Becker's ASC Review

32 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine - call (800) 417-2035 Biggest Concerns of ASC Physician Owners in 2014: Q&A With Dr. Brad Lerner of Summit Ambulatory Surgical Centers By Heather Linder B rad Lerner, MD, is a urologist, physician owner and medical director at Summit Ambulatory Surgical Centers, a group of 15 Urology ASCs in Maryland that performed more than 20,000 procedures last year. He is also a partner in Chesapeake Urology Associates and the chief of the division of urology for Union Memorial Hospital in Baltimore. Dr. Lerner splits his time and works approximately 80 percent as a clinician and 20 percent as an ASC administrator. He's heavily involved with both the business and clinical operations of all the organizations he's affiliated with. Here Dr. Lerner discusses what issues are at the forefront of his mind going into 2014 and where the year's biggest challenges — and opportunities for growth — will lie. Question: What are you focused on going into the New Year? Brad Lerner: The overriding issue is always achieving the highest possible level of patient care and safety. We are always looking for ways to improve patient care and stay current with changing state, Medicare and AAAHC regulations. A recurrent theme entering into a new year is to investigate ways to decrease expenses and/or to increase revenue while maintaining our focus on patient care. This involves multiple areas including critical review of existing and potential lines of service, vendor contracts, staffing models, supply costs, environmental services and more. Of course, we are looking at the potential changes related to the Affordable Care Act and what might be occurring in 2014. We are preparing ourselves for a larger patient population with higher deductible plans. We also know that we may be looking at bundled payments or outcomes-based compensation down the road as well. Our organization is also looking more closely at the patient financial end of things, and we feel that it's becoming increasingly important to communicate with patients as far as their financial obligations prior to surgery so that there are no surprises at the time of their procedure. We actually experienced a higher cancellation rate this past year as compared to prior years related to this issue but feel strongly that there needs to be increased efforts to address this prior to performing any elective ASC procedure. Collecting the financial obligation upfront saves your billing staff the cycles of trying to collect from patients afterwards and improves cash flow. We have looked at alternative financial plans to help patients that may have difficulty meeting their financial obligations for their procedures. We've engaged a third party financial provider that patients can look work with if desired especially when in a self pay situation. We have also incorporated a credit card payment option where patients will automatically pay a designated amount per month. The times have certainly changed with a different environment related to insurance coverage options and potential changes coming from the government. We really do have to have a stronger focus on the business side of things and be more diligent from a collection aspect. Q: How can you strive to be more efficient? BL: We know that our physicians are their most efficient time-wise and from a revenue standpoint in the ASC as compared to the hospital or medical office. We predominately utilize block time sessions in our centers and are always looking at ways to allow our physicians to maximize their use of ASC time whether it be by changing length or numbers of sessions, providing the appropriate supportive staff as well as state of the art equipment and upgrading existing technology. Dr. Brad Lerner We also are constantly evaluating additional lines of service that traditionally may have been performed in a hospital setting but may actually lend themselves appropriately to an ASC setting. We also review historic case volumes as well as projected case volumes going forward for individuals and certain lines of service.  Certainly, review of block time utilization with adjustments being made for under utilization as well as increasing available time for those that are maximizing their sessions takes place on a regular basis. There is huge difference between perception and reality and showing data to the physicians concerning utilization is a powerful tool. Q: How will technology shape your business and your practice? BL: One does have to look at committing a center to new or improved technologies as an investment. With improved technologies, there may be additional expenses but these same technologic advances will also likely improve patient care and safety and, potentially, revenues. We've been utilizing EMR for about seven years now. The electronic medical record is vital if you want to start measuring outcomes. We know the emphasis in the future may be more and more on outcomes. If you can show these positive outcomes, it's certainly something that could potentially be marketed to hospitals, other physicians, patients and insurance companies that may be seeking the safest option with the lowest complication rates at a lower cost. Introducing new technologies and lines of service may help to increase case volumes and revenue. We are presently looking at adding new procedures including pediatric urology, ureteroscopy and expanding our genitourinary prosthetic program to include artificial urinary sphincters to treat incontinence. One recent example involves trans-urethral resection surgeries, which has traditionally utilized a monopolar cautery technology. After an in-depth analysis of the clinical, financial and operational aspects of this new technology, we made the decision to bring in bipolar cautery and plasmavaporization, mainly for endoscopic the treatment of bladder cancer. It's safer for patients as the electrical current doesn't travel through the patient. There is less risk in stimulating regional nerves and interfering with implantable electronic devices such as pacemakers and defibrillators. It's also the scenario where there is an increased expense to our organization as it is more expensive technology with the same CPT code and reimbursement as the former technology. Our organization made the decision to invest in this technology to improve patient care and safety as well as the efficiency of our physicians. Now that we offer this technology, we are already seeing physicians moving cases from the

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