SUCCESS IN THE ASC

PART 2 IN A SERIES

It was 2014 when the Cincinnati Eye Institute (CEI), founded in 1945 and one of the largest private regional ophthalmic ambulatory surgery centers (ASCs) in the United Sates, reached a major milestone.

“We just couldn’t do any more cases in that facility,” says Todd Albertz, vice president of surgical and specialty services at CEI, based in Blue Ash, OH. “We were already running Saturday surgeries for a number of years to accommodate the volume of some of our specialties.”

The Institute has since joined a private equity group, which formed CVP Physicians, and today it owns four ASCs of its own and manages two others in the Midwest region of CVP. All told, CEI’s own surgery centers perform more than 25,000 eye surgery and laser procedures each year (see sidebar).

Albertz credits CEI’s growth largely to the same consistency that has helped franchise-based companies like Starbucks to scale their way to success: Consistency of layout. Consistency of technology. Consistency of personnel development and patient care.

Consistent Approach to Layout

Take the floor plan of each CEI surgery location. Using its Blue Ash, OH, location—at seven operating rooms its largest ASC—as a template, CEI has sought to replicate the ASC’s layout at its other three surgery centers in and around the Cincinnati area.

“The philosophy behind it is that, as we have staffing needs at different facilities, we can reallocate staff from one facility to the other, and they feel perfectly comfortable because it’s almost an identical model to where they normally work,” Albertz says. “It’s the same for our providers. When they’re in the OR, they feel like they could be in the OR at any one of four different facilities.”

Consistent Approach to Technology

The Institute takes a similar approach to technology. For example, all surgery centers are linked via the same electronic medical record (EMR) system. This enables Albertz and his team of administrators to log into any individual facility’s EMR system.

“It gives me the ability to, from one location, go into any surgery center’s EMR to conduct audits, look at patient flows, and look at specific things within the EMR system, because we’ve created this consistency across all of the centers,” he explains.

The same is true of with respect to each ASC’s clinical and surgical instrumentation. A retina surgeon traveling from one ASC to another that offers the same procedures, for instance, can be assured of having identical instrumentation and equipment on hand. The same is true for CEI’s refractive specialists.

This level of uniformity also permits careful management of CEI’s capital budget. Albertz says CEI has a “very deliberate” budgeting process involving not only its budget committee, but also its medical advisory board of nursing managers and medical directors from each ASC, as well as one surgeon from each subspecialty.

“Because we have become so large, we can’t just change microscope vendors on a whim. That would be a massive investment for a network like ours,” he says.

“We have several hundred policies and procedures, and they run the gamut from how we handle patient check-in to how we clean instruments and maintain sterility in the OR,” he notes.

Budget management is also required to help CEI to roll with the financial punches of almost continuous changes in state and federal healthcare regulations governing virtually every aspect of ASC operation.

Observing that 80% of CEI’s procedure volume consists of cataract surgeries, he explains that these patients are typically older than 65 and on Medicare.

“The challenge is to maintain a profitable surgery center while working through cuts and adjustments to the payment system that can impact the two biggest variable costs in operating an ASC: materials and labor,” he says.

Consistent Approach to Staff Development

CEI’s emphasis on consistency includes its network-wide polices on staff training and development. Albertz says every ASC manager always starts on the ground floor and climbs through the ranks.

“Our director of nursing, who’s been working with me for 12-plus years, started as a clinical tech, moved to the ASC as a scrub tech, became a nurse, was promoted to charge nurse and then to assistant director of nursing, and now is director of nursing,” he says. “We’ve had that same kind of progression through our entire leadership team over the years.”

This promote-from-within philos-ophy has served CEI incredibly well, Albertz adds.

“It’s a huge benefit for staff because they know they can grow. Also, everyone who comes through our leadership team and then moves out to one of our satellite surgery centers takes what they learned regarding patient care, policies and procedures, and overall management to the other surgery centers. That culture of our regional facility is then instilled in that smaller facility.”

Consistent Success

In terms of measuring its surgery centers’ performance against other ASCs, CEI relies on criteria and data supplied by the Ophthalmic Outpatient Surgical Society (OOSS). The OOSS benchmarks a variety of factors within ASC operations, including patient safety, staff salaries, and cost per case—all based on surveys completed by its member surgery centers.

“OOSS shares the data, so we’re able to see how our ASC compares to others,” says Albertz, who reiterates his view that the focus on consistency provides the foundation for CEI’s high standing in the markets served by its ASCs.

“We pride ourselves on having the ability to look at the landscape and its demand for ophthalmology services, and bring that to the community,” he says. “We want to be everybody’s resource for taking care of their ophthalmology needs.

“It is almost like establishing a franchise,” he observes.

Starbucks would be impressed. ■