Here are five tips for improving your orthopedic practice's bottom line.
1. Work with staff to shorten the pre-operative phone call. According to Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, most surgery centers spend a lot of time on patient triage, a process that proves costly when nurses or front desk staff members spend more time on triage than necessary. "If anesthesiologists do not take ownership of the process, the center spends a lot of wasted time on the phone call asking questions that aren't as directed as they could be," Dr. Wherry says. "They may be gathering labs and data that aren't necessary." He says the first thing ASCs should do is look at how much time and how many FTEs are devoted to the process of the pre-op phone call. He says for a center performing 200-300 cases per month, 1-1.5 FTEs should be sufficient. Additional savings could be realized if the pre-op admitting and recovery room staff makes the calls versus a full-time phone call nurse.
ASC anesthesiologists should then work with those responsible for the pre-op phone call. They should explain which information is necessary for the procedure and try to reduce the phone call to less than 10 minutes. "[Staff members] are trying to do their best, but these calls can turn into half hour conversations," Dr. Wherry says. "Anesthesia has to step in and say, 'This is all we need.'"
2. Maintain up-to-date payor patient information. Before performing a procedure, ensure the patient's payor information is current and the patient is still paying for his or her insurance. Additionally, make sure the payor will cover some of the procedure and the patient understands his or her copay in order to ensure complete reimbursement. "In orthopedics, if you don't check the payor information you stand the chance of spending four hours in the operating room you aren't going to be paid for," says Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California. "Just by collecting the information you should be collecting, doctors can improve their bottom line significantly."
3. Don't open surgical supplies until the surgeon asks for them. Nurses or operating room staff will open supplies before the surgeon asks for them during a procedure. According to Carlos Guanche, MD, managing partner of the Southern California Orthopaedic Institute in Van Nuys, this practice is particularly prevalent in the hospital setting. "I've frequently had as many as $250-$300 in opened items that I didn't use for every case in the hospital," he says.
In order to stop this waste in supplies in revenues, Dr. Guanche instituted a policy where OR staff does not open any supplies, other than the obvious (i.e., retractors, knives, etc.), before the surgeon explicitly asks for it. These items include shavers, anchors and dressings.
Dr. Guanche suggests presenting surgeons with an itemized "bill" after surgery to demonstrate to the surgeon and OR staff that includes what items the surgeon asked for, what items had been used and what had been opened. "By using the bill, surgeons can see how much unused, opened items are costing them," he says.
4. Outsource billing services to save on overhead costs. Outsourcing is becoming a more popular option for cutting costs as ASCs seek different ways to save dollars spend on staffing hours and supplies. Billing is just one example of a service that ASCs can outsource as a way to cut work hours and supplies such as paper or even medical equipment. "We use companies that supply implants and they actually do the billing directly with insurance companies, so instead of us absorbing the price of the implant — which is substantial — they do the billing and take care of all that," Lorreine Borrayo, director of nursing at Carillo Surgery Center in Santa Barbara, says. "We get the prior authorization to make sure insurance companies can cover the costs, and it's a substantial savings because now our own staff doesn't have to do the billing."
5. Perform a cost-benefit analysis of new procedures and services. The ASC manager should be constantly hunting for procedures and services to be added to the facility's repertoire, says Susan Kizirian, MBA, BSN, RN, chief operating office of ASCOA. This means keeping on top of new procedures, technologies and services available in ASCs, rigorously analyzing implementation costs and presenting findings to surgeons on staff. The manager should also be looking to recruit area surgeons in markets that are not saturated.
1. Work with staff to shorten the pre-operative phone call. According to Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, most surgery centers spend a lot of time on patient triage, a process that proves costly when nurses or front desk staff members spend more time on triage than necessary. "If anesthesiologists do not take ownership of the process, the center spends a lot of wasted time on the phone call asking questions that aren't as directed as they could be," Dr. Wherry says. "They may be gathering labs and data that aren't necessary." He says the first thing ASCs should do is look at how much time and how many FTEs are devoted to the process of the pre-op phone call. He says for a center performing 200-300 cases per month, 1-1.5 FTEs should be sufficient. Additional savings could be realized if the pre-op admitting and recovery room staff makes the calls versus a full-time phone call nurse.
ASC anesthesiologists should then work with those responsible for the pre-op phone call. They should explain which information is necessary for the procedure and try to reduce the phone call to less than 10 minutes. "[Staff members] are trying to do their best, but these calls can turn into half hour conversations," Dr. Wherry says. "Anesthesia has to step in and say, 'This is all we need.'"
2. Maintain up-to-date payor patient information. Before performing a procedure, ensure the patient's payor information is current and the patient is still paying for his or her insurance. Additionally, make sure the payor will cover some of the procedure and the patient understands his or her copay in order to ensure complete reimbursement. "In orthopedics, if you don't check the payor information you stand the chance of spending four hours in the operating room you aren't going to be paid for," says Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California. "Just by collecting the information you should be collecting, doctors can improve their bottom line significantly."
3. Don't open surgical supplies until the surgeon asks for them. Nurses or operating room staff will open supplies before the surgeon asks for them during a procedure. According to Carlos Guanche, MD, managing partner of the Southern California Orthopaedic Institute in Van Nuys, this practice is particularly prevalent in the hospital setting. "I've frequently had as many as $250-$300 in opened items that I didn't use for every case in the hospital," he says.
In order to stop this waste in supplies in revenues, Dr. Guanche instituted a policy where OR staff does not open any supplies, other than the obvious (i.e., retractors, knives, etc.), before the surgeon explicitly asks for it. These items include shavers, anchors and dressings.
Dr. Guanche suggests presenting surgeons with an itemized "bill" after surgery to demonstrate to the surgeon and OR staff that includes what items the surgeon asked for, what items had been used and what had been opened. "By using the bill, surgeons can see how much unused, opened items are costing them," he says.
4. Outsource billing services to save on overhead costs. Outsourcing is becoming a more popular option for cutting costs as ASCs seek different ways to save dollars spend on staffing hours and supplies. Billing is just one example of a service that ASCs can outsource as a way to cut work hours and supplies such as paper or even medical equipment. "We use companies that supply implants and they actually do the billing directly with insurance companies, so instead of us absorbing the price of the implant — which is substantial — they do the billing and take care of all that," Lorreine Borrayo, director of nursing at Carillo Surgery Center in Santa Barbara, says. "We get the prior authorization to make sure insurance companies can cover the costs, and it's a substantial savings because now our own staff doesn't have to do the billing."
5. Perform a cost-benefit analysis of new procedures and services. The ASC manager should be constantly hunting for procedures and services to be added to the facility's repertoire, says Susan Kizirian, MBA, BSN, RN, chief operating office of ASCOA. This means keeping on top of new procedures, technologies and services available in ASCs, rigorously analyzing implementation costs and presenting findings to surgeons on staff. The manager should also be looking to recruit area surgeons in markets that are not saturated.