Here are nine best practices to help you increase ENT case volume, attract new physicians and make your ASC the most desirable setting for your ENT patients and physicians.
1. Community outreach. ENT stands out from most ASC specialties because a significant portion of the patients you are likely to see in ENT are children. Because parents of children often play a critical role in influencing where their children will have a procedure, it is extremely important that your ASC reach out into its community and inform these parents about why your center is a viable, if not better, option to the hospital.
“By and large, half the patients are children, so you need to play up the extra care you take with your patients,” says Jeffrey Kunkes, MD, a solo practitioner (Kunkes ENT) and surgeon at Mt. Zion Surgery Center in Riverdale, Ga. “The bottom line is that we do everything they do (at the hospital). The problem is that parents don’t know that. What we need to do is assure them that we treat their kids like our own kids and show that we take care of the patient from top to bottom. Not everyone has a beautiful, peaceful setting like we do.”
Playing up the appeal of your center and performing effective community outreach can be accomplished in a number of ways. Developing an informative Web site that captures the appeal of your center, including information about your surgeons, and then publicizing the Web site is one effective technique, says Dr. Kunkes.
The St. John’s Clinic: Head and Neck Surgery in Springfield, Mo., performs regular public relations outreach, says Lynda Simon, RN, director of nursing and manager of head and neck surgery for the clinic.
“The Teddy Bear Rally at the zoo (an annual event for children), senior fairs, health fairs, career fairs … be out there where they can see you, and they start to associate you with health, hearing and surgical needs,” she says.
The doctors at St. John’s also hold outreach clinics in neighboring communities to expand their potential patient base.
“They travel from Springfield to Lebanon, Bolivar, Aurora and Branson,” says Ms. Simon. “(While) the patients may be seen in an outlying town, they usually come to Springfield for surgery. But the post-op visit is close to home again, so it’s very convenient.”
2. Publicize your efforts. Another way to drive more volume to your center is to publish information about the special services you offer, says Ms. Simon. For example, Ms. Simon suggests publicizing information about your physicians and highlighting any special skills or surgeries they perform.
“We also publish information in the local paper when a nifty new procedure or diagnostic tool is added, or when one of our doctors has a special event or award,” she says.
3. Patient satisfaction. Patient satisfaction is certainly critical for all specialties, but parents may pay more attention to it when their children’s happiness and comfort is at stake. Explore ways to make the surgical experience less stressful for your young patients.
“Invest in music players for the kids,” says Dr. Kunkes. “It would be nice for them to have iPods or a choice of music to listen to as they are being wheeled in — it’s very calming and peaceful. A lot of dentists do that so you don’t hear the drilling. The center needs to go a step further and make the whole experience blissful.”
Little gestures like this can only help spread the word about the quality of your care.
“Happy mommies and daddies make the best advertisement around,” says Ms. Simon. “You can have the best and brightest surgeons and the newest bells and whistles, but happy patients and families really turn the tide. Our patient satisfaction is running at 97.62 percent, and we are very busy. Patients will call the ENT office ‘because my niece had her tonsils out there and (the staff) was so nice.’”
It is important to remember that patient satisfaction is not just determined by how the patient feels when he or she is leaving the facility but also the experience leading up to the surgery. Since many patients may have never set foot into an ASC, it is important to ensure that patients — and their families, especially in pediatric ENT cases — are comfortable with the surgery center setting. Southwestern ASC in Pittsburgh, Pa., works to develop a comfort level well before the day of surgery.
“In our literature, we offer to any patient, especially to pediatrics, that if the family desires, they are welcome to bring the children in ahead of time to take a tour,” says Pam Wrobleski, CRNA, MPM, CASC, administrator for the center. “We try to play up that we are very comfortable performing [surgery] on children. We get a lot of calls from parents who are very apprehensive about their child having surgery in the first place and some place other than the hospital. We let them know that we do this number of cases on children on average in a week, and that tends to be much higher than most of the local hospitals.”
The center works to finds ways to maintain this comfortable feeling from the start to the end of the patient experience. One way is through involvement with a few community groups which have an interest in helping to make a surgical experience for a child a little less frightening.
“There’s one group that does a project called Project Linus where they have groups of retired people that actually make little blankets for the kids,” says Ms. Wrobleski. “They bring the blankets in and we give those out to the kids when they’re going into the OR and they can take it home with them; we will try anything we can do to make it a more pleasant experience.”
4. Nurse practitioners. Ms. Simon says that having nurse practitioners on staff can help grow an ENT practice.
“They allow more patients to be seen in a day’s time and provide assistance to the physician on every level,” she says. “And many kids are more comfortable with the nurse practitioners. For some reason they just don’t ‘freak’ as much.”
5. Surgeon outreach. Reaching out the patient community is certainly important, but perhaps equally important is connecting with physicians in your area who can become sources for referrals, and possibly more.
“All of our doctors go out to meet and greet other physicians in the region,” says Ms. Simon. “Our group administrator tags along and they take sweets for the offices. Having the opportunity to meet with the ENT specialists allows the other doc to feel comfortable recommending them to their patients. Hearing a name and connecting that name to a face and sweet treat is a winning combination.”
These physicians could also eventually become surgeons in your center, and then potentially surgeoninvestors.
“You need to get to the doctors and say, look, we know you can make money in your (office), but you can still make money and have a safer environment and less of an overhead expenditure in our place,” says Dr. Kunkes.
As new surgeons are brought in to your center and then see new patients, these patients become more likely to return to your center for other services if the first experience goes well.
“My whole thing is the more foot traffic, the more foot traffic,” says Dr. Kunkes. “Whatever comes in the door will eventually settle out to a lot of different people.”
6. Develop physicians’ office staff appreciation of the ASC. Your surgeons’ office staff and scheduler can play a critical role in whether a case ends up at your surgery center or the hospital, especially if the surgeon is not an investor in your center. Spending a little time to develop a relationship with the office staff and getting them to know your staff and facility can go a long way.
“We want to make sure the office staff understands the experience level of the facility and of the staff that works here,” says Ms. Wrobleski. “We spend a lot of time working with their office managers and their schedulers to have them really present our facility as the doctor’s first choice to do these cases.”
While it is important for the physician to express to his or her office staff that the center is the top choice, helping the staff understand why helps justify the choice.
Besides just meeting and talking with office staff, Southwestern ASC usually holds an breakfast or a lunch at the center for its physicians’ office staff a few times every year.
“Many of them have never seen a surgery center, let alone the one where their doctor might be working,” says Ms. Wrobleski. “A lot of the staff members don’t know what to expect when they come and they’re pleasantly surprised. We take them on a tour and they get a better understanding of what actually happens from the time the patient walks in the door till they leave. They’re able to explain it better to the patients and they’re able to help market us as their preference for the site of their surgery. A lot of times I don’t think that would have happened until they had actually been on site.”
Sometimes the center will combine the meal with a talk from an insurance company representative, so the visit also provides an educational experience, an opportunity often welcomed by both the office staff members and their physicians.
“We really try to make it a good experience,” says Ms. Wrobleski. “Anything you can do to reach out to them and try to develop a good relationship with them is always helpful.”
7. Cutting-edge technology and procedures. Patients want to know that they are getting the finest care and treatment possible, and this often correlates to new procedures and technology. If it is financially practical (and profitable) for your center to invest in technology and perform new procedures, this can be an effective way to attract new patients.
“We are using a coblator for tonsillectomies rather than cold knife and cautery,” says Ms. Simon. “The coblator has dropped the average time for a (tonsil and adenoid surgery) to about 13 minutes for two of our doctors and 18 minutes for the other three. People really like that we are using cutting-edge technology. They will also call the office and go out of their insurance network to take advantage of our technology.”
The public’s realizing that the surgeons are committing time and resources into exploring better methods for treatment is appealing.
“Our doctors go to the (American Academy of Otolaryngology — Head and Neck Surgery meetings) to learn new procedures, rub shoulders with other otolaryngology specialists and to scope out the new equipment,” says Ms. Simon. “They seem to like being on the cutting edge of ENT. It’s really nice to have that mind-set in your group. You can always go back to ‘the old way,’ so they are willing to try new and improved techniques. The patients like that they are able to embrace change and improve outcomes.”
8. Case partnerships between specialties. Southwestern ASC performs a fair amount of plastic surgery, says Ms. Wrobleski. The opportunity exists for the plastic surgeons and ENT surgeons to perform separate — but related — procedures on certain patients during the same visit.
“We’ve noticed that sometimes the plastic surgeon, if he does any nasal surgery, will partner together on particular with one of the ENT surgeons may do the more functional, therapeutic part, like a rhinoplasty or some nasal/septal surgery or reconstruction, and the plastic surgeon will do more of the cosmetic part,” says Ms. Wrobleski. “They sometimes decide to do both at the same time because it saves time and money, and pain for the patient to have all of that type of surgery done at the same time. That’s been nice for the patient as it wasn’t an option for the patient before we really started doing much more ENT.”
The ASC can bill for both procedures and the joint procedures saves the insurance company money because they only have to pay for one visit. This convenience and savings can potentially be used by the surgery center as a bargaining chip when negotiating with commercial payors, says Ms. Wrobleski.
9. Find unconventional ways to add cases. You certainly want to be working to learn about the types of cases your physicians are performing in settings other than your ASC, and identifying whether any of these cases can find their way into your ASC, even if it entails some “outside of the box” thinking.
For example, some physicians at Southwestern ASC were performing a variety of small and minor procedures — cheap and quick to perform — but the surgeons were not considering the surgery center as the appropriate setting as these procedures required frozen sections or other types of pathology, thus requiring the services of hospital pathologist. But Southwestern ASC did not let this requirement stand in the way of bringing these cases to the center.
“We’re close enough to the local hospital that we were able to work out an arrangement with their pathology department to be able to have the cases done that require frozen sections,” says Ms. Wrobleski. “The pathology department will send us a courier, we will get the specimens to the lab and the results back in no longer than it would take if (the physician) was in the hospital because we are just a couple of minutes away from the hospital. Those pathologists are happy to have the business and we’ve been able to work out a nice arrangement, so that gave us another option for some cases we wouldn’t normally get.”
If such an opportunity exists for your center, it may be worth exploring.
“There was an increase in a lot of the reimbursement rates in the recent Medicare changes for some of the ENT cases, so you need to review those and see if there are cases the doctors’ currently do in the practice that would work in the surgery center,” says Ms. Wrobleski.
Contact Rob Kurtz at rob@beckersasc.com.