As simple as many want to make it, the business of running a successful ASC is complicated. There are numerous systems, processes, and strategies that a center must implement to achieve success. As with any market-driven industry, an ASC's ability to meet certain goals will determine whether it succeeds or fails.Increased government regulation and scrutiny continue to challenge healthcare providers. In this demanding era, ASC providers must establish and maintain operations that comply with all licensing and regulatory requirements while providing high-quality care in accordance with the principles of professional practice and ethical conduct. The following is a checklist of actions ASC owners may use to ensure they meet these goals.
o Have you developed and implemented Policy and Procedures that ensure the orderly and efficient management of your organization?o Does your governing body annually review your Policy and Procedures?
o Do you provide a History and Physical for every patient prior to surgery, and does it include a list of current medications and dosages, physical examination, and pertinent preoperative diagnostic studies?
o Do you obtain an informed consent from each patient before performing an operation? Does this document explain the necessity or appropriateness of the proposed surgery as well as mention any available alternative treatment techniques?
o Except when otherwise required by law, do you treat the medical or any other record that contains clinical, social, financial, or other patient data as confidential and protected from unauthorized or inadvertent disclosure?
o Does your center comply with federal and state laws and regulations regarding the protection of your employees' health, and does it provide for appropriate occupational health services for those employees?
o Does you center comply with all applicable state and local building codes and regulations?
o Have you implemented policies that comply with the Occupational Safety and Health Administration rules on Occupational Exposure to Blood Borne Pathogens?
o Have you established a mechanism to fulfill all applicable obligations under local, state, and federal laws and regulations such as the Americans with Disabilities Act, Health Insurance Portability and Accountability Act, Fraud and Abuse, and Self-Referral?
MEASURING CLINICAL OUTCOMES
Underlying all measures of an ASC's success is its surgeons' good clinical outcomes. Systems must be in place to evaluate your ability to achieve and demonstrate good clinical outcomes. To this end, your ASC must ascertain the following:
o Have you established protocols for instructing patients in self-care after surgery, including written instructions to be given to patients who receive regional and general anesthesia?
o Do you appropriately train registered nurses and other personnel who assist in the provision of services for the surgical care given?
o Do you maintain an active, integrated, and organized process of peer review as part of your peer-based quality management and improvement program?
o Does your quality improvement program address clinical, administrative, and cost-of-care issues, as well as actual patient outcomes (results of care)?
o Do you maintain a program of risk management appropriate to the organization that is designed to protect the life and welfare of patients and employees?
o Does your center's risk management program include reporting, reviewing, and follow-up of all incidents involving patients and employees?
o Does your ASC's governing body have specific criteria for the credentialing and recredentialing of practitioners?
o Does the medical staff application provide sufficient evidence of training, experience, and current documented competence in the performance of the procedures for which privileges are requested?
o Does your ASC have the necessary personnel, equipment, and procedures to handle medical and other emergencies that may arise in connection with services sought or provided?
CONTROLLING EXPENSES
In an era of fixed or reduced revenues, providers must increase their efforts to reduce overhead and devise strategies to achieve solid financial performance. As with any business, you need to understand your costs in order to manage your financial performance. The key is to identify and carefully manage those expenses that can be reduced without compromising the quality of care. Simple expense-control measures can maximize your ASC's cash flow.
o Do you have a person responsible for managing materials who is educated, trained, and motivated to meet the needs of the center?
o Do you purchase supplies through a group buying contract to obtain volume discounts?
o Does your ASC have an established basic inventory of necessary supplies based on the types of procedures performed and physicians' preferences?
o Is there a system in place to update the item master list and preference cards for the efficient use of supplies and inventory control?
o Have you established and maintained par levels for supplies based on the volume and specialty of the procedures provided?
o Do you have a system in place to rotate stock and remove unused items in order to avoid outdated and wasted materials?
o Does a system exist to review OR schedules for any special nonstocked supplies or equipment in order to prevent surgical cancellations and/or overnight shipping charges?
o Do you conduct supply-cost comparisons on a regular basis to ensure the best pricing and use of materials?
o Do you employ reusable versus disposable supplies?
o Do you evaluate new products prior to adding them to the inventory?
o Do you have in place a system to track and follow up on surgery cancellations?
o Have you established a goal and system for measuring the percentage of salary, wages, and benefits expenses versus net revenues?
o Do you track and evaluate downtime in your ORs?
o Do you evaluate and update your fee schedule on a regular basis?
o Is a system in place to ensure appropriate charges are captured and billed?
o Do you bill the insurance company within 48 hours of the date of surgery?
o Are billing statements mailed weekly?
o Do patients receive a preoperative call notifying them of any copay responsibilities?
o Do you perform insurance follow-up within 21 days of filing?
o Do you review your accounts receivable weekly to meet established benchmarks?
o Have you implemented a denial and rebill log and process?
o Do you perform bad debt write-offs according to policy?
CUSTOMER SERVICE AND SATISFACTION
The healthcare environment is forever changing, and today's healthcare consumers expect a high level of customer-specific services. The baby boomer generation holds much higher service-level expectations and needs than their parents did. In order to stay competitive in today's consumer-savvy marketplace, you can take some simple but effective steps toward improving customer service and patient satisfaction.
o Does your staff have the necessary training and skills to deliver patient care in a professional and personable manner?
o Do you give every patient the opportunity to provide feedback and suggestions regarding his surgical experience via a questionnaire?
o Do you have a process by which to follow up on patients' complaints?
o Do you contact every patient postoperatively to assess and follow up on his recovery?
IN CLOSING
Having a strong, well-managed organization can drive quality outcomes while controlling expenses in ways that result in increased patient satisfaction, cash flow, and profitability.
However, both quality of care and operational efficiency are strongly influenced by the number and types of procedures performed in the ASC. Keep this fact in mind when conducting an operational evaluation and assessment of your facility. How you assess your ASC's performance and what it needs to continue to thrive will ultimately become a key factor in its success.
Denise Mayhew is Vice President of Strategic Development with Nueterra Healthcare Company (formerly the ASC Group) in Shawnee Mission, Kansas. Ms. Mayhew may be reached at (913) 685-2111; dmayhew@nueterra.com.
