OASC | EDUCATION

Educating ASC Personnel

Learn about services that help ophthalmic staff broaden their clinical knowledge, improve customer service and stay current with changes in reimbursement and regulation.

By Erin Murphy, Contributing Editor

ASC personnel have the combined schooling, in-service training and on-the-job experience to prepare them for their daily tasks. But ophthalmic ASCs are constantly changing. Treatments and technologies are continually evolving. ASCs are always searching for ways to improve patient flow and deliver a better patient experience. Staff must also stay current on changing rules for coding, reimbursement and regulatory compliance.

These changes require additional education for personnel, which administrators and managers must provide in addition to their existing duties. Fortunately, there are resources and services available to help.

Education Made for Ophthalmic ASCs

General training and certification programs exist for ASC staff, but there is no ophthalmic-specific training available at this time, according to Albert Castillo, Member Services Consultant at the Outpatient Ophthalmic Surgery Society (OOSS; ooss.org).

“Front desk staff, medical assistants, scrub techs and RNs typically receive general training for working in an ASC or hospital. However, we’ve learned in our own ASC that while an employee may have the general skill set, title and education for the position, he has a good deal to learn before he can become proficient and productive in our ASC,” says Bruce Maller, President and CEO of BSM Consulting. “For example, scrub techs learn how to scrub for all cases and often have little experience with eyes. RNs are highly skilled but often don’t have specific training for the pace and variables that are inherent in ophthalmic surgery cases. These staff members need to acquire specific skill sets and knowledge of the eyes, including specialized terminology, the processes involved in ophthalmic surgery, how an ophthalmic OR flows and how to handle the emergencies that can arise during eye surgery. Right now, this training takes place on the job.”

Castillo and others at OOSS view the general lack of ophthalmic ASC-specific clinical training as an opportunity for the organization to create more courses. They are working on new educational offerings for the future.

Today, OOSS partners with the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) to offer operations-related courses for ASC nurses and managers at professional meetings. Classes cover topics such as financial education for nurses, business and clinical aspects of ASC efficiency and performance metrics (benchmarks).

Practice Management Online Education

BSM Consulting (bsmconsulting.com) has a large learning center portfolio that includes BSM Connection for Ophthalmology, an online training center accessed by approximately 75,000 ophthalmic personnel at 900 member practices each year. It includes a distance-learning center with more than 100 courses for front desk, back office and clinical staff. Students can obtain continuing education for Certified Ophthalmic Assistant and Certified Ophthalmic Technician credentials and complete credits approved by the Joint Commission on Allied Health Personnel in Ophthalmology. Opticians can obtain American Board of Opticianry credits as well.

“For years, the mission of our consulting company has been to put cost-effective education solutions right on the desktop of administrators, managers and staff. We’re proud of how extensive BSM’s product offerings are today,” Maller says.

Three years ago, BSM created a certification program for a Certified Patient Service Specialist (CPSS). Initially targeted to front desk staff, the program has expanded to include all ophthalmology personnel. It’s now open to everyone and co-promoted by the American Society of Ophthalmic Administrators.

With the CPSS offering, a stand-alone program from the BSM Connection subscription, students or employers pay a registration fee to begin. Students complete 19 study courses to prepare for the exam, with topics ranging from communicating with patients to handling phone interactions. They complete courses through a dedicated online portal. When students feel prepared, they take the CPSS exam. Recertification for the credential occurs every 3 years.

“For any practice that pledges exceptional service and strives toward a good patient experience, it’s a valuable program,” according to Maller. “It’s built to be very robust, with rigorous testing that ensures students fully understand the material. And it’s very inexpensive.”

BSM Consulting will be launching the CPSS program for the ASC during or near the dates of the annual AAO meeting in November in Las Vegas.

“OOSS asked us to develop a product for ophthalmic ASCs that would be focused specifically on the terminology and procedures with which staff should be familiar,” Maller says. “We’re very proud and excited to be introducing an ophthalmic ASC product.”

In conjunction with the launch of CPSS for the ASC, BSM will offer these five ASC courses in addition to the 19 courses currently offered for clinic personnel: Front Office Guide to ASC Safety; Advanced Directives and Elder Abuse: Annual Regulatory Training; Patient Rights: Annual Regulatory Training; Introduction to Infection Prevention and OR Medications; and Common Ophthalmic Surgeries.

Reimbursement and Coding E-learning

For an ophthalmic ASC to succeed, coding and reimbursement for the Centers for Medicare and Medicaid Services (CMS) have to be accurate and efficient. To that end, ASC personnel must be knowledgeable and current in this complex area.

“Medicare enrollment is more than 50 million. Because a great deal of money flows through this system, coding has become more complex, intense and challenging. Practices are concerned about compliance, and our job is to help them stay out of trouble,” says Kevin J. Corcoran, COE, CPC, CPMA, FNAO, President of Corcoran Consulting Group (corcoranccg.com).

Corcoran Consulting has specialized in ophthalmology and optometry coding and reimbursement for 30 years. Corcoran and his team provide training at conferences, symposia and workshops and via in-service sessions. The company offers an online subscription service as well.

“About 50% of our students are billing and coding staff, followed by about 25% technicians, nurses and scribes — anyone who writes in the medical record and selects codes. The remaining students are doctors and administrators in charge of revenue, liability and legal disputes,” explains Corcoran. “All of these people are busy. We provide ways for them to learn based on their needs, whether that’s fast and easy or an in-depth course. For example, if someone has a question about coding and reimbursement for complex cataract surgery, she can read about it in our FAQs and monograph library or complete distance learning on the subject through our website.”

In addition to being difficult to decipher, coding and reimbursement rules also change periodically, which means staff members need ongoing training. Corcoran works to make that process easier for ASCs. “Every time a code changes, folks have to re-learn the process, and nobody likes to do that. Busy staff members want someone who understands the new changes to lay out what those changes mean to them. That’s what we do.

“In fact, we’ve been doing that for some time with ICD-10, the tenth edition of the World Health Organization’s International Classification of Diseases, which CMS will implement in October,” he continues. “The clock is ticking, and although we’ve been educating people about ICD-10 for more than a year, we will probably continue to do so through early 2016.”

Regulatory Compliance In-service

Regulatory compliance is another key area for staff education in the ophthalmic ASC. Debra Stinchcomb, a consultant at Progressive Surgical Solutions (progressivesurgicalsolutions.com), helps educate ASC staff and makes them feel confident that their facilities are compliant.

“We work in surgery centers from the ground up — from accreditation survey assistance to helping with manuals and human resources — everything that ASCs need to have in place for compliance,” she explains. “Part of our role in an ophthalmic ASC is to translate general CMS rules into actions that can be enforced in the ophthalmology setting. The CMS rules apply to all specialties — sterilization, OR turnover and so on — but we develop policies for ophthalmology that fit the specialty’s instruments, equipment and pre- and postoperative processes.

“For example, if an ASC adds a femtosecond laser, staff need in-service training on the equipment. Administrators have to ensure that staff members understand the new technology and how it pertains to their roles and duties, such as what they should expect during surgery and in postoperative care.”

When a new center opens or an ASC hires new employees or adds new services, consultants at Progressive Surgical Solutions provide orientation for regulatory compliance. They help ASC staff prepare for accreditation, state licensing and CMS certification and help implement plans of correction. When they evaluate a center’s efficiency or business operations, they train staff to implement the recommended changes. In addition, they help confirm ASC staff’s competencies.

“The ASC is required to give staff a list of competencies in writing and observe them using those competencies — often annually. As a simple example, can a nurse use a glucometer in pre-op? Certainly the nurse has learned this in school, but the ASC has to observe the competency to confirm it. We ensure that this observation and confirmation take place,” says Stinchcomb.

In addition to in-service training, Progressive Surgical Solutions created the Progressive eSupport service line to pull together ASC compliance, consultation and continuing education into a single subscription. According to Stinchcomb, “To help subscribers stay current on compliance issues, eSupport has modules for every in-service need. Managers can have staff view the modules and answer questions to show they’ve learned the material. eSupport also offers continuing education units for registered nurses.”

Pulling It All Together

With so many resources and services available to help educate personnel, an ophthalmic ASC’s choices will likely depend on its individual situation. Managers might feel confident that they’ve verified the competencies of a dozen staff members, but are managers confident performing the same verification at ASCs with staff five times that size? Or managers may feel very comfortable with clinical training but less confident about understanding all the regulatory or compliance issues.

No matter what the situation is, the myriad options available today means that when it comes to staff education, administrators and managers at ophthalmic ASCs can find a great deal of help to meet their needs. ■