical cases toward outpatient facilities due to lower infection risk, improved efficiency, and reduced costs. Medicare is continuing the trend of approving more complex surgeries to be performed in outpatient centers. Finally, patients are seeking safe locations for their surgical care, which is pushing them away from hospitals and toward ASCs.
As the future spread of the virus decreases and is hopefully contained with immunization, caseloads will transform quickly from low to high volume. Upon opening your de novo center, you may face a faster volume ramp-up period than originally planned or expected. Your ASC may need to consider the possibility of instituting extended hours of operation (evenings and weekends) than what you intended for the early days and weeks of your center.
This caseload increase — which may become its own "new normal" for ASCs — will require additional staff and space. Allotting more space for clinical use prior to opening will support an easier transition during the caseload ramp-up period and allow you to ensure you're in the best position to continue capturing the volume of cases available to your center.
Reason 3: Human resources/staffing
While there are many talented individuals helping ambulatory surgery centers nationwide navigate the crisis and achieve success, recruiting such talent during this transitional period may prove difficult and come at a higher cost than budgeted. As a new center with no cash flow and history of safety precautions, you will be competing for clinical and business office talent against established ASCs in your area.
To attract the kind of employees you desire for your de novo center, you will need to offer competitive salaries and benefits. However, due to the increased demand for qualified talent, salaries will likely be appreciably higher than those prior to the -pandemic. Meanwhile, insurance companies are rapidly raising their rates (e.g., premiums, deductibles, co-pays) due to COVID-19 expenses. Another cost consideration is the ratio of the number of business office employees to the required furniture and IT equipment/services needed for staff to perform their jobs. Outsourcing revenue cycle management allows you to access ASC-experienced staff ready to meet your billing needs while reducing your business office expenses and required footprint.
An additional challenge will be finding talented staff members willing and able to be flexible in their hours worked during your ramp-up period. Not everyone will be on board with starting as part time and eventually moving to full time as caseload increases if options that allow them to start as full-time employees exist in your market. A revenue cycle management company provides the necessary staff to support your startup operations and can grow your assigned team as caseload increases.
Role of revenue cycle management outsourcing
In our discussions with de novo surgery centers, we have learned that many are responding to the new safety needs and expectations by building larger patient care areas. They are offsetting these unexpected allocations of clinical space by outsourcing business office functions, including revenue cycle management. An ASC-experienced RCM company essentially acts as an off-site extension of your business office while delivering many positive benefits, as previously discussed.
During these uncertain times, as the peaks and valleys of the spread of the COVID-19 virus dictate whether businesses are open or closed and to what capacity, outsourcing revenue cycle management gives ASC leadership one less aspect of the new operation to worry about and focus on. ASC revenue cycle management companies have experienced staff readily available for immediate servicing of revenue cycle tasks, thus avoiding any backlog of cases while decreasing accounts receivable and increasing cash flow. In addition to reducing budgeted business office salaries and benefits, this ready-to-go staff relieves your ASC of the need to allocate time and resources to education and training.
Experienced revenue cycle management companies also have an emergency plan in place which: a) allows their staff to work offsite with no interruption of service, b) gives flexibility of staffing to address caseload fluctuations due to the ramp-up associated with the opening of a new center or inconsistent caseload due to COVID-19 and other disaster-induced surges and restrictions, and c) provides dependable IT service with connectivity to your center’s data. Outsourcing revenue cycle management provides an ASC with uninterrupted continuation of business office functions and a dependable revenue stream.
Key takeaway for de novo surgery centers
Developing a new surgery center is an exciting enterprise. However, due to the COVID-19 pandemic, a de novo center faces additional challenges, such as new safety requirements, the need for additional patient care space due to social distancing guidelines and testing requirements, and difficulties in hiring experienced business office and clinical staff. Outsourcing revenue cycle management to an experienced company can alleviate these challenges.
Whether your de novo center chooses to outsource any of its functions, the safety of patients, staff, and providers must remain the highest priority. The business plan needs to be based on what is best for your ASC and your community. Outsourcing your revenue cycle management can help strongly position your ASC for short- and long-term success coming out of and well after this health crisis.
Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing, and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned, or independent) and anesthesia providers. Ms. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.