6 Things to Know About Running a Successful ASC

- December 01, 2014 -

Did you know that 50% of Ambulatory Surgery Centers (ASCs) ultimately fail?

The efficiency benefits of ASCs are well known, but they’re still remarkable: Procedures at an ASC take significantly less operative time, while still managing to produce better outcomes [PDF]. And ASCs deliver consistently first-rate care: A 2009 study found that outpatient surgery performed at an ASC was generally superior to the same surgery at a hospital. The ASCs studied had 0 unexpected safety events, compared to 9 for hospitals; patient satisfaction was similar; and differences in timeliness approached 30 percent.

These kinds of results don’t just magically materialize, however. They’re the result of careful thought - and diligent work - by adept healthcare professionals. There are many challenges, financial and practical, associated with running an ASC.

Don’t be on the losing side of the coin flip. Take these 6 pointers to heart and it’ll help you land on heads:

1. Have a Plan for Infection Prevention

In 2007, an ASC in Las Vegas caused an outbreak of Hepatitis C by reusing single-use medication vials [PDF]. The State of Nevada responded by auditing all 51 ASCs in the state, and found that 28 centers had lapses in infection control. Other states took Nevada’s lead and decided to audit their centers, and the findings were similar. The Centers for Medicare and Medicaid (CMS) now require a 5-point audit for all ASCs [PDF], and centers that don’t fix their problems risk termination.

ASCs don’t always have the same kind of dedicated infection-control staff that hospitals do. So it’s even more important to be conscientious. Make sure you’re using best practices for infection prevention, and train your staff appropriately.

2. When Bringing in New Practice Areas, Renegotiate Your Existing Contracts

Suppose you run an ophthalmology center, but are considering bringing in new physicians to do gastroenterology. Of course, they’ll need equipment and supplies of their own, and will bring with them new contracts. However, bringing in a new specialty is also the perfect occasion to consider renegotiating with your existing payers. Adding a line of specialty can give you more leverage in negotiation, but it can also mean additional costs. According to Luke Lambert, CEO of ASCOA, the prices on your other contracts will have a big effect on whether you’re able to integrate the new practice area.

3. Adopt an “Upfront Communication” Approach to Billing

For one reason or another, patients who don’t pay their medical bills upfront tend to pay them very late – or, sorry to say, not at all. Perhaps they’re struggling financially, and have had to prioritize monthly expenses over medical debt. Whatever the reason, having a large balance of accounts receivable is tough for the ASC as a business. Despite these facts, many ASCs still default to using the “Bill Me Later” system with patients.

There’s a better approach. Get in touch with your patients beforehand – call them a few days before the procedure and discuss payment arrangements over the phone. There’s no need to embarrass anyone by demanding payment at the front desk. Patients are people – get them on the line and have a conversation about how they’re going to handle it.

4. Experiment with Creative Scheduling

Setting staff schedules for an ASC presents unique opportunities for creative thinking and requires people to be flexible. Many ASCs have found that seeing a high volume of cases on just a few days a week [PDF] is the best way to allocate time. However, patient volumes vary from week to week. It may not make sense to bring in your clinical staff every day. And it may not make sense to be rigid about how much work each person will have to do every week. On days with few patients, see if you get by with a skeleton crew. In times when you’re trying to handle many cases in a single day, it’s all hands on deck. Change things up – and find people with the flexibility to handle those changes – so you can figure out what works best.

5. Avoid Simple Billing Mistakes

This point may seem obvious, but is the cause of many a headache. Managing the ever-changing volume of CPT codes and insurance requirements [PDF] can be challenging, so it’s important to have staff who are well-trained and up-to-date. Even simple mistakes, like the ID number or date of birth, can lead to automatic denials of payment. And coverage errors – like loading patient benefits into your system incorrectly – can mean you don’t get as much as you’re entitled to. Paying attention to the nitty-gritty can yield big dividends.

6. Be Serious about Regulatory Compliance

ASCs are like miniature hospitals. So it’s not surprising that they’re regulated that way. According to CMS regulations, ASCs “must have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the ASC's total operation.” The governing body has to implement quality assurance, the infection control program, manage surgeon credentials, and guarantee peer review. In addition, ASCs have to comply with OSHA regulations and state anti-kickback statutes [PDF].

These matters are serious and require serious attention. Even if it means seeing fewer patients, it’s worth taking the time to ensure that your business is fully compliant: it’s your reputation and your livelihood, after all.

With contribution by Vadim Yesilevsky of Hippo Reads