As anyone who manages a facility knows, running a tight ship in the ASC is no easy feat. From scheduling surgery to staff management and retention to recruiting new surgeons and surgical cases, there are many factors that affect the success — or failure — of every surgical center.

Here, two industry experts explore four approaches that will not only help to avoid the common pitfalls of inefficiency, but will also help to improve overall operations and efficiency — and have your ASC sailing toward a successful future.

1. Avoid Swiss Cheese Scheduling

Do you have a good number of holes in your schedule? Scheduling is an area that isn’t reviewed often enough, says Maureen Waddle of BSM Consulting. It’s not uncommon for ASCs to fall into habits with surgeons who get used to block scheduling, but then don’t fill their blocked times.

Performing more cases in one day is always more cost-effective than spreading cases over multiple days, says Waddle. Filling holes in your schedule is one of the quickest ways to boost efficiency and, in turn, increase profitability. (For more information, see “Calculating and Controlling Case Costs,” page 6).

Of course, Waddle admits that making a change like this may require some finesse. Surgeons prefer their time blocked, and may be resistant to change. “I frequently see a situation where a doctor performs eight cases every Tuesday,” Waddle explains. “But the ASC would be better off from an efficiency standpoint having 16 cases every other Tuesday.”

“It takes some negotiating talent,” Waddle says. “But, the more you can batch your work, the better your efficiency will be. If you have enough surgeries to be open 5 days a week, that’s great, but in most cases, ophthalmic surgery centers don’t have that kind of volume. It’s better to have 20 cases in 2 days and be closed for 3 days than it is to spread five cases over 4 days.”

2. Reduce Turnover

Turnover isn’t just a hassle; it’s also incredibly costly, says Stephen C. Sheppard, CPA, COE, managing principal of Medical Consulting Group. “Recruiting new employees and training them can be really expensive,” he says. “That’s especially true in a small market where the people with the skill set you require are hard to find. Thus, preventing turnover is incredibly important.”

Sheppard says one way to reduce turnover is to pay careful and frequent attention to your payroll numbers. If you find that you’re paying a great deal of overtime, your staff may be in danger of burning out — which can lead to turnover.

One way to avoid turnover, suggests Waddle, is to put more emphasis on training and engagement. When employees are valued and feel like part of the team, they tend to be more committed and less likely to leave.

In general, Waddle says the turnover rate in the healthcare field tends to run high, and it’s not always because of pay. The salaries you’re paying might be just fine, but there is much more to it than that.

Working in an ASC can be a high-stress job, and in the ophthalmic world, it may not be accompanied by enough hours. You might be paying a great hourly rate, but simply not have enough hours to give. See tip #3 below for ways to increase volume, which should help boost staffing needs, as well.

3. Increase Surgical Volume

Recruiting additional case volume is the most obvious way to boost profitability, but it’s not always the simplest way. That’s because, in an ASC, you’re limited to what the surgeons who use your center are scheduling there. Therefore, says Waddle, there are essentially only two ways to increase volume: increase the number of cases coming from surgeons who already use your center, or recruit new surgeons to the facility.

The first question you should ask is whether any of your surgeons are performing procedures elsewhere that could be relocated to your ASC, as this is probably the easiest way to address volume, adds Sheppard.

“For example, if they’re not performing SLT laser surgeries at your ASC, could they be moved there for an additional stream of revenue?” Sheppard suggests. “Or if they’re only performing cataract surgery, but are performing other corneal procedures elsewhere, moving those procedures to your surgery center would make good business sense.”

Waddle adds that when surgeons from one practice all share and use only one ASC, then the ASC can support the marketing efforts of the practice to build surgical volume. But, it gets more complicated when various practices are using one center.

“A surgery center that hosts multiple practices must support each practice equally to help generate more cases,” Waddle says. “For these centers, one marketing tactic is to devise its own website that features educational materials about its procedures and a listing of the doctors who use the facility.”

Waddle says that improving the center’s customer service is probably the best way to encourage more volume. If the surgery process is smooth and easy, then surgeons will want to bring all of their cases there. This is especially important for surgeons who have multiple facilities from which to choose.

Finally, if you do choose to add other surgeons to your center, seek out those who are performing procedures you already offer, Waddle suggests. You’re already good at it, and it will require the least investment.

“Next, you can look for subspecialty procedures within ophthalmology followed by complimentary or similar specialties to fill in the blanks,” Waddle says. “For example, tapping pain management specialists to fill Fridays, an unpopular eye case day, also helps make a center more efficient.”

4. Don’t Be Afraid to Seek Help

There are any number of reasons why ASCs don’t turn to consultants for help or guidance but the difference between letting things carry on the way they are and receiving some much-needed assistance could be the difference between performing well and performing great. As Waddle says, it often comes down to the age-old adage that good is the enemy of great. More often than not, businesses get comfortable, so they fail to reach outside their comfort zone to examine how they could be doing better.

Assuming everything is running well, Waddle suggests that ASCs get a “check-up” every 5 years or so by an outside facilitator who can take a fresh look at the big picture to evaluate how efficiently the center is operating.

“An evaluation like this can be enough to help be more strategic in mapping future growth for the center,” Waddle says. “When you’re immersed in the everyday happenings, it’s hard to step back and get that big picture view of how things could be better. That’s where an outside facilitator can make a difference.”

Sheppard says he would advise ASCs to pose three questions when considering a consultation:

1. Do you need help?
2. Do you need outside help?
3. Does the consultant you are considering seem like the right help for your ASC?

He says that if the answer to any of those questions comes back as “no,” then you aren’t going to be receptive to change. To make changes for the better, there must first be that recognition that change is in fact needed.

“Sometimes, an ASC recognizes that it isn’t running as efficiently as it could be, but it’s a quality-of-life situation,” Sheppard says. “The perfect example is one surgeon operating out of two ORs. That may allow him to be done in 3 hours rather than 6 hours, but it’s certainly not the most efficient use of time or space. However, if that’s a lifestyle choice, and the efficiency factor is recognized, then that’s not a change that will likely be made.”

At the end of the day, Sheppard says any solution must be customized to the specific ASC. There is no one-size-fits-all approach.

“There simply isn’t one solution for every problem,” Sheppard adds. “There may be a conscious decision to forgo some profitability for quality of life — and that’s okay. The most important thing is that potential areas of improvement are at least recognized. Then the decision falls on that particular ASC to determine what works best. It’s when problems or potential areas for improvement are unconsciously overlooked that the biggest problems lie. Awareness is the first step on the path to real change.” ■