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12 ASC Turnarounds: Ideas to Improve Performance 3. Geriatric procedures. Innovative technology and techniques now allow surgery centers to treat more geriatric patients safely. Anesthesia has advanced for patients with more comorbidities and procedures that are common among the Medicare population — such as cataract surgeries — can increasingly come to the ASC. However, there are still a few challenges with procedures like outpatient spine surgery for this population. Though outpatient spine surgery seems like an obvious win, for both ASCs and patients, the specialty's migration to the outpatient center is not without its hurdles to overcome. "The big challenge is that Medicare doesn't pay and many commercial payers are reluctant to pay or do so poorly," says Mr. Lambert. ASC leaders are no strangers to reimbursement struggles and receiving adequate and sustainable reimbursement for spine procedures begins with educating commercial payers. 4. Vascular surgery. Traditionally vascular procedures were too complex for the outpatient setting, but with new technology and a push toward costeffectiveness, ASCs are able to capture more of these high acuity cases. Surgery centers most prepared to take on high acuity cases are supported by stellar staff. From the staff 's perspective, adding any new specialty involves setting up the right protocols so patients are as comfortable as possible, streamlining the scheduling process and ensuring the entire process goes smoothly all the way through to receiving the correct payment, says Mr. Carrera. "There need to be physician champions to drive these cases to surgery centers," says Mr. Carrera. Physicians are the spokespeople from a community standpoint. From an internal standpoint, physicians, staff and the managed care coordinator work together to demonstrate to payers that the ASC is a safe and economic environment for performing these kinds of cases. 5. 23-hour stays. Sending patients home too soon is a concern often associated with bringing higher acuity cases, such as spine, neurosurgery and total joint, to the ASC. In states that allow it, adding 23-hour stays is an opportunity to provide an environment designed to make these kinds of patients more comfortable. At the SMP centers the idea was introduced through a clinical and financial briefing presented to the board. "The more we discuss this with physicians, the higher the comfort level," says Mr. Lipomi. Visits to centers that already have 23-hour stays gave physicians and staff a chance to see how the process worked. As with any new specialty or procedure at a surgery center, it is important to perfect the process before leaping too far ahead. "Do a case, analyze it. Cover every contingency," says Mr. Lipomi. At the SMP centers, the process began with one case a month and slowly built from there. The centers are now accommodating three to five 23-hour stay patients a week. "It takes so long because you don't want to make a mistake. You are under the magnifying glass," says Mr. Lipomi. Surrounding hospitals and payers will be watching closely for the sign of any mistake. Surgery centers provide patients an alternative to hospital care with higher nurse to patient ratio and lower infection rates. "ASCs are familiar with providing superior service," says Mr. Lipomi. "I definitely think 23-hour stay procedures provide a safer, cleaner and more controlled environment for the patient." n HFAP 1051 Final_Layout 1 3/20/13 3:26 PM Page 1 Confirm Your Excellence Ambulatory Surgical Center Accreditation "The HFAP survey process is straightforward. Mackinaw Surgery Center knows exactly what the regulatory expectations are without the guess work. This allows our Center to be consistent in its operations and at the same time challenges our team to strive to be the best at what we do. " -Steve Corl Administrator, Mackinaw Surgery Center, LLC Saginaw, MI www.hfap.org info@hfap.org CLIENT: Healthcare Facilities Accreditation Program APPEARANCE: ASC Review, April 2013 AD SIZE: Half page horizontal, color Norcom Incorporated Phone: 847-948-7762 E-Mail: theteam@norcomdesign.com