5 Key Concepts for Success With Orthopedics in Surgery CentersWritten by Laura Miller | February 03, 2012
Here are five key concepts for having success with orthopedics in surgery centers.
1. Hire and maintain a strong team of orthopedic physicians. The ASC market has boomed tremendously since the first ASC was established more than 30 years ago, and because of that, ASCs must work harder than ever to maintain a competitive edge in their communities. One way to do this is form a strong and reputable team of orthopedic physicians and staff members who can collectively achieve excellent clinical outcomes, patient satisfaction and high throughput. David Ott, MD, founder of Gateway Surgery Center in Phoenix, Ariz., says ASCs should turn to their own physicians in reaching out to other community physicians who can bring more cases and their great reputation to the facility. Physicians and staff members are also retained by distributing bonuses for great performance.
2. Benchmark physician use of implants. Dean Brown, MBA, CASC, CEO of Alabama Orthopaedic Clinic and administrator of The Orthopaedic Center at Springhill in Mobile, Ala., says his center also benchmarks internally by presenting data on physician use of implants. "We actually publish that to the physicians, so if the surgeons see that somebody is an outlier, they can put peer pressure on one another," he says. The center discusses implant preference and cost at its medical advisory committee meetings, and if a surgeon is two to three standard deviations above everyone else, the leadership sits down with the physician to talk about the difference in cost.
Mr. Brown says this side-by-side cost comparison has incentivized physician owners to standardize implants and choose less pricey alternatives. "The surgeons always say, 'I love this thing, but I never knew how much it costs,'" he says. "Being owners, they appreciate the information."
3. Allow profitable physicians to perform less profitable cases on occasion. An ASC can't consistently perform unprofitable cases without losing money overall, but that doesn't mean your center should reject every less-profitable case, Mr. Brown says. His surgery center tries to look at the totality of a physician's case load rather than nitpicking each individual case. For example, if a physician brings nine profitable cases to the center and wants to perform one less profitable case, the center can accept the tenth case as long as the loss does not offset the earnings provided by the other cases.
He says this approach helps boost physician loyalty, which in turn contributes to center profits. "There are sports medicine cases that we lose a little bit of money on, but if the physician is bringing [overall profitable cases], we don't force them to take one case somewhere else," he says. He says this approach does not work if your center is too lenient with unprofitable cases: At The Orthopaedic Center at Springhill, a spine surgeon who wants to bring only unprofitable cases will not be suitable for the center.
4. Take advantage of commercial payors with Medicare/Medicaid companion plans. David Schlactus, CEO of Hope Orthopedics of Oregon and Willamette Surgery Center in Salem, says in Oregon, many commercial insurance companies have Medicaid or Medicare companion plans. He knows that the insurance companies would prefer to send those Medicare or Medicaid patients to the surgery center because of the lower cost, but some surgery centers do not accept Medicare and Medicaid patients because they suffer a loss due to low reimbursements.
5. Don't let case volume drop off during renovation. Thomas Holecek, administrator of Palos Surgicenter in Palos Heights, Ill., says his ASC recently underwent a significant renovation to improve the facility and attract new physicians and patients. A facility renovation is a great way to boost case volume, since physicians and community members will notice your project and want to experience the newly- remodeled facility. On the other hand, a renovation can span several months and involve significant noise and physical change, creating an obstacle to maintaining robust case volume. Mr. Holecek says his ASC did not experience a decline in case volume during its renovation due to the ability of the staff to keep the ASC safe, clean, and functional.
"Physicians want to know whether the patient has a safe pathway throughout the continuum, if there are efficiency barriers, and if infection control is maintained" he says. "If they see you've maintained a good, clean work environment, they'll feel comfortable bringing their patients to you." He says he benefited from the expertise of the general contractor's adherence to healthcare regulations during construction, along with routine meetings with senior Regent Surgical Health advisors. Mr. Holecek performed required walk-throughs several times a day to make sure the corridors were clear and there were no fire or safety issues during construction.
If your surgery center can accept Medicare and Medicaid patients without significantly hurting profitability, negotiate with insurance companies that benefit from your Medicaid/Medicare business. "We're up front with our payors," Mr. Schlactus says. "It's not our fault that Medicare pays cost and Medicaid pays less than cost, so our commercial payors have to pay us more [on commercial cases] so we can keep doing those patients." He tells the payors that if they want to send their Medicare patients to the ASC, they have to pay fairly on the commercial side.
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