Issue link: https://beckershealthcare.uberflip.com/i/170040
14 ASC Turnarounds: Ideas to Improve Performance schedulers, especially during vacation or meeting season. Ask practice schedulers to inform the ASC when the surgeon takes time off so you can give their time to other surgeons that week. time to pursue these other projects," says Mr. Jacobs. "The staff doesn't want to be idle; they want to be involved with everything going on at the center." "We have to set up at the beginning of the day and take down at the end, so we want as many cases as possible in the middle," says Mr. Jacobs. "We want to keep surgeons and patients happy as well, so we communicate with them about vacation time and make sure we can fill those gaps when necessary." 6. Cross-train staff members. If your ASC maintains a lean staff, cross-train everyone to help with different functions at the center. This will minimize downtime and maximize efficiency to support patient volume growth in the future. 4. Consider where to save time during set-up and take-down. Experience will make nurses and surgical techs more efficient with set-up and take-down every day, but there may be additional opportunity to speed the process by cutting unnecessary waste or steps. "We used to take an hour at the beginning of the day to set up and we were able to cut that to 45 minutes, and that makes a significant difference in time saved for the entire year," says Mr. Jacobs. "The impact of these overhead hours diminishes on a per case basis. We realized that the standard of coming in an hour ahead of time was too much and so we were able to cut that down, and that saved 195 hours per year." 5. Stay productive during downtime. Sometimes downtime can't be avoided, but staff members can take on projects to fill that downtime with constructive initiatives. Staff members can work on patient call backs, quality improvement studies, patient control or other special projects to stay productive during the day. "The people who work at ASCs enjoy the quicker pace environment and they'll usually have free "The biggest, most beneficial thing you can do is cross-train," says Ms. Martin. "When our receptionist has down time and doesn't have any more work with making charts, she posts bills and keeps our accounts payable in order. Our credentialing person is cross-trained to do reception. People have endless tasks that they can complete during their downtime." Ms. Martin says there isn't normally any nonproductive time in the center, but if there is on a rare occasion, she'll send the employee home. 7. Close down on slow days. When surgery centers have one day that is consistently slow every week, consider closing down that day and working the clinical staff for four longer days per week. This saves on overhead and could compact the schedule even more. "Some parts of the business, like the clinical aspect, you can flex to four days," says Ms. Martin. "Other parts, like the business portion, must happen all five days." You can also implement this policy on a micro level by rearranging cases the week before for particularly slow days. "We ask doctors on slow days to move their cases to a different day and sometimes we close Thomas Jacobs the center down with only a skeleton crew to collect money, answer calls and complete business office functions," says Ms. Martin. "Sometimes it's better for staff to collect four-tens or four-nines that week then scattered hours for all five days." 8. Commit to low turnover times. The culture at the ASC should promote low turnover times and staff members really need to buy-in to the process. Surgeons need quick turnovers so they can get back to their practices or the hospital, and efficiency could allow more cases into the ASC overall. "We try to allow only a little time between cases to meet the surgeons' expectations," says Ms. Martin. "Having staff motivated to do that is important. We make these expectations clear to the staff; they must be willing to participate in all aspects of success at the center. I hired two people without medical experience for reception and materials management, and they have done a really excellent job. They were motivated to succeed." n 6 Ways ASCs Must Evolve to Meet Billing Challenges From Surgical Management Professionals CEO Mike Lipomi (continued from page 1) While patient collection is not a new problem for ASCs, some co-pays and deductibles are significantly higher than they used to be, and insurance policies are becoming more convoluted. day of surgery. As a result, these ASCs may have a high number of accounts receivable days, largely driven by unfulfilled patient responsibility portions, especially in the first quarter of the year when patients have not yet met their deductibles. As deductibles and co-pays continue to increase, ASCs must devise new financial approaches, Mr. Lipomi says. "People often forget about their deductible," he says. "They may have a 20 percent co-pay and think they will owe $300 for a $1,500 procedure, when really they will owe $1,100 with the co-pay and deductible." Centers need to display near the front office appropriate information to inform patients of policies for their payments. This can be done sensitively, without appearing too materialistic or demanding, he says. 2. Only use implants or hardware with proper reimbursement. Before adding procedures that require costly implants or hardware, surgery centers need to count the cost of implants against the cost of the procedure. They could be losing money on these procedures, Mr. Lipomi says. "If a patient comes in to have a $1,500 procedure, and they have a $1,000 deductible, we want to know they are going to be responsible for that part of the bill," Mr. Lipomi says. "Ask them how they are going to pay or what portion they can provide at the time of service. Work with them." A solution could be carving out implants in a managed care contract. However, some centers still won't be able to provide the same service a nearby hospital could perform at a much lower cost because of generic purchasing agreements. "It's critical that they find out the costs and make sure they know what they are doing," he says. "It is a cautionary area." Patients are up to 50 percent more likely to pay their portion of the bill if they are educated and asked to make payment arrangements prior to surgery. 3. Conduct regular coding audits. SMP is performing more coding audits now than ever before, Mr. Lipomi says, largely because of the growing penalties for improperly coding or billing claims. While improp-