Five different ASC-focused physicians discuss best practices that contribute to the development and operation of a successful ASC.
1. Fix physicians’ problems to attract them to your ASC. To recruit more physicians to your center, Philip Grossman, MD, FACP, FACG, AGAF, FASGE, CEO and medical director of Kendall Endoscopy and Surgery Center in Miami, advises ASCs to think of the fable of the lion and the mouse, in which the mouse fixed a splinter in the lion’s paw and was later remembered and rewarded. Find out what the physicians in your community are missing, and fulfill that need, he says. “I’ve done a tremendous amount of computer consulting at a variety of levels, including healthcare, and I use that as a driving force,” he says. “Find out the things that are making life difficult for people and then fix them.”
He says these difficulties will vary. “Is it the fact that they go to the hospital and can’t start on time? Is it the fact that they don’t have a particular piece of equipment that would really allow them to distinguish themselves and their specialty?” he says. “Is it that clerical staff can never get a patient registered without 15 follow-up phone calls?” Physicians will be pleasantly surprised if you fulfill a need they’ve been struggling with for a long time, and will be more likely to bring cases to your ASC.
2. Work with nurses to draw up patient discharge guidelines. According to Thomas Wherry, MD, medical director for Health Inventures and principal with Total Anesthesia Solutions, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. “Anesthesiologists should help determine discharge guidelines,” he says. “Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it’s all on [the nurses’] shoulders, they’ll take the more conservative approach and keep the patient an extra half hour.” He says all these “extra half hours” add up to significant extra staffing hours over time.
To speed up patient discharge, and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. “You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged,” he says.
3. Designate a managing partner for an independent ASC. The independent ASC needs a physician-owner who has the interest and the skill set to actively manage the center, says Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich. The managing partner does not need an MBA or even training through the business course, but since the job requires a significant amount of commitment, compensation should be in the six-figure range. “You can’t impose this job on anyone,” Dr. Metz says. “It involves a great deal of commitment.”
4. Invest in software to facility quality improvement studies. Investing in software can seem daunting, especially for a smaller facility, but software and technology are essential to conducting quality QI studies. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says this technology works best when it is specifically tailored to the needs of the facility.
“We bought various software for the staff to use on their desktops so they can produce meaningful information,” says Dr. Dooley. “In some cases, we’ve had staff members save a document to a hard drive and then someone else accidentally deletes it. We’ve had to go to a new software system so that accidental deletion doesn’t happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don’t work. In that case, we’ve had to switch to a larger database like Microsoft Access.”
5. Pick the right size space for your ASC. Most ASC industry experts agree that getting the size of your ASC right during the development process is absolutely essential to optimum profits. “There are only two ways to make square footage work: either get it right in beginning, or sublet to make it work later,” Jim Reichheld, MD, board-certified gastroenterologist and director of Northeast Endoscopy Center in Lowell, Mass., says. “There are many restrictions on subletting space for other uses, so that can be difficult. Not building a Taj Mahal is critical because your building is a fixed, recurring expense and you can’t change that.”
1. Fix physicians’ problems to attract them to your ASC. To recruit more physicians to your center, Philip Grossman, MD, FACP, FACG, AGAF, FASGE, CEO and medical director of Kendall Endoscopy and Surgery Center in Miami, advises ASCs to think of the fable of the lion and the mouse, in which the mouse fixed a splinter in the lion’s paw and was later remembered and rewarded. Find out what the physicians in your community are missing, and fulfill that need, he says. “I’ve done a tremendous amount of computer consulting at a variety of levels, including healthcare, and I use that as a driving force,” he says. “Find out the things that are making life difficult for people and then fix them.”
He says these difficulties will vary. “Is it the fact that they go to the hospital and can’t start on time? Is it the fact that they don’t have a particular piece of equipment that would really allow them to distinguish themselves and their specialty?” he says. “Is it that clerical staff can never get a patient registered without 15 follow-up phone calls?” Physicians will be pleasantly surprised if you fulfill a need they’ve been struggling with for a long time, and will be more likely to bring cases to your ASC.
2. Work with nurses to draw up patient discharge guidelines. According to Thomas Wherry, MD, medical director for Health Inventures and principal with Total Anesthesia Solutions, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. “Anesthesiologists should help determine discharge guidelines,” he says. “Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it’s all on [the nurses’] shoulders, they’ll take the more conservative approach and keep the patient an extra half hour.” He says all these “extra half hours” add up to significant extra staffing hours over time.
To speed up patient discharge, and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. “You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged,” he says.
3. Designate a managing partner for an independent ASC. The independent ASC needs a physician-owner who has the interest and the skill set to actively manage the center, says Keith Metz, MD, medical director of Great Lakes Surgical Center in Southfield, Mich. The managing partner does not need an MBA or even training through the business course, but since the job requires a significant amount of commitment, compensation should be in the six-figure range. “You can’t impose this job on anyone,” Dr. Metz says. “It involves a great deal of commitment.”
4. Invest in software to facility quality improvement studies. Investing in software can seem daunting, especially for a smaller facility, but software and technology are essential to conducting quality QI studies. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says this technology works best when it is specifically tailored to the needs of the facility.
“We bought various software for the staff to use on their desktops so they can produce meaningful information,” says Dr. Dooley. “In some cases, we’ve had staff members save a document to a hard drive and then someone else accidentally deletes it. We’ve had to go to a new software system so that accidental deletion doesn’t happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don’t work. In that case, we’ve had to switch to a larger database like Microsoft Access.”
5. Pick the right size space for your ASC. Most ASC industry experts agree that getting the size of your ASC right during the development process is absolutely essential to optimum profits. “There are only two ways to make square footage work: either get it right in beginning, or sublet to make it work later,” Jim Reichheld, MD, board-certified gastroenterologist and director of Northeast Endoscopy Center in Lowell, Mass., says. “There are many restrictions on subletting space for other uses, so that can be difficult. Not building a Taj Mahal is critical because your building is a fixed, recurring expense and you can’t change that.”