Efficiency means more than cost per case

November 15, 2009

To a busy ophthalmologist, time is a valuable commodity, and with proposed Mediare cuts looming, it is a daily focus and concern.

We hear it frequently these days: A physician makes a claim that he or she can be more productive and profitable spending quality time with patients in the office rather than operating at an inefficient surgical center or hospital outpatient department (HOPD). To a busy ophthalmologist, time is a valuable commodity, and with proposed Medicare cuts looming, it is a daily focus and concern.

What is most astonishing about this statement is that there still are some ambulatory surgery centers (ASCs) that are not as focused as they should be on operational efficiencies. Our objective is to shed light where efficiencies can be improved upon but may not always be top of mind when it comes to managing the bottom line.

1 Scheduling. It is important to identify one member of the ASC staff who will have overall responsibility for scheduling. In centers where the attending surgeon staff is limited to a principal owner and perhaps 3 to 5 additional surgeons, the task can be performed by a staffer cross-trained in other areas.

Occasionally, there may be a tug of war regarding the schedule. A good way to resolve scheduling conflicts between surgeons when they do occur is to have the conflict resolved at the level of the governing board. A resolution that is adjudicated by the peers of the surgeons involved will be much more readily accepted.

Scheduling effectively also means that the clinical director or nurse supervisor needs to know about each surgeon's surgical preferences and skill sets in the operating room. A tough subject for sure, especially when scheduling block time or trying to get the fastest, most efficient surgeons in the prime operating spots.

2 Staffing. The importance of having an experienced, full-time core staff cannot be understated. It is what your surgeons will come to rely on. However, maintaining an adequate list of per diem staff in all job categories is important to cover the regular days off, vacation time, and sick calls of the full-time staff. Per diem employees often can be recruited from local hospitals and do not command benefits.

Flexible scheduling also is a valuable tool-not only for the facility that is not yet fully utilized, but also for the mature ASC where staffing needs may not always require the traditional 40-hour-per-week employee. And let's not forget the importance of cross-training all staff.

Also, don't feel that you need to bring on nurses, operating room techs, or allied personnel with a ton of experience. Don't rule out hiring someone who is eager to learn but may not have the traditional ophthalmic background. You'll have an opportunity to train and mold these employees for the best fit for your ASC.

3 What to do during downtime? In a busy surgery center, downtime is a very valuable commodity, but can be abused and/or mismanaged. Efficient and important use of that time should include staff meetings, in-service training, quality assurance chart reviews, and fire and disaster drills. Have a quarterly calendar of events that either are scheduled or will be scheduled during your facilities "down time." It will keep you organized and make sure that you are fully utilizing the staff's time as well as complying with state and federal regulations.

Mandatory in-services cannot be overlooked and, therefore, need to be on the schedule yearly. Many resources, such as DVDs, are available to satisfy these requirements. Many centers will enlist the support of contracted consultants to complete mandatory and other in-services. For those who retain the services of outside consultants (social workers, pharmacists, medical records, and OSHA), be certain that their contracts require them to provide such training.

4 Attracting good physicians. Although owner-surgeons typically command premium start times at their ASCs, it may make more sense to make accommodations for efficient outside surgeons with sufficient surgical volumes. Non-owner physicians (and their patients) must feel welcome in the center and not feel as if they are second-class citizens.

One of the most powerful recruitment tools has two key components: happy patients and happy surgeons. The overall service provided to both patients and surgeons by your staff should be exceptional at all times. Exceptional patient care and clinical outcomes in an efficiently run and friendly ASC is a powerful recruitment tool.

If you have shown that you manage downtime well and you have consistent volume, your ASC probably will be much more attractive than a hospital setting, which traditionally may receive poor marks on patient throughput, convenience, and friendliness. This not only goes for operating surgeons but for anesthesia professionals.

They are important members of the team and also are looking to maximize productivity. ASCs represent an excellent working environment for anesthesiologists. Recruiting a team of anesthesia professionals with a temperament and personality that is aligned with that of the center is not easy. Managing patients who are elderly is a particularly difficult skill. Be certain that this individual or group has both the clinical skills and the personality to match that of your center.