1. Continuously review workflow. The business office and other staff should get together and review the center's workflow process every three or four months. "Staff may be working hard but they're not always working smart," Mr. Blankinship says. If they brainstorm, staff could come up with many areas ripe for improvement. Staff identifies the inefficiency and then suggests ways to address them.
Many issues seem minor at first glance. In a facility that relies on scanning a large number of documents, for example, staff have to remove staples from documents each time they scan. One answer is to use paper clips instead. When downloading dozens of reports, an employee might be pushing the button for each report, instead of pushing the button to download all of the reports at once. Instead of coming up with its own solutions, an ASC might decide following a general list of best practices, but Mr. Blankinship says this not enough because each ASC has its own set of problems that have to be identified.
2. Study each employee's tasks. In many cases, higher-paid staff are doing tasks that could have been done by people paid a lot less. For example, operative nurses paid $30 an hour might be assigned to scanning documents or calling patients for satisfaction surveys. This work could easily be done by staff earning $10-$15 an hour. "With salaries making up [a significant portion] of a center's budget, this waste of high-paid staff can add up," Mr. Blankinship says. The solution? Ask employees to list each and every task he or she performs. Then closely review these detailed job descriptions to determine which tasks could be shifted to best reflect the skills of each person.
3. Automate as much as possible. An estimated 85-90 percent of ASCs still manually prepare charts. "It's very laborious but it's what they have been doing for years and years," Mr. Blankinship says. When an ASC has 30 cases a day, staff has to prepare 30 charts per day, each containing perhaps 30-50 pages. Staff have to affix a pre-printed sticky label with the patient's information on each page. If there is an error in the patient's information, the whole chart has to be reassembled from scratch. It's a laborious process that takes roughly 2-4 hours each day, with each chart taking 10-15 minutes to compile. Using chart preparation software that includes selection of the correct forms, "the time to compile one chart can be greatly reduced and the human error rate eliminated," Mr. Blankinship says. In addition, this improvement allows for chart assembly on the day of surgery, allowing staff to confirm patient data before assemblage.
4. Let the patient enter information. Instead of asking patients to write down their medical information on a clipboard, which staff must then manually enter into the computer system, it is much more efficient to have patients enter the information themselves. They can do this via secure email or on a secure website before the visit or at a computer in the ASC when they arrive.
5. Bring vendors back to conduct training. Technology vendors initially train all employees on their products, but when new employees arrive, they usually receive their training from a fellow employee instead. Mr. Blankinship equates this to teaching a friend all the applications you know on your iPhone. Most iPhone users know only about 25 percent of its functions, so it's not very effective. Without direct vendor training, employees' pool of knowledge gradually shrinks and the technology becomes less useful. To get the most out of the product, invite the vendor back to give refresher courses. "The extra cost is minimal compared with the money lost from not being aware of the full variety of valuable applications," Mr. Blankinship says.
6. Get technology upgrades. IT vendors for ASCs constantly upgrade their software, but unlike Microsoft or Apple, they typically do not remind customers of these software updates via e-mail and let them immediately download the upgrade. The ASC customer has to take the initiative, contacting the vendor regularly and learn about the upgrades. "Once a quarter have an interaction with the vendor," Mr. Blankinship says. "Ask if there is anything new or on the horizon."
7. Consolidate vendors. ASCs often sign up with a variety of vendors for various services, requiring more administration and less opportunity to interface between products. In many cases, the facility may miss out on vendor discounts awarded for buying more than one of their products. "Review vendors' capabilities and prices to see if offerings can be consolidated," Mr. Blankinship says. For example, one vendor could cover coding and transcription.
8. Use computers instead of phone or paper. "You can reduce phone bills by using Internet-based telephone and faxing services," Mr. Blankinship says. This is less expensive than traditional faxing or long-distance calling. Also, emails are easier to respond to than a phone message. Instead of sending out the bill, ask patients if they want it emailed to them, which is how the Apple store handles receipts. There are plenty of applications for Internet-based communications. For instance, rather than calling each physician's office when compiling infection logs to find out what happened to the patient post-op for the log, the offices can be emailed. "Secure emailing is actually more accurate that phoning and then writing down what they say," Mr. Blankinship says. "It also saves time and builds an audit trail." While phoning each physician's office can take 3-5 days, emailing takes half a day. "Start thinking of what else could be automated through email or text messaging," he suggests.
9. Incorporate new technology. A great deal of technology available in other industries still hasn't penetrated surgery centers. For example, giving patients the option of online registration means nurses don't have to call each patient. "Patients can enter the necessary data from the comfort of their own home at the time of their choosing," Mr. Blankinship says. Automation can also be used to verify insurance coverage or obtain medical records. Once physicians dictate their operating reports they can apply an electronic signature, eliminating a cumbersome step of getting the medical record to coders. This gets the claim processed faster.
10. Consider substitutes for EMR. Electronic medical record systems are expensive and, unlike hospitals and practices, ASCs do not have access to federal payments for installing them. But Mr. Blankinship argues surgery centers don't really need EMR systems. "Most EMR systems are not paper-based and physicians and clinical personnel are always going to want to touch paper," he says. And since ASCs have short patient stays, continual patient monitoring through the EMR is not necessary. Instead of full EMR systems, Mr. Blankinship says ASCs should use smart technology that involves scanning in the patient's chart, storing that data and sharing it with payors and others in a timely manner.
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