1. Make good use of technology. There are many ways ASCs can adopt technology to cut costs and generate more revenue. Midlands Orthopaedics Surgery Center in Columbia, S.C. is pursuing implementation of new software as part of a facility-wide goal to improve scheduling and case costing. The software will allow the surgery center to better measure cost per CPT and per surgeon. Now only is this information valuable for insurance contracting, but it is useful to influence physician behavior.
"We will be able to evaluate the supply and staffing cost for each case per CPT code. Even if the same CPT code is performed by different surgeons, there can be significantly different cost outcomes. So there's a benefit in showing and knowing what particular procedures are costing you on average," says Ann Margaret McCraw, CEO. "And if you have a surgeon who is an outlier, the data may encourage him to consider different techniques or supplies without compromising quality."
2. Have an appropriate staff size. It is critical for an ASC to maintain the correct number of staff to meet its case volume and mix. The best way to do this is to benchmark against other comparable centers and make sure staff levels are monitored often. "It's more important to know how many nurses you're using than what you're paying them," says Ross Alexander, MBA, the administrator of The Surgery Center of Fort Collins (Colo.), a multi-specialty ASC owned and managed by a group of surgeons, Poudre Valley Health System and Surgical Care Affiliates. "Most surgery centers pay market rates; it's knowing how many nurses you need to provide care efficiently and safely."
3. Make sure staff is comfortable asking for money. Smart ASCs hire friendly and personable team members for their front-desk and registration positions. While these character traits are important for providing a good patient experience, another critical trait often overlooked, that is vital to the financial stability of a center, is the ability to comfortably ask for the money owed to the center from patients. "Many, if not most, front desk personnel are generally not trained to ask people for money, and many are downright uncomfortable being asked to do so," says Bill Gilbert, vice president of marketing for for AdvantEdge Healthcare Solutions. "An ASC's management needs to recognize that and deal with it in their training. You can be pleasant and professional and still ask for what you're entitled to get paid."
There are many different ways to train staff to ask for money, including providing scripts or individual training with experienced staff members. What's also critical is making it understood that asking for monies owed is a job requirement, says Mr. Gilbert. "[Staff members] need to know how to easily look up the co-pay and deductible, tell the patient what is owed, and find out how the patient will pay for [these expenses] as opposed to leaving it to their own devices to figure out how to ask that question," he says. "They're going to be uncomfortable if they're not coached through the process."
4. Coordinate efforts between surgeons and anesthesiologists. Ensuring that blocks and other anesthetics are administered at times that make the surgeon most efficient is also very important to success for an orthopedic service line. "Work with anesthesia to help them understand how [surgeons] want to coordinate their blocks," says Timothy Kremchek, MD, medical director at Beacon Orthopedics and Sports Medicine and a physician-owner of the clinic's surgery center. "This is very important for ensuring that procedures can begin in a timely manner. Otherwise, you may be waiting in a room before a procedure can start."
5. Use surgery center data in negotiations. Having accurate data about costs makes you a more persuasive negotiator. Demonstrating that you would lose money on the proposed rate may not impress the payor, but it could stiffen your resolve to propose a higher rate or walk away from negotiations. "A payor in one of our Symbion facilities was going to cut our rates dramatically," says Ron Brank, a group vice president for Symbion in Nashville, Tenn. "From our data, we knew that they were proposing rates that would not even cover our variable costs. We determined the proposal was financially unacceptable and informed the payor we could not continue with the contract." The ASC team also pointed out that the payor's cases would go to the local hospital, where payments would likely be considerably more than the ASC asked for, assuming the hospital was getting at least HOPD rates. "While you won't always be successful in these situations, accurate data does often help us to gain fair and acceptable rates for our ASCs," he says.