Running a High-Volume GI Center

Success depends on your ability to create efficiencies, control costs and bring on the best possible staff. 

If you’re on the fence about entering the outpatient GI space, a few statistics on colonoscopy cases should be all the convincing you need.

Consider the following numbers: U.S. gastroenterologists perform approximately 15 million colonoscopies — the gold standard for detecting colon cancer — annually.

These procedures account for up to 24 percent of total ASC volume in the U.S. each year, and gastroenterologists are present in 34 percent of all ASCs. On average, an ASC does 3,744 GI procedures each year.

Efficiency = staffing plus organization

When you look at the above figures, it’s easy to see the opportunity GI presents savvy, business-minded OR leaders. But running a successful center is a constant challenge. Even at our facility in a small South Carolina city, we still manage a significant caseload, and the workload is demanding. Keeping our center running at peak conditions depends on various factors, but one constant is optimizing efficiencies.

Performing efficient care increases our revenue and profit margins, and it ensures we provide the highest-quality care to our patients. Efficiently ultimately comes down to appropriate staffing and organization.

• Staffing. We have our base staff, but we also have PRN staff to call if anyone is out sick, on maternity leave, or unavailable for whatever reason. Having a dependable pool of backups is a must for any high-volume ASC. It ensures you’re never in a situation where you’re forced to close a procedure room simply because you don’t have enough nurses or techs.

• Organization. With proper staffing in place, it’s all about creating a system and ensuring everyone — from surgeons to administrative staff — sticks to it. Every staff member knows their routine and where to go with each patient. We always have two doctors working at a time, each with his own assigned group of employees. This breakdown ensures staffers aren’t running around taking care of both doctors’ needs at once.

Organization also extends to scheduling. At the beginning of each week, I complete a weekly schedule so staff know where they’re going to be each day and can plan ahead. They always know in advance if they’ll be in recovery, a procedure room or in the cleaning room. Many of our staffers have gotten so used to the routine of this schedule they’ll often go ahead and prepare their areas for the following week. Eliminating the rushing at the beginning of each shift help us run much more efficiently.

We’ve also expanded our schedule to allow more patient visits. Extending the schedule enables more patients to come in later in the day at their convenience. Our cases are scheduled every 15 minutes, so adjusting the schedule allowed us to add four patients per room. Four patients per room may not sound like a lot, but it adds up. In fact, those four procedures per room add up to 3,000 more cases for the center each year. All told, our center does 9,500 procedures annually.

Opportunities to trim

Cost control is crucial for any GI center, and opportunities to shave off a little here or there always present themselves to facility leaders who are willing to put in the effort. One ASC I know cut down on costs related to medical waste that added up to an extra $800 monthly. The director of the endoscopy center conducted audits on what employees and doctors were tossing into medical waste bags and found plenty of materials in the waste bags that didn’t belong there, such as cups and gloves. She then re-educated staff on what was supposed to be in the waste, and ended up saving the GI Center quite a bit of money in the long run.

We’ve enacted a few strategies of our own here. For instance, we have a dedicated employee who’s in charge of managing supplies. She keeps our supply room incredibly organized so we can see what’s getting low and what we have too much of and can back off on in terms of ordering. In addition, we work closely with our sales reps to determine if and when we should change products. While the products we purchase don’t change, different vendors could certainly offer more attractive prices.

Of course, equipment is another major expense. Our motto here: Don’t scrimp on quality when purchasing equipment because cheaper isn’t necessarily better. Instead, we hold monthly practice meetings to see if there’s a need for an equipment upgrade or replacement and weigh our options. If so, we’ll meet with our various sales reps, field offers and do a close cost comparison analysis.

For our major equipment, we currently have a contract with a single vendor that offers contract (i.e., less expensive) pricing based on the volume of products we purchase. But it pays to keep all your options open. Networking with other GI Centers to glean the best equipment purchasing practices and attending conferences to learn tips and tricks on levering contracts are relatively simple ways to find better pricing options for your ASC.

While our main vendor has been great for large-ticket items, we tend to closely analyze the warranty period for other purchases. Even warranties with the best terms are only as good as the vendor behind them. We ensure we’re confident the supplier will stay in business while we own the equipment and that they can deliver on their promises — a must because many equipment suppliers in the secondary market often have no reliable access to parts.

The core business driver

SEAMLESS SCHEDULING By closely analyzing its case volume, and adjusting the schedule slightly, The Greenwood (S.C.) Endoscopy Center was able to add four patients per room — an amount that added up to 3,000 more cases for the center each year.

None of the things I just described would matter if we didn’t have the right people in place.

Fortunately, we’ve never had too much trouble recruiting nurses and techs. We use Indeed, social media and local newspapers as our primary recruiting channels — to varying results. Social media has worked exceptionally well because we can put a job ad post up, and if someone shares it, their reach could be limitless. On the other hand, ads in the local newspaper haven’t worked well (the last ad had zero responses), so we’re reconsidering whether we’ll continue running ads with them.

Recruiting physicians is a different story. We’ve had two doctors who recently retired, and our biggest challenge has been convincing doctors, many of whom are drawn to bigger cities, to come to our little old town of Greenwood, South Carolina.

Despite the challenges, we know we have a skilled staff who understands GI and provides quality care, so if we just keep putting ourselves out there, we’ll eventually find some quality physicians to fill the gaps left by the retiring docs.

Our entire staff is a cohesive team, and that makes all the difference in delivering the most efficient, top quality care our patients have come to depend on from us. It’s their dedication to the GI specialty that has allowed us to build a solid community reputation and a strong roster of recurring patients, many of whom return because of the positive interactions they’ve had with the doctors and staff.

There are many facets to running a thriving GI center, but it’s truly a team effort. With the right business practices in place, it all comes down to cooperation between the doctors and the staff. It’s about listening to your team and giving them the tools they need to maintain a successful and highly efficient GI Center that provides quality care. OSM