Proven Strategies for ASC Success

Surgery centers are in line to capture a sizable number of cases as insurers and providers look to shift more complex procedures out of hospital ORs. As the migration of surgeries to same-day settings continues to increase, ASCs that focus on strategies designed to limit expenses and maximize throughput will be well positioned — and well prepared — to generate new business.

Brian Bizub, CEO at Raleigh (N.C.) Orthopaedic Clinic, runs two surgery centers. One, which is eight years old, is where 22 surgeons perform about 7,000 orthopedic and pain management cases each year. The second facility is a multispecialty center that opened less than a year ago. Surgeons there currently perform about 110 procedures per month. Mr. Bizub expects the total case volume to reach 2,000 by the end of the year as more surgeons come on board.

He’s seen incredible growth in orthopedics at his primary facility: total joint cases have increased by 40% and spine procedures have jumped by about 20% over the past 12 months. “We’re moving patients from the local hospital to our surgery centers as we’re able to perform more complex cases, including total hips and total knees, and one- and two-level spine fusions,” says Mr. Bizub. Medicare patients make up about 25% of the case mix, Blue Cross and Blue Shield about 45% and other commercial payers comprise the rest.

He knows that ASCs wanting to remain at the forefront of outpatient care in a landscape that prioritizes quality outcomes and access to safe, affordable surgery must implement smart and efficient supply purchasing and practices. 

• Cost containment. Mr. Bizub points to the importance of working with surgeons to select cost-effective implants for orthopedic cases. His main surgery center is 51% owned by the local hospital, which is a passive partner. Surgeons from a single orthopedic group operate at the facility, so it’s not difficult to standardize implant purchases.

A medical executive board determines the safest and best care pathway for patients, including the best implants to use, according to Mr. Bizub. “We bid the pricing out to four or five vendors every three years, and whichever one provides the best deal gets our business,” he says.

Most of the implant vendors the facility works with provide tier rebates based on purchasing volume, according to Mr. Bizub. If the facility spends more on implants over the course of a year than what was agreed upon in the contract, it receives a percentage of the overage. The same rebates are available through the GPOs the center partners with to procure needed supplies.

Recent supply chain issues have made it challenging to ensure the necessary items are on hand, so Mr. Bizub has avoided signing long-term contracts with supply vendors and bases the decision to enter into an agreement on their ability to meet agreed upon par levels. If they can’t provide enough items to meet the par level, they don’t get a contract. For example, Mr. Bizub recently moved away from the facility’s typical glove supplier and negotiated a 12-month deal with a new manufacturer, which guaranteed it would be able to supply the volume of gloves the facility needed.

• Clinical efficiencies. Room turnover time is second only to quality patient care on the list of surgeon priorities, according to Mr. Bizub. “We work constantly to retool the process to make sure turnovers are between 10 and 20 minutes, depending on the complexity of the case and the equipment and instruments that were used,” he says. “The process commences as soon as surgeons begin closing, a practice that moves the process along as efficiently as possible.”

The center’s staff also relies on custom supply packs containing the gloves, gowns, drapes and other standard supplies the surgical team uses during each case to further speed up room turnovers. Supplies needed for scheduled cases are pulled the night before based on surgeon preference cards and placed on case carts. The team prepares three carts per OR, so the surgical team simply exchanges the carts as they’re setting up for the next case.

• Data analysis. Alfonso del Granado, MBA-HC, CASC, was brought on board a couple years ago as the administrator and CEO at Covenant High Plains Surgery Center in Lubbock, Texas, because of his track record of controlling costs and maximizing revenues at his previous facility. There, he had the benefit of working with analytics to take daily deep dives into the performance of the center. Mr. del Granado says the 43 physician-partners at his new facility — a multispecialty, 11-OR space — are expected to perform about 8,300 cases this year. He’s in the process of establishing baseline data and generating trend reports in order to perform the analyses he needs to make positive change happen.

For example, he can use documented room turnover times to identify inefficiencies and take corrective action. “At my previous center, we noticed inexplicable gaps between pain management cases and discovered the physicians, surgical team and pre-op nurses were chasing each other’s tails,” says Mr. del Granado. “The patient would be ready without the surgeon realizing it or the patient was ready in pre-op but the surgeon wasn’t in the procedure room. It was a simple communication fix that increased our efficiencies. We went from averaging three cases an hour to more than four cases an hour.”

When his former facility launched an ophthalmic service line, Mr. del Granado calculated a per-case profit of $50. After a year, they were off the expected total revenue by 15 cents, an incredibly accurate result afforded by analytics. “When profits went down, we’d tighten up spending,” says Mr. del Granado. “When revenues increased, we’d loosen it back up. Having access to real-time data lets you make adjustments on the fly.”

At his former facility, Mr. del Granado was also able to increase the staff’s overall productivity by 23% while increasing employee retention and optimizing labor costs through creative staff scheduling. Everyone worked enough hours to be satisfied with their pay, but no one was sitting around idly wasting company time. “That’s what you can achieve with access to analytics,” says Mr. del Granado.

Hard data can also help facility leaders identify physician outliers at the top and bottom of the case cost scale, analyze the factors that are contributing to the differences and make adjustments as needed to the supplies or equipment the high-spending surgeons use.

“In order to identify these opportunities,” says Mr. del Granado, “you have to be able to find them.” OSM

Note: This three-part article series is supported by Zimmer Biomet.