A Holistic Approach to Measuring ASC Performance

By Kent L. Jackson, PhD

If you want to evaluate the performance of your ASC but you're having trouble finding ways to measure it, the Ophthalmic Outpatient Surgery Society (OOSS) offers an annual survey designed by, and exclusively for, ophthalmic-oriented facilities. Last year, a total of 151 facilities participated, reporting clinical and financial results for all of 2009. Results for 2010 are now being reported with nearly 200 facilities participating, representing nearly 20% of all U.S. single-specialty centers and a sampling of multispecialty centers with a strong ophthalmic component.

Benchmarking is a powerful tool for initiating and sustaining performance improvements. Here's how one mid-sized facility describes the benefits of this year's survey: “Benchmarking allows us to compare our performance to other similar ASCs, and provides data to set realistic goals, improve performance.” Surgeon owners, clinical directors and managers and facilities administrators each have a stake in the process. Here is a sampling of survey highlights that demonstrate the kinds of information that can be measured and how each can be used to enhance the performance of your center.

Tracking case mix: How might the economy and other factors have an effect on the number and mix of cases performed? Is your case mix right for the market you're serving and to what extent is your case mix balancing your revenue and cost picture? Comparing 2009 year-end results with early results for 2010, the average number of cases is down only slightly, from 3829 in 2009 to 3776 cases in 2010. Note the increase in the number of retina cases reported so far (See Table 1).

Tracking cancellations: Cancellations on the same day of surgery can be costly to facilities and disruptive to patient care. OOSS began tracking cancellations at the request of participating facilities with the 2009 study and is seeing an uptick in the number of cancellations from early 2010 results. Comparing this year's benchmarking to last year, the average number of cancellations is showing an increase from 7.5 cancellations per 1000 ophthalmic cases in 2009 to 12.5 cancellations per 1000 in 2010.

The revenue picture: Early results indicate that average revenues measured by “net collections” are up slightly, from an average of $3.6 million in 2009 to an average of $3.9 million in 2010. Average net collections per patient case also appear to be up at just over $1000 this year. We're seeing very little change in payor source, however, when comparing 2010 with 2009 (See Table 2).

While facilities find it important to balance procedure and payor mixes to optimize the overall and per case revenue picture, equally important is the managing of receivables. For instance, aging analysis looks at accounts receivable and the number of days until payment is received to determine a healthy number of days for collectionOOSS tracks this data and provides facilities with valuable side-by-side comparisons (See Figure 1).

Figure 1. At year-end 2009, what was your average dollar amount for accounts receivable/aging?

Accounts receivable findings: Benchmarks for Accounts Receivable include Aging Analysis and Net Collections Ratio. Aging Analysis is the mean dollar amount for accounts receivable/aging by number of days divided by the mean dollar amount for all accounts receivable/aging. Net Collections Ratio (NCR) is the amount collected divided by the amount charged after adjustments. The mean NCR reflects the influence of substantial “carry over” of collections from the previous year reported by a few facilities. Note that mean accounts receivable for all facilities as reported for 2009 was generally within the healthy range, except for accounts receivable in excess of 120 days. The 2010 results are still be analyzed.

Quality measures: There are many ways to assess quality with OOSS benchmarking, for example, comparing the frequency of patient burns, infections, hospital admissions and readmissions, incorrect medications dispensed, or errors in side, site, patient, implant or procedure. Results per 1000 cases in ophthalmic-oriented facilities reveal a consistently low occurrence of these incidents when compared with other surgical settings. Equally important are other more general measures related to patient, surgeon and staff satisfaction. These, too, are included in the OOSS survey.

Figuring Out the Facts

This gives you a taste of the many measures you can use to evaluate the performance of your sur gery center. Tracking supply costs, people costs and facility costs are included, as well as clinical measures that address medical clearance practices and patient cycle time are additional examples. Benchmarking is an essential part of evaluating the performance of your ASC. Begin tracking these important financial and clinical pieces of the puzzle to ensure that you always have a com plete picture of your center's health, growth and future direction.

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Kent Jackson, PhD, is vice president of member research & development for the Outpatient Ophthalmic Surgery Society. He can be reached at kjackson@ooss.org.