Becker's ASC Review

14 EXECUTIVE BRIEFING EXECUTIVE BRIEFING 1 Hidden costs can erode ASC margins: Insights on potential trouble spots + how to solve them O ne of the most important trends in healthcare in recent years is that ambulatory surgery centers have become the setting of choice for a wide range of outpatient procedures, due to the lower costs and positive patient experiences at these facilities. In the field of gastroenterology, for example, a study conducted by Johns Hopkins Bloomberg School of Public Health found that on average, colonoscopies performed at hospitals cost 55% more than the same procedures performed at ASCs. Running an ASC profitably, however, requires close attention to hidden costs. These hidden costs can contribute to operational inefficiencies, reduce margins and affect patient, physician and staff experience. To learn how to uncover and address these hidden ASC costs, Becker's Healthcare recently spoke with Nancy Schlossberg, BSN, RN, CGRN, CER, past president of the Society of Gastroenterology Nurses and Associates (SGNA) and the American Board of Certification for Gastroenterology Nurses (ABCGN). The four "S's" of inefficiency: scheduling, staffing, space and supplies Scheduling In an ASC, schedule gaps can be extremely expensive, especially in terms of unproductive salary dollars. As a result, the ability to compress and control the schedule is essential. Scheduling software can provide a data-driven tool to improve clinical operations by optimizing provider schedules, resources, and capacity. Staffing "When it comes to staffing, " says Ms. Schlossberg, "staffing is a facility's most expensive resource. ASCs need to examine their staff mix and the associated costs. It may be possible to modify the staff mix and reduce cost per procedure without sacrificing quality of care. In endoscopy settings, for example, many organizations still require two RNs in the procedure room. However, keeping state regulations and facility policies in mind, you might consider modifying procedure room staff mix from 2 RNs to one RN and one experienced, competent tech. In Endoscopy, the importance of a well-trained competent reprocessing room tech is vital to maintaining efficient procedure room turn over by ensuring availability of endoscopes to meet scheduling demands and minimizing risks of potential endoscope contamination resulting from failure to follow all steps of original equipment manufacturer's Instructions for Use. Space The best ASCs utilize space in ways that support highly efficient operational workflow. These facilities optimize the number of prep bays, procedure rooms and recovery bays to best support safe and efficient patient throughput. "Money comes from the procedure room, not the prep or the recovery bays," Ms. Schlossberg said. Do not forget the importance of adequate reprocessing space along with competent reprocessing techs to support the daily case load. You do not want to delay cases waiting for instruments! Supplies Supplies can be another source of hidden costs for ASCs. To minimize inventory carrying costs, organizations must determine the right PAR levels (Periodic Auto-Replenishment; minimum and maximum quantity limits set for certain items) for different supplies. It's important for teams to continually evaluate new or alternative products that deliver high quality at a lower price. However, despite potential expense, ASCs also need to stock supplies that may be needed in emergency situations. "You need to be ready for an emergency," Ms. Schlossberg said. "In GI and endoscopy, you might use an over-the-scope clip for closure of a perforation. Make sure you have the right equipment on hand and know how to use it. Your staff must be trained and demonstrate competence using devices that are rarely used." At GI and endoscopy centers, the importance of having the right mix of well-functioning "workhorse" scopes can't be underestimated. "Once scopes go out for repair, you lose the use of the scope, put more wear and tear on remaining scopes and potentially delay case starts. If possible, have loaner scopes on hand. Every time you delay a case, it costs money. Staff may receive overtime pay and delays may compromise patient, physicians, and staff experience," Ms. Schlossberg said. Good scope handling and maintenance practices can preemptively reduce repair costs. Analyzing the different types of scope repairs that are needed can shed light on scope-handling issues. Large numbers of angulation repairs, for example, may suggest that staff aren't hanging scopes correctly.

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