One change can have ripple effects to improve a practice.These 24 industry leaders explain one cange they've made in the last few years.
The executives featured in this article are all speaking at Becker's 30th Annual The Business and Operations of ASCs which is set for Oct. 30-Nov. 2 at the Hyatt Regency in Chicago.
If you would like to join this event as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.
Question: What is one change you made in the last two years that had great results?
Sap Sinha. COO of Allied Digestive Health: We are adopting machine learning in coding and billing which has been a game changer for Allied Digestive Health by increasing the accuracy and speed of our billing process. It has also allowed us to scale at a fast rate.
Sandra Oglesby. Administrator of The Surgery Center at TGH Brandon Healthplex: An estimator tool was implemented to increase collections of fees due at time of service. The facility began offering an in house payment plan option as well as an outside source for no interest credit, for those patients that need additional time or resources for funding. This change has resulted in 100% collection of time of service fees, the elimination of back end billing to patients and patient AR at 0%.
The estimator tool is accurate for time of service estimates, but there is an increase in partial patient refunds related to timing of claim submission.
Taif Mukhdomi, MD. Pain physician of Pain Zero: Being in private practice, competing with hospital systems and private equity-backed groups is always a challenge. Direct-to-consumer marketing has been a vital strategy to our practice. Our efforts in social media marketing and SEO have improved our web presence and brand awareness. We always make it a point with new patients to discuss how they found us. At the end of the day, patients drive their own care; so even if they are known to hospital systems, the moment they want to explore their care elsewhere – they can and they do! With the challenges of insurance and healthcare strain across the country, patients are looking for accessible, timely care with providers who listen. Some patients are even looking for newer options and cutting edge technology which may not even be available in hospital systems or health systems given the processing time. Our interventional pain group trained outside of the central Ohio area, thus our training and offerings differ from our counterparts. We use marketing and advertising to showcase our skillset and discuss alternative interventions that may not have been discussed with patients. The hope is that we not only increase awareness of our services but also educate patients on their options for care. For being a little bit more than a year out, our practice shows up on the first page of many common pain conditions and it shows.
Maan Fares, MD, FACC. Staff physician for clinical cardiology and chairman of global patient services of Cleveland Clinic: Digitizing our clinical operation for international patients has had an enormous impact on our global team's performance. It helped us improve the triaging accuracy which has great downstream consequences for better planning to improve financial estimation for the cost of care. Furthermore, it allowed us to establish metrics to track performance and improve patient satisfaction with a faster and more accurate turnaround.
Nyleen Flores, CPMSM, CPCS, CPCO. CEO of Total Surgery Center: My focus was on cross training all of my nurses to ensure proper coverage and less turn over. This was done by providing a small incentive and marketing growth and leadership opportunities within the center. This led to PRN staff moving to part time and a part time nurse moving to full time, making the turnover rate remain at zero.
Jonathan Davis. COO of Clearway Pain Solutions: Following Covid, we were really struggling with our call center. We couldn’t find or keep staff, calls were being abandoned and patient satisfaction was at an all-time low. Something had to change and so we decided to completely question and restructure everything. We invested in new leadership, recruiting and added experienced, and proven external partners. We redefined our KPIs, added daily and intraday reporting for more transparency, and held daily huddles with key leadership to review current results and implement changes quickly. With these changes and more, the results surpassed our expectations. Answer rate and service levels improved dramatically and every month, we were setting a new all-time high in patients scheduled and seen. I am now excited to talk about our call center and scheduling results, and I am excited to see us move forward with innovative tools and ideas to tackle some of the more complex issues we all face in improving the scheduling experience for our patients.
Samuel O. Jones IV, MD, MPH, FACC. Cardiologist of The Chattanooga Heart Institute: Hospitals and physician practices are amazing in many regards but frequently fall short on measures of efficiency. Over the last two years, we have instituted more scientific processes in our workflows. These projects involved careful measurement, observation and tracking. We analyzed the sources of waste and non-value activities to streamline patient flow. While the goal started as higher efficiency, we learned the more significant benefits were:
- Safer and more reliable processes
- Better care for patients
- Less frustration for our staff
Rick Ngo, MD, FACS. Founder and general surgeon of Texas Hernia & Surgical Specialists: I became way more proactive about having my patients fill out Google reviews, and it's really helped our marketing efforts.
Leon Anijar, MD. Interventional pain physician of Spine and Wellness Centers of America: I started focusing on two to three hard metrics as opposed to general trends. It was important for me to increase the number of patients enrolled in remote therapeutic monitoring and chronic care management, and I hyper-focused on those numbers for three to four months, which led to significant results.
Devi Nampiaparampil, MD, MS. President and CEO of Metropolis Pain Medicine: I worked with the folks at the front desk to fine tune our overall tone when speaking to patients, vendors and others. Often, the focus is on the clinical care and the providers' bedside manner. However, people usually develop their first impressions interacting with the front desk via phone, email, fax, portal or in-person. If the tone is right, the patients trust what the team says about pre-authorizations, costs and other administrative burdens related to providing medical care. If the tone at the front desk is off, we have to spend a lot more time explaining things. When we improved the tone and messaging of the front desk, I noticed we became more efficient overall, saving both money and time.
Ali Ghalayini, MBA, CAPM, CPHQ. ASC administrator of Munster Surgery Center: Implementing enhanced communication strategies among staff members as well as addressing and eliminating toxic habits within the team has led to significant improvements in our ASC, particularly in pain management. This change aimed at fostering a positive work environment, enhancing team collaboration and ultimately improving patient care.
- Enhanced team collaboration: We have seen increased team collaboration by improving communication. Staff members are now more willing to share knowledge, work together on patient care and support one another, leading to a more cohesive team effort and a smoother workflow.
- Increased job satisfaction: Addressing toxic habits and improving the workplace environment have significantly increased employee job satisfaction. A positive work culture encourages staff to perform their best, reduces turnover and attracts high-quality professionals to our organization.
- Improved patient care: The most significant impact has been on patient care. Enhanced communication means patient needs are more effectively identified and addressed, improving patient outcomes. Moreover, a positive and collaborative work environment reflects the quality of care, enhancing patient satisfaction.
- Efficient problem-solving: Better communication channels resolve problems and issues more quickly and efficiently. Staff feel more empowered to voice concerns and suggest improvements, leading to a more adaptive and responsive ASC.
- Reduced conflicts: The frequency and severity of workplace conflicts have decreased by eliminating toxic habits and fostering open communication. This has created a more pleasant work environment for everyone and allows staff to focus more on patient care than interpersonal disputes.
These changes underscore the importance of a healthy work culture and effective communication in healthcare settings. Not only do they contribute to a more positive and productive workplace, but they also directly impact the quality of patient care, which is the core mission of our ASC.
Chuck Schwab. Executive director for ASC ventures of Illinois Bone and Joint Institute: On an intrinsic level, I made it a point as a leader to listen more and speak less. It stems from the adage we have two ears and one mouth for a reason. By wilfully listening more, I am able to connect with people in my workplace on a deeper level, which allows for better bidirectional communication. The results yielded by active communication have allowed for faster turnaround of patient safety processes, increased grassroots efforts and overall positivity in the workplace.
Janet L. Carlson, MSN, BSN, RN, CRN NE-BC, FACHE. Executive director for ambulatory surgery centers of Commonwealth Pain & Spine: One change that I made in the past two years was to involve my leadership team in the survey and certification process early. I have encouraged their active participation when we host surveyors to assess our clinical spaces and want them to welcome the collaboration that occurs to help improve our ASCs for optimal safe patient outcomes. This changes the dynamic from the 'old days' when surveyors were falsely viewed as punitive when in reality their goal is active collaboration towards continual improvement as partners.
Brian Gantwerker, MD. Spine surgeon and neurosurgeon of The Craniospinal Center of Los Angeles: One change we made as a practice is converting all of our records to digital. We were thinking about moving offices. The whole office, myself included, hauled bags of shredding and pitched in to start scanning any remaining paper records into our electronic medical record. It was a herculean task, as we had transitioned EMRS a number of years ago as well, but managed to coalesce everything together. Now that we have a comprehensive record, it is so much better and patients now have a fantastic historical record that we can all follow chronologically. It has taken over a dozen years to get to this point, but we finally did it as a team.
James Chappuis, MD, FACS. Orthopedic spine surgeon, founder and CEO of Spine Center Atlanta: One of the best changes I have made in the past two years is appointing Kimberly Franklin as COO of Spine Center Atlanta. Her direct leadership, comprehensive strategic vision and deep understanding of healthcare operations have enabled and continue to enable our company to achieve new levels of efficiency, excellence, growth and success. Having a driven, thoughtful leader to collaborate with has broadened the horizons for our possibilities above and beyond our sector. I'm proud to have her as our COO!
Johnny Russell. Director for area operations of Sutter Health: One thing we have reviewed and changed in the past year is staff retention. We added part-time positions to our mix. This helped with psychological well-being, reduced sick calls and staff were increasingly happier at work. This not only became a win for the staff, but the patients received the overall benefit as well.
Ben Seals. CEO of Thomas Eye Group: Over the past two years, the most impactful change we've made is investing in robust clinical, surgical and administrative leadership across all our surgical centers. Establishing this triad of leadership has fostered greater cohesion within our organization and enabled us to implement numerous crucial changes. Through collaborative efforts, this team has significantly enhanced our operational efficiency, financial performance and overall teamwork.
Comprising a nurse manager (clinical), director of surgical services (administrative), and our chief medical officer (surgical), this dynamic trio has spearheaded several transformative initiatives. Together, they have nearly tripled our ASC capacity, boosted daily throughput by almost 50% in one center, inaugurated a new center, expanded an existing one and effectively curtailed hundreds of thousands of dollars in unnecessary expenses.
The most significant and meaningful transformation often lies in aligning the right individuals with the appropriate roles. Our unwavering dedication to achieving this alignment has unleashed an extraordinary amount of untapped potential within the surgical services team at Thomas Eye Group.
Waldo Herrera, MD, MBA, CPE, CHCQM. Medical director, CDI, north region of Endeavor Health: The most significant change I made in the last two years was completing a MBA at Kelley Business School. This program equipped me with essential skills in business, finance and conflict resolution, which I realized were crucial for my role as a physician advisor and leader in healthcare. Applying this knowledge to my daily work significantly enhanced the structure and performance of my institution's CDI program.
After completing the MBA, I was promoted to medical director. The skills I learned helped me integrate the CDI programs of several recently merged healthcare facilities, forming an extensive health system of nine hospitals.
Reflecting on our performance and recognizing our main weaknesses is a vital step to start making changes that will pay dividends in the short and long run.
Gareth J. Morgan, MD. Congenital interventional cardiologist of Children's Hospital Colorado and University of Colorado Hospitals: I'm trying to think before I speak. Pausing to consider the impact of my response on the specific audience has allowed me to ensure that I deliver the appropriate message. One focused breath before speaking can change an abrasive remark into an effective comment.
Leasa Hermanson, DNP, MBA, RN, NEA-BC, CASC. Administrator of Ambulatory Care Center: We began utilizing our online registration platform to conduct post-op and patient satisfaction surveys. Initially, there were concerns about access, ability, etc., to utilize the technology, but our results tell another story. Over 55% of our patients utilize the post-op survey, and about 30% complete the patient satisfaction survey. Our nurses call anyone who hasn't returned the post-op survey to follow up, but, on the whole, we are saving thousands of dollars a year on post-op calls and postage for patient satisfaction surveys. Our patients, many of whom are at work the next day, appreciate the ability to respond when they're able, rather than coming home to a missed call after the center is closed.
Lisa Cooper. CEO of Santa Cruz Surgery Center: When some eye physicians rejoined staff, we decided to change our workflow and have all cataract patients be admitted through their own entrance directly into PACU where we set up three bays to be dedicated for preop/PACU for cataract patients. Having patients go directly to the clinical area and complete registration paperwork in the clinical area then returning to the same place for discharge helped eliminate parking issues with the drive up/drop off process as well as decreased overall ASC time for the patients.
We added to our benefit package a lifestyle allowance of $750 to help employees cover expenses that improve their health such as gym membership or copays for counseling that are not otherwise covered by health insurance. It has become a great tool for working with employees with attendance issues by encouraging them to take advantage of more preventative care services.
Sarah Sterling, CASC. Area director of operations of Sutter Health: Over the past two years, we have faced challenges in maintaining sufficient anesthesia coverage to meet the needs of our patients. By incorporating CRNAs into our care team model, we have experienced significant improvements in patient outcomes, staff satisfaction and surgeon experience within our centers.
Mario Gössl, MD, PhD, FACC, FAHA. Director of Interventional Cardiology Fellowships, director for transcatheter valve therapies and interventional cardiologist of Allina Health Minneapolis Heart Institute: Optimization of advanced practice provider use in our valve clinic. In order to improve access, and patient experience, we opened up additional follow-up appointment slots in our APP clinics. The shift of follow-up appointments to APP clinics provides additional access for new patients and reduced wait times.
Anthony J. Tortolani, MD. Cardiac and thoracic surgeon and professor emeritus for clinical cardiothoracic surgery of Weill Cornell Medical College: Ambulatory cardiac catheterization laboratories will provide additional value and efficiency. Attention frequently is focused on the construction of the ambulatory unit. However, the focus also requires securing volume and/or physicians with appropriate patients to fill the new unit and simultaneously to back-fill the inpatient unit to maximize patient care. The initial underutilization of both units can lead to financial loss which may be significant. Therefore, concurrent with the construction of the new unit is the recruitment of physicians and patients.