Enhancing ASC Management and Growth

Satisfied surgeons and an efficient center equal maximum profits. Here's how you can use technology to make it happen.

Mr. Sheppard: Let's discuss the impact of technology and the center itself — the equipment and disposables — on recruiting and retaining your medical staff.

Recruiting and Retaining Surgeons

Mr. Sheppard: One of my clients bought a particular phacoemulsifier that was widely used in his area, hoping to attract surgeons to his facility. This ties into our discussion of technology and cost control, but I want to know what strategies you're using to attract and keep surgeons.

Ms. Acker: To succeed, you must think of surgeons as your customers. Without your surgeons, you have no patients. Technology is important to surgeons, so you have to have quality, efficient devices that make good use of their time. And as an administrator, you have to be responsive to surgeons' issues, requests or complaints. In short, you have to be responsive to their needs, and you have to provide the best technology that you can to get them into your facility and keep them in your facility.

Mr. Sheffler: I agree that investing in technology is important. I also think you need to pay attention to the doctors' needs. Not only should you help them in the surgery center but also in their offices. For example, we've held training sessions in their offices to help surgical coordinators do their jobs more efficiently. This type of outreach makes things easier for the doctors, because they're trying to manage their businesses and treat patients at the same time. If you can take some of the business problems out of the doctors' hands, they'll be more likely to use your facility.

To succeed, you must think of surgeons as your customers. Without your surgeons, you have no patients. Technology is important to surgeons, so you have to have quality, efficient devices that make good use of their time. — Margaret G. Acker, R.N., M.S.N.

Reimbursement Changes

Mr. Sheppard: How should ASCs prepare for the Medicare reimbursement changes?

Ms. Steigerwald: Each practice must carefully review the list of separately payable items. It's a simple spreadsheet, so it's easy to manipulate the list. Coders should mark any items that they might use for any reason.

Many people aren't doing that, and they're going to lose money on drugs, imaging and other billable items. ASC coders and billers aren't used to doing this billing, so they need to work with the clinical staff to note the items that must be billed on the charts.

Mr. Sheppard: Can you clarify where ASCs stand now in terms of purchasing and supplying products for intravitreal injection, for example, drugs used for treating age-related macular degeneration, such as ranibizumab (Lucentis, Genentech) and photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis Ophthalmics)? There was a time when the physicians and hospitals could get reimbursed for these drugs, but ASCs could not.

Ms. Steigerwald: Yes, these drugs weren't on the approved lists for ASCs. They will be now, and they're definitely separate line items. They're quite expensive, so if there's no method in place to make sure that they are billed, the ASCs doing those procedures are going to be in trouble very fast.

Ms. Harmer: Billing intravitreal injections will be a major issue, because this will be a totally different methodology for ASCs. We've been used to flat-fee billing for facility fees for so long, so it will be very easy for people to miss billable costs.

Ms. Steigerwald: Unfortunately, many will miss these charges. Recently, I spoke to a group of 43 medical professionals, and only one was aware that these changes were coming. After the presentation, no one was asking questions, so I thought they understood it. Later, they told me that they were so overwhelmed, they didn't even know what to ask.

Watching Your Carriers

Mr. Sheppard: Has anybody heard anything from the carriers about the Medicare changes? My concern all along has been that most of our carriers — both Medicare and commercial carriers — have been focused on nine payment groups for ASCs. Now they have hundreds. Obviously, they need to make some massive software changes in their payment structures to be ready for us.

Ms. Steigerwald: We have to keep a very close eye on how those claims are paid. When the aspheric IOL became available, I believe it took 4 months between approval for billing and actual delivery of payment, because the CMS carrier software wasn't set up to handle the Q1003 code. And because it's a device and not a procedure, the billing staff wasn't supposed to put a modifier on the code like they do with a procedure, but some did. So, even when the CMS carrier paid, the facilities found that they'd made that billing error. This transition won't be any easier. We'll see some errors, and everyone — the facilities and the carriers — will make the transition over time.

Keep Your ASC Growing

Mr. Sheppard: We've talked about time and technology investments. What about staffing? Can staffing choices make a difference to the surgeons?

Ms. Harmer: As I developed surgical centers, I made sure that I had the best possible staff member as my scheduling person, and I put serious investment into that employee because he or she would be communicating with the offices from which I planned to derive my business. On day one, you have to look like you've been in business for 2 years. You've got to deliver the goods, and your scheduling person is key.

The scheduler knew more information than I could ever know in my role as administrator or nursing supervisor, and she was my gold mine. Her job was to keep me whole, quite frankly, and to inform me about any problems if anyone in the offices weren't happy. It's a very important position in every facility.

Ms. Acker: Speaking of schedulers, I think it's also wise to court the surgeon's schedulers. I know them all, and I visit them every month or so. You want to form positive relationships, and visiting and interacting with them usually works. OM