1. Train management appropriately
John Merski Jr., Managing Partner and Executive Director of Human Resources for MedHQ, says the most common management problem he sees at surgery centers is a general lack of management training. He says surgery center administrators are frequently hired for their operational, financial or clinical skills with little emphasis placed on their “people skills” or management abilities. In many cases, an OR nurse may be promoted to the position of administrator without undergoing management training.
“Managers are not born, and most surgery center managers today do not go to school for management,” he says. “They’re usually someone who is a strong technician and is picked by upper management to advance, and when they get to the next level, they are armed with very little management skill.” He says most managers fall into one of three categories: overly nice, overly harsh or effective. Unfortunately, Mr. Merski sees more “overly nice” and “overly harsh” managers than effective ones simply because they have not undergone the proper training. He says if a surgery center administrator is hired without management experience, they should undergo training in order to learn how to direct people.
2. Create a clear policy for materials management
“One of the first things that has to be done [in an ASC] from a materials management perspective is for the facility or the management entity to develop clear policies related to how inventory is set up (physically and within the information database), controls for purchasing and receiving and how the entity plans to handle requests for new items,” Ms. Johnson says. If the facility plans to case cost, which Blue Chip highly recommends, accurate pricing/unit of measure and how to account for supplies used should be outlined in policy, according to Ms. Johnson. “Apples to apples comparison is essential,” she says. Blue Chip also recommends limiting the number of storage locations and determining inventory par levels when creating supply chain policies.
Mr. Scheller says one costly mistake for ASCs is to acquire supplies for a new surgeon who never commits to the ASC. Creating policies for supplies in relation to new surgeons may prevent the loss of money from unused materials.
Consistent and standardized policies ensure the ASC knows the expectations for supplies and strategies for meeting these expectations. If there is a discrepancy in inventory counts of more than 5 percent, Blue Chip requires its ASCs to develop an action plan to identify and resolve the variance. The action plan may be as simple as changing the number of people involved in calculating inventory or setting up teams responsible for different parts of the supply acquisition and depletion process.
3. Train staff to excel in orthopedics
In a multispecialty center training OR staff to specialize in orthopedics improves efficiency in the OR and in providing supplies, says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. When staff is well trained, “the room turnover is better and physicians are satisfied,” Mr. Brock says. At NorthStar, staff members are still cross-trained in other specialties but there are crews whose primary focus in orthopedics. “This is not so much for clinical competency as for process competency,” he says. “They understand the nuances of certain products.”
4. Manage the surgery schedule aggressively
Make sure to receive regular and timely updates on when your surgeons will not be using their block times. When future block time becomes available, contact other surgeons’ schedulers at least a month in advance to provide adequate time to arrange the appointment. “Unused OR time is like two-week old cheese rotting on the supermarket shelf,” says Rajiv Chopra of The C/N Group. “You have to find alternative surgeons to absorb unused time.”
5. Treat commodities as commodities
“We all have to think about the huge cost-price difference across the instrument, implant and device markets once you leave the United States,” says Chris Zorn, vice president of sales for Spine Surgical Innovation and executive director of Minimal Incision-Maximum Sight (MIMS) Institute. “Cost pressure is rapidly mounting. The question is how long can these huge cost-price differences be acceptable to the consumers of surgery service and the payors?”
6. Coordinate patient benefits to prevent claim denials
Coordination of benefits is as simple as making sure the patient’s primary, secondary and tertiary coverage — if applicable — are loaded correctly into the system, Mr. Flesner says. Many patients are unaware of which insurance plan is their primary and which is their secondary, and if you submit the claim to the wrong plan, you will receive an automatic denial.
He says when determining which parents’ coverage is the primary, some companies use the spouse with the birthday that falls earliest in the month — a fact that many patients are unaware of. “If mom was born in March and dad was born in February, they’re going to go with dad,” Ms. Rock says. “[Patients] are absolutely unaware and think they can pick and choose. If dad’s has a large deductible and mom has a $20 co-insurance, they think they can choose her plan as the primary, and that’s not how it works.”
Ms. Rock also warns ASCs to be careful of indicating an injury or illness is related to a motor vehicle accident. “There’s a spot on the claim that asks the provider if the injury or illness is related to a motor vehicle accident, and if you mark that box yes and you’re billing private insurance, you’re going to get a denial,” she says. “They’re going to want it to go to MVA first or at least want more information because if it looks like an injury, the private insurance is going to see if someone else is responsible for paying that bill.” In MVA cases, mark the claim form correctly and submit to the auto insurance first for any possible PIP benefits, Ms. Rock says. Only submit to the private insurance with a letter of exhaustion.
7. Improve staffing
Finally, ASCs should recruit an experienced and talented administrator and strong clinical lead to empower staff and ensure appropriate coverage for case volume. A best practice in this area also involves providing incentives for productivity and patient satisfaction to all levels of staff. “Staff has to know you have their back. You can’t run a great organization if you have high turnover,” says Robin Fowler, MD, founder of Interventional Management Services.