Becker's ASC Review

8 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs – Call (800) 417-2035 savings programs all promote outcomes over volume and require healthcare providers to take on risk. "As payers increasingly sell health plans tied to ACOs, ASCs will progressively feel compelled to participate in ACOs as well," says Adam C. Pow- ell, PhD, president of Payer+Proivder Syndicate. "This is likely to be particularly pronounced in high-density areas in which ACOs have a strong presence. Many ASCs will have to take a seri- ous look at how they position themselves in this changing environment." There are some ASCs preparing to participate in ACO contracts independently while hospitals are acquiring others before participation. 2. EMR implementation. The U.S. govern- ment provided incentives for hospitals and phy- sicians to begin using electronic medical records, but not for ASCs. As a result, many ASCs haven't implemented EMR and are now behind in data collection. "Another reason ASCs lag behind in EMR imple- mentation is they offer a certain value — doing procedures more efficiently than hospitals — and EMRs could slow the pace," says Steven Gayer, MD, MBA, chair of the American Society of Anes- thesiologists' Committee on Ambulatory Surgical Care and an anesthesiologist with Bascom Palmer Eye Institute in Miami. "The challenge is to find an EMR built around the ASC's efficiency. At the hospital, you might have time to click through many screens while waiting for the operating room to open up, but at ASCs when you're doing multiple procedures in a row, there isn't time to fill in every field. We need a specialized EMR and that's been slow in coming." However, the data gathering potential is significant for ASCs. They can find inefficiencies or negative trends and fix them quickly before a bigger issue arises. 3. Data collection and optimization. Gather- ing single-center data is great for identifying and fixing issues at the center, but outside data is nec- essary for benchmarking and additional improve- ment. The Ambulatory Surgery Center Association offers a benchmarking program collecting data from a large number of ASCs across the country with the potential to offer both broad benchmarks as well as very specific numbers for certain types of centers. Clinical organizations — including the So- ciety for Ambulatory Anesthesiology — also have outcomes registry data available. The SAMBA registry is a web-based database that aligns with some EMR records. "Gathering data is not sufficient on its own. You have to gather data and then do something with it," says Dr. Gayer. "Anesthesia leaders are looking for what the data says about quality of care and how they do things at their facility. We're looking to make things more efficient, safer and improve patient satisfac- tion postoperatively." 4. Promoting ASC benefits. There is strong data showing ASCs generally have higher quality and lower costs than hospitals because of their smaller size and often focused expertise. Patient satisfaction is also high at surgery centers, but in many communities people still go wherever their surgeons recommend and aren't aware of ASCs. "As a result of their smaller size, ASCs often lack the brand recognition of local health systems," says Mr. Powell. "Furthermore, some patients may be hesitant to receive care outside the walls of a hospital. Quality fears can be mitigated by shar- ing literature on the positive relationship between volume and quality, as well as applicable perfor- mance scorecards." Prices published online will help patients make comparisons with other healthcare facilities and determine the best value. A few ASCs across the country are already publishing prices online, a trend expected to grow. 5. Physician recruitment. Hospitals are pur- chasing physician practices and offering employ- ment contracts to new and veteran surgeons across the country. Independent physicians are also finding it harder to maintain their business with new regulations and expenses, making the hospital contracts seem even more attractive. However, hospital-employed surgeons are often unable to perform cases at ASCs. Rural ASCs are especially hit hard, as surgeons of- ten train in urban areas and decide to begin prac- ticing in the urban environment. "According to a survey conducted by the Colo- rado Health Institute, the top three factors that rural doctors rated as very important were the availability of recreational and leisure activities, the sustainability of the environment for raising children and the degree of professional indepen- dence available to them," says Mr. Powell. "Em- phasizing these benefits during the recruitment process may be helpful." 6. Patient experience with higher acuity cases. Higher acuity cases once relegated to hospital settings are coming into surgery centers. These include orthopedic joint replacements, spine surgeries and older patients with more co- morbidities. Technology allows surgeons to per- form these cases with less invasive procedures and allows anesthesiologists to better control pain. Surgeries involving catheters were once hospital- only procedures, but now anesthesiologists work- ing in ambulatory centers can thread the catheter and inject the catheter before the surgery is over to maintain the block. Pain pumps gradually in- fuse the local anesthetic mixture for the patient so they can go home with the pump still intact. "The patient can either come back to the center for us to remove it, or remove it at home on their own. In that case, we would conduct a follow-up call to make sure all went well," says Dr. Gayer. "This helps us minimize postoperative narcotic use and allows patients to resume their typical activities of daily living earlier. We're extending the physician anesthesiologist's presence from the preoperative evaluation, the intraoperative expe- rience, the postoperative recovery room stay and finally into patients' homes as well." There is great patient satisfaction associated with continuous catheters and pain pumps, says Dr. Gayer, and more ASCs are implementing them. "It takes a leader to come in and say we can do this and we should do this." 7. Case cancellations. Canceling cases — especially the day of surgery — has a significant impact on patient satisfaction and the ASC's bot- tom line. The surgery center has staff ready and waiting for the patient, and sometimes they even begin the preoperative process. If the case is can- celled, it wastes time, and prevents another pa- tient from filling that slot. In some cases, cancellations are preventable — such as when the patient doesn't follow prepara- tion protocol or history isn't taken beforehand. The patient history can identify red flags that would prevent them from having surgery at the center, such as sleep apnea, high BMI or ASA score. "The ambulatory surgical center may not be the appropriate venue for some patients," says Dr. Gayer. "A good quality database allows bench- marking with similar facilities to compare the percentage of cancelled and postponed cases and 10 Concerns Facing ASCs Heading Into 2015 (continued from cover) Adam Powell Dr. Steven Gayer

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