OASC | BUSINESS

Tools and Tactics to Help Boost ASC Performance

Ophthalmic ASC experts share tricks of the trade.

By Diane Donofrio Angelucci, Contributing Editor

In an era of shrinking reimbursements and rising costs, enhancing efficiency in the ophthalmic ASC has never been more important.

To heighten performance, ASCs need to analyze and fine-tune every facet of operations, including staff productivity and training, OR downtime, documentation and resource management.

Here’s what experts suggest to keep your ASC operating at peak performance.

Enhancing the ASC Culture

Personnel is a major focus when boosting efficiency. “For the vast majority of surgery centers, the staff represents in the range of 20% to 25% of the operating revenue of the center. Some more, some less, but it’s a significant line item,” says Bruce Maller, president, BSM Consulting.

Therefore, increasing staff productivity is key, and Maller says it doesn’t just happen accidentally. “The center owners have to focus on creating a culture that encourages staff members to want to stay, to want to work harder and smarter and to achieve greater efficiency in terms of better management of staff resources.” This requires a strong leadership and management team and an incentive program tied to specific productivity metrics that may also motivate staff, he says.

To maximize efficiency, American SurgiSite Centers, with headquarters in Somerset, N.J., standardize nursing practices in all eight locations. “Our expertise is to get the optimum routine that creates the greatest efficiency and the least amount of turnover time from a nursing standpoint,” says Louis Sheffler, COO of the company.

Training plays a vital role in this strategy. “It’s very important that everyone does everything the same way. If you don’t do it the same way, you run the risk of safety issues,” Sheffler says. When they’re hired, nurses often have varying skill sets. To standardize performance, the company provides the nurses with specific training on the ophthalmic procedures that are performed at their centers.

Driving Revenue

Increasing profits can be achieved by developing new revenue sources and/or by decreasing the number of resources you are currently utilizing, Maller says. “In a surgery center, once you meet your fixed costs, you can achieve significant margin improvement as you add incremental volume,” Maller says. Therefore, an ASC’s business plan needs to focus on increasing the number of cases — which may result from increasing patient volume within a medical practice or attracting surgeons to the ASC who can bring the right mix of cases to the center, he says.

“If I were driving, or trying to improve, efficiency on the revenue side, I’d be evaluating all of the third-party contracts the center has,” Maller says. “Most centers don’t proactively manage their insurance contracts or HMO and PPO contracts. I’d perform a baseline assessment of all of the center’s existing third-party managed care contracts, evaluating exactly what they’re getting paid or reimbursed for on the most commonly performed procedures, and I’d be more proactive about negotiating better payment rates on contracts whenever possible.”

Analyzing Time Expenditures

Technology plays an important role in boosting time management in the ASC, particularly electronic medical records (EMRs).

“You want to use your EMR to evaluate how time is utilized — if surgeons are starting on time, how long it’s taking them to complete a case, what supplies they’re using, how much they’re spending on surgical supplies per case, and so on,” Sheffler says. “It’s an easy way to help you analyze your business.”

American SurgiSite surgeons use the iMedicWare EMR system. “On the EMR system, the surgeon’s office staff book their cases on our system in their office. As they’re booking them, we know how filled our schedule has to be and how many people we need for the day to perform the surgery,” he says.

With a continued eye on quality of care, Bernadette Santana, RN, BSN, nursing administrator of the Somerset Eye Institute, PC, an American SurgiSite Center, uses EMRs to keep track of surgery times so the center can appropriately schedule patient arrivals, preventing patients from staying at the center longer than necessary. Based on surgeon history, she can determine how much time to allow for preoperative assessments.

Santana explains that after a medical office schedules the patient’s surgery, she can access charts in the ASC even a month before the procedure to check a patient’s medical clearance, make arrangements for special equipment or supplies, or make sure the patient’s procedure can even be performed at an ASC, increasing surgery day efficiency.

Furthermore, EMR systems help ASCs pinpoint trends and readjust block scheduling as needed. “Interestingly, in the Northeast, cataract surgery is a seasonal business, and what we found out is that the last quarter of the year is our busiest,” Sheffler says. “It’s because people have paid all of their insurance deductibles. It’s toward the end of the year and getting near the holidays and they want to get their eyes taken care of.”

In addition, Santana says she uses the iMedicWare system to view the surgical schedule and identify gaps where she can schedule emergency procedures or provide extra time for surgeons who may need it.

Santana also uses the system to help plan the order of cases to improve time management. Quicker cases like cataract surgery are scheduled first, and the longer cases such as glaucoma or retina procedures — which require less staff — are done at the end of the day. This increases the efficiency of the OR and eliminates the need for a full staff for cases that don’t require it, she says.

Streamlining Data Needs

The iMedicWare EMR system also allows users to access data quickly. When patients return for treatment of their second eye, Santana says, staff can access their charts from several years ago. “The information is accessible with a click, allowing for continuity of patient care,” she says.

Staff members also can use EMR systems to run reports on various aspects of the visits. For example, the staff can look up the average length of surgical procedures, time in and out of the center, number of specific implants used, cases per month or year, hospital transfers, as well as other types of data. “There are various required reports I can run from our EMR program, and this helps with efficiency and allows for better time management. I’m not sifting through piles of paperwork to generate reports,” Santana says.

Practices rely on other EMR systems such as the Medflow EMR system. In the clinic, Medflow can use its separate installation and database in the ASC, which meets the requirements of the Centers for Medicare and Medicaid Services (CMS) for separate charts, says Jim Messier, vice president of sales and marketing for Medflow, Inc., Charlotte, N.C.

Surgical staff can perform a one-time push of health history information recorded in the clinic to the ASC for a starting point as they begin the interview. “EMR in the ASC is an efficient and great way of being able to accumulate a great deal of information — which is very similar from procedure to procedure — efficiently, quickly and accurately. The system, through predefined templates, can mandate what needs to be done by nursing, by anesthesiology; and by following a predefined workflow, it can ensure regulatory guidelines are met and G codes are created from a CMS prospective,” Messier says.

Two staff members in the ASC are able to document information at the same time, such as a certified registered nurse anesthetist and preoperative nurse, Messier explains, and then the circulating nurse picks up from there when the patient moves to the OR. “Most of our installations have large 42- to 46-inch monitors hanging within the OR, which provides convenience for both the scrub nurse and physician as they can be looking at certain data elements brought up by the circulating nurse, like IOL Master, corneal topography, Pentacam, toric lens calculations, and limbal relaxing incision calculations.” Nursing staff also can use the system to scan the bar codes of supplies used during the procedure. The nursing staff also auto-creates the operative note using the Medflow system, Messier says, reducing the surgeon’s documentation time in the ASC.

In an EMR system that is fully integrated with the clinical EMR, staff members have the ability to generate outcome analyses and surgical complications reports with ease and efficiency, in comparison with what they need to do with paper. “The ability to pass information directly from your EMR in your clinic to the ASC EMR and vice versa allows you to easily compare data between the two charts, track post-op visual acuities, intraocular pressure, and any refractive information to help improve surgical outcomes,” says Heather Bush, product manager for ophthalmic products for Compulink Business Systems. “Doing this on paper is obviously laborious in pulling charts, flipping through charts, and trying to find the data to enter into spreadsheets. With a fully integrated ASC EMR in your clinic, your staff will be able to run these types of reports much more efficiently.”

Depending on the EMR system, Bush says staff can perform structured data mining of any type. Furthermore, for audit purposes, all records are time and date stamped with the staff members who are logged in, and the system identifies documentation errors if records aren’t stamped or staff members don’t sign off on records.

Improving Patient Care and Tracking Resources

As well as investing in the right technology to streamline time management, ASCs need the right accounting and payroll systems to increase efficiency in those areas.

Sheffler explains that American SurgiSite uses the ACCPAC accounting system by Sage and electronic bar-coded inventory tracking by Accelos to manage its supplies. “A surgery center uses a ton of supplies, and we actually spend more money on supplies than we do on personnel,” Sheffler says.

To manage its payroll, the company uses ADP Payroll Services. “They have analytics on how much time and overtime you have,” Sheffler says. “All of these electronic systems make running the business much easier.”

Effective and Efficient

In the current healthcare environment, ASCs need to focus on the strategies and technologies that will help them detect areas for improvement and increase performance.

“If you don’t have the tools, you won’t be able to do the job effectively,” Sheffler says. ■