Here are eight best practices for managing orthopedic and spine surgery centers.
1. Make strategic moves to improve efficiency. There needs to be an understanding of how well your ASC is performing against industry accepted best practices, which means you need to compare how well you are performing in each specific business office function — from transcription and coding and feed through the billing, claim follow-up, patient statements, collections, payment processing and reporting — to other ASCs in your area. "This will enable you to focus on areas that need improvement and then create a plan that will address this," says Jim Freund, senior vice president of GENASCIS. "This can include staff training, on-going education, implement the appropriate rules and processes along service lines, and continually track your performance. The challenge for any ASC, whether independent or managed, is to truly understand their business and make the appropriate changes."
There are continuous changes that positively impact the way procedures are performed and patients are cared for in the ASC setting. An example of this changes is the ability to leverage technology, expertise and processes to significantly impact both compliance and the financial success of surgery centers. "By creating a seamless and transparent solution for ASCs we have been able to effectively improve all of their billing processes, give them real-time insight into their business and provide them with the data analytics necessary to make informed decisions," says Mr. Freund. "Now is the time to evaluate your entire business and implement changes that will enable you to survive and thrive moving forward."
2. Strategically negotiate contracts with insurance companies. Supply costs are arguably one of an ASC's highest expenses. Given the high cost of procedures and especially implants, ASCs must work diligently and regularly with payors to ensure they are committing to financially sound contracts with reasonable coverage. For implant reimbursement specifically, Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, urges orthopedic-driven ASCs to ensure they receive a low threshold for each implant; at least cost plus shipping and handling, and no limitations on the number of implants.
3. Hire professional staff members and keep them educated overtime. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
4. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. "The front desk staff needs to be trained in collection procedures because most people naturally aren't very comfortable asking for money," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay." This might mean asking the patient which type of credit card they'd like to pay with instead of asking how they would like to pay.
5. Confront the patient yourself about payment issues. Patients visiting ASCs see their physician as the ultimate authority figure, versus the front desk employee or a billing person calling the patient for outstanding payments. "Many times pain management physicians will be willing to confront their patients because they have the business in mind," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. "Practices should have a process to have the pain management physician spend 10 seconds to bring the payment to the patient's attention, when that is warranted."
6. Limit staff turnover by keeping employees happy. According to Robin Lacine, the executive director of business development at MedHQ, providers can improve efficiency and reduce cost by using expert HR, payroll and accounting services that also specialize in the medical industry. Such specialists already have an understanding of the unique accreditation and compliance issues, industry standards and potential areas of risk commonly confronted by ASCs.
In HR, it's important to maintain a healthy balance between serving the company and serving the employees. John Merski, the executive director of HR services at MedHQ, says that favoring one over the other may result in ineffective service to both "clients." In addition, HR should bolster rather than burden managers and employees. As Mr. Merski says, "You know HR is good when you don't know it's there."
Many people view administrative services as an expensive necessary evil — barely necessary at that. But in order for any organization to succeed, the bills need to be paid, the money collected, the performance tabulated and recommendations for improvement implemented. Administrative services, good administrative services, can help to identify and capture real savings in addition to the blocking and tackling any organization needs every day.
7. Don't feel threatened by an acquisition or a merger. Surgeons are often interested in the details of an acquisition or a merger while administrators feel threatened because they fear they could lose their jobs. However, Jon Vick, president of ASCs Inc., has helped more than 200 ASCs through the process by representing the seller and bringing the surgery centers purchase proposals from ASC management companies, says that after an acquisition or a merger, the new company wants to keep good administrators on board and will often offer better salaries and benefits for all personnel. "Good companies look for solid, well-trained staff who are oriented toward patient satisfaction," he says. "They want to make sure there is a good pre- and post-operative process and the staff can answer questions for the patient during that process." As long as the administrators and staff members are doing well before the merger or acquisition, the new company will want them to continue their job afterward.
8. Keep tabs on infection control. There are products out there which are sold but do not comply with the state and national requirements of regulatory agencies. You need to look at the label and if it's legal, it will give you an EPA registration number, says Jack Wagner, president of Micro-Scientific. That number is like a driver's license. It lets regulatory people and you know the product has been tested, evaluated and it has been approved by the U.S. EPA. If there's no registration number on the label, it's not a legal product to use, he says.
Related Articles for Orthopedic Surgeons:
10 Trends in ASC Payor Contract and Reimbursement for 2012
To Bundle or Not to Bundle? Thoughts on Bundled Payment for Care Improvement
6 Factors to Consider When Choosing a GPO
1. Make strategic moves to improve efficiency. There needs to be an understanding of how well your ASC is performing against industry accepted best practices, which means you need to compare how well you are performing in each specific business office function — from transcription and coding and feed through the billing, claim follow-up, patient statements, collections, payment processing and reporting — to other ASCs in your area. "This will enable you to focus on areas that need improvement and then create a plan that will address this," says Jim Freund, senior vice president of GENASCIS. "This can include staff training, on-going education, implement the appropriate rules and processes along service lines, and continually track your performance. The challenge for any ASC, whether independent or managed, is to truly understand their business and make the appropriate changes."
There are continuous changes that positively impact the way procedures are performed and patients are cared for in the ASC setting. An example of this changes is the ability to leverage technology, expertise and processes to significantly impact both compliance and the financial success of surgery centers. "By creating a seamless and transparent solution for ASCs we have been able to effectively improve all of their billing processes, give them real-time insight into their business and provide them with the data analytics necessary to make informed decisions," says Mr. Freund. "Now is the time to evaluate your entire business and implement changes that will enable you to survive and thrive moving forward."
2. Strategically negotiate contracts with insurance companies. Supply costs are arguably one of an ASC's highest expenses. Given the high cost of procedures and especially implants, ASCs must work diligently and regularly with payors to ensure they are committing to financially sound contracts with reasonable coverage. For implant reimbursement specifically, Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, urges orthopedic-driven ASCs to ensure they receive a low threshold for each implant; at least cost plus shipping and handling, and no limitations on the number of implants.
3. Hire professional staff members and keep them educated overtime. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
4. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. "The front desk staff needs to be trained in collection procedures because most people naturally aren't very comfortable asking for money," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay." This might mean asking the patient which type of credit card they'd like to pay with instead of asking how they would like to pay.
5. Confront the patient yourself about payment issues. Patients visiting ASCs see their physician as the ultimate authority figure, versus the front desk employee or a billing person calling the patient for outstanding payments. "Many times pain management physicians will be willing to confront their patients because they have the business in mind," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. "Practices should have a process to have the pain management physician spend 10 seconds to bring the payment to the patient's attention, when that is warranted."
6. Limit staff turnover by keeping employees happy. According to Robin Lacine, the executive director of business development at MedHQ, providers can improve efficiency and reduce cost by using expert HR, payroll and accounting services that also specialize in the medical industry. Such specialists already have an understanding of the unique accreditation and compliance issues, industry standards and potential areas of risk commonly confronted by ASCs.
In HR, it's important to maintain a healthy balance between serving the company and serving the employees. John Merski, the executive director of HR services at MedHQ, says that favoring one over the other may result in ineffective service to both "clients." In addition, HR should bolster rather than burden managers and employees. As Mr. Merski says, "You know HR is good when you don't know it's there."
Many people view administrative services as an expensive necessary evil — barely necessary at that. But in order for any organization to succeed, the bills need to be paid, the money collected, the performance tabulated and recommendations for improvement implemented. Administrative services, good administrative services, can help to identify and capture real savings in addition to the blocking and tackling any organization needs every day.
7. Don't feel threatened by an acquisition or a merger. Surgeons are often interested in the details of an acquisition or a merger while administrators feel threatened because they fear they could lose their jobs. However, Jon Vick, president of ASCs Inc., has helped more than 200 ASCs through the process by representing the seller and bringing the surgery centers purchase proposals from ASC management companies, says that after an acquisition or a merger, the new company wants to keep good administrators on board and will often offer better salaries and benefits for all personnel. "Good companies look for solid, well-trained staff who are oriented toward patient satisfaction," he says. "They want to make sure there is a good pre- and post-operative process and the staff can answer questions for the patient during that process." As long as the administrators and staff members are doing well before the merger or acquisition, the new company will want them to continue their job afterward.
8. Keep tabs on infection control. There are products out there which are sold but do not comply with the state and national requirements of regulatory agencies. You need to look at the label and if it's legal, it will give you an EPA registration number, says Jack Wagner, president of Micro-Scientific. That number is like a driver's license. It lets regulatory people and you know the product has been tested, evaluated and it has been approved by the U.S. EPA. If there's no registration number on the label, it's not a legal product to use, he says.
Related Articles for Orthopedic Surgeons:
10 Trends in ASC Payor Contract and Reimbursement for 2012
To Bundle or Not to Bundle? Thoughts on Bundled Payment for Care Improvement
6 Factors to Consider When Choosing a GPO