Issue link: https://beckershealthcare.uberflip.com/i/332156
12 ASC Turnarounds: Ideas to Improve Performance find which procedures can be done at an outpatient center but are [currently] being done at a hospital. The next part of this is to determine why these procedures are being done in a hospital. Do the surgeons know what a center can offer them? Do the insurance companies know what a center can offer them? Do patients know that the center is an option? It may be an issue of education to the involved parties. Ms. Yuva: Our first question in our assessment is does this provide an oppor- tunity for patients to receive excellent clinical care and surgical experience. For orthopedics, we first assess clinical patient risk; we do not elevate risk in an ambulatory setting. We then assess if we are able to provide comprehensive epi- sode of care, from pre-op consult through post-op recovery care and therapy. We evaluate if these patients can safely return to their homes (with support present). We consider and review procedures currently being completed in a hospital setting with patient discharge within 24 to 36 hours. We further as- sess if patient discharge was based on the healthcare delivery system or clini- cal patient indicators. Our final step is working with insurance companies to negotiate procedures and reimbursement. At this point we have defined: if we have the patient population; if we have the surgical specialist(s) on staff; if we can deliver appropriate discharge and home pain management care; if we have the re- sources to provide full service of care consult through post-op recovery and if all of this is fiscally possible. Q: Which specialties are hardest to add? Easiest to add? Why? Mr. Kamps: In my experience the most difficult specialties are those with lots of instruments and implants. The issue tends to be centered around the need to get different sets for the same procedure. This happens due to the different approaches and training each surgeon takes. Of course, these specialties are often very rewarding to add to a center and should not be shied away from by any administrator. In fact, having a meet- ing with all the surgeons prior to buying anything and putting the instru- ments into their hands can save a lot of questions later. Q: Is there anything of which ASCs adding new specialties should be aware? Mr. Kamps: Find out what your reimbursements are before moving forward. A simple return on investment goes a long way in providing information to your board on whether the new specialty is worth the money and time needed to get the specialty running. Ms. Martin: Fully investigate current reimbursement contracts that are in place and whether the specific specialty or procedures were addressed under current reimbursement contracts. Ms. Yuva: Is this a best practice for the patient? Will this be an affordable ser- vice line? This needs to be clearly vetted prior to moving forward. A poor spe- cialty mix can be financially harmful to ASCs, depending on their specialty mix and contracts. In addition, OR time, surgeon case time, total cost of capi- tal equipment and instrumentation, possible implant cost, reimbursement, staff support in education and surgeon needs also need to be considered. Q: As an administrator, what is your best piece of advice for an ASC adding a new specialty? Mr. Kamps: Communicate. Over-communicate. Be sure to talk to each of the staff involved in making the new specialty a success, every day if possible. Make a list of tasks and set up a timetable to achieve the tasks. Update your surgeons and board on the progress you are making and the hurdles you are encountering. Ms. Martin: I would recommend introducing the idea early to everyone (staff, physicians, board members, etc.). Resistance is common with any change, and in addressing the concerns that come up, this will allow time to research, implement methods to address concerns, help people with con- cerns, get involved in the process of working through the challenges and get comfortable with the change that is being considered and implemented. Nev- er underestimate the amount of time that is needed to generate the support needed to make a change like this to your facility. Ms. Yuva: Overprepare. We represent a fairly conservative medical practice, and we are allowed the time and resources to be well prepared to deliver excellent care to our patients, as well as our medical and clinical staff. Make sure your medical staff is invested and involved in the program development as well. n H aving surgeons commit to bringing cases is one of the most important aspects of run- ning a viable ambulatory surgery center. While ultimately surgeon-controlled, administrators are responsible for maintaining adequate case vol- umes at an ASC. Their efforts to do so are enhanced exponentially via effective communication. "I think there can be a fear of the unknown," says Kelli McMahan, vice president of operations at ASC company Pinnacle III. However, there are ways to make the transition easier. 1. Give the grand tour. For new surgeons, help- ing them understand the benefits of the ASC is vital. "Schedule welcome meetings with them to tour the facility and meet the OR staff. Create frequent op- portunities for them to be in the facility," she says. This tactic allows administrators to become famil- iar with surgeons and allows surgeons to familiarize themselves with what the ASC has to offer. According to Ms. McMahan, having the surgeon return to the ASC several times is not unusual during the onboarding process. She suggests in- cluding a day when procedures are scheduled to facilitate the surgeon's observation of the center's workflow in action. 2. Find out what surgeons need. A personal level of attention is also required. "Initiate conver- sations with surgeons to find out what they need and how you can get it for them. If a surgeon is bringing a new specialty to your ASC, discuss what equipment is necessary to perform their cases, and identify their preferences. Engage them as much as possible," suggests Ms. McMahan. 3. Connect with the scheduler. An addition- al wrench in the works is a surgeon's scheduler. "When schedulers aren't used to scheduling at your facility, administrators have to engage them as well. Make scheduling as easy as possible for [schedulers], and connect with them frequently. If scheduling isn't easy, they'll schedule the surgeon elsewhere. Surgeons go wherever they're sched- uled," says Ms. McMahan. 4. Identify obstacles. For surgeons who are already at the ASC and are not necessarily bring- ing expected or necessary caseloads, much of the strategy is similar. "Meet with the physician and ask about the rationale behind doing the majority of cases elsewhere," says Ms. McMahan. She rec- ommends asking if there's something the center can do to facilitate a surgeon's cases, focusing on scheduling, equipment, workflow issues and any other of the surgeon's potential concerns. "Ad- dress anything he foresees as a problem," she adds. 5. Be proactive. Ms. McMahan recommends ad- ministrators perform regular facility and staff assess- ments to ensure all aspects of the ASC are well-run and efficient; that employees are happy; that equip- ment is in top condition; and that surgeons are com- fortable with the resources at their disposal. "It re- ally comes from the top down, that careful eye over the entire center," she asserts. "You have to make the physician's experience seamless, so he doesn't have to do extra work. It goes back to customer service — facilities have to remember physicians are some of their most important customers." n Engaging Surgeons in ASCs: 5 Simple Strategies to Grow Case Volume By Ellie Rizzo