There continues to be major changes for outpatient healthcare providers in 2011, with continued reimbursement changes, a renewed focus on quality initiatives, and a potential for a rise in government-sponsored insured patients. The Surgery Center of Allentown (SCOA), a Pennsylvania-based ASC, which is a joint venture between its 28 surgeon partners and the Ambulatory Surgery Centers of America (ASCOA), provided some insight on how they are preparing for the 2011 changes.
With declining reimbursement in almost all specialties except orthopedics, it is important for any ASC to consider this specialty. Luke Lambert, CEO of ASCOA, states, “We’ve seen significant orthopedic reimbursement improvements with government and many commercial payors over the past several years. This has enabled the specialty to become a pillar of strength for many surgery centers around the country as these cases can now be transitioned out of the hospital without causing financial hardship to surgery centers." Although it provides services in eight specialties (orthopedics, ENT, ophthamology, pain management, colorectal, general surgery, plastics and podiatry), orthopedics makes up 50 percent of the current overall volume with 12 orthopedic surgeons providing services in sports medicine, hand and spine.
In order to combat declining reimbursement, one step SCOA continues to take is maximizing their volume. Jennifer Hunara, MHA/MBA, the administrator for the center, and her team spend a large amount of the week working with the surgeon offices to maximize use of block time. “We often start early and end late," Hunara says. “The surgeons own this facility and we want them to bring every case here." In addition to examining center numbers, Hunara also looks each month at the cases that get scheduled elsewhere. “We maintain compliance with HIPAA, but we do look at any outpatient cases that did not get scheduled with us. If I see that we have a physician who is not bringing eligible cases to the center, we work with them to determine why." Whether it is a specific piece of equipment, problem with staff, etc., Hunara has a vested interest — as all administrators should — in creating an environment where all eligible cases are coming to the center. In addition to maximizing case volume, attention to cost is also a major factor in increasing profitability in the outpatient setting. Each case scheduled is examined from a profitability standpoint so a determination can be made by the surgeon whether or not it makes financial sense to bring the case to the center. In addition, Hunara provides the surgeons with a case-costing report that shows a breakdown of supply and overhead costs by case. It compares all surgeons within each specialty and gives an overall summary of how the center is doing financially. “This report provides us with a wealth of information," Hunara says. “The surgeons can see why they have a higher or lower cost than their peers and then work with us to see if there are opportunities to streamline supply type and use." SCOA has also kept their implant costs, which are often the highest cost in a case, as low as possible by encouraging the board of directors not to sign any exclusivity agreements. “Creating competition amongst vendors has been effective for us in keeping costs down," Hunara says. “All of my orthopedic surgeons work with my materials manager to determine the most cost-effective implant that will still achieve the clinical efficacy they are seeking. The vendors know they have to be competitive to have their product considered." In addition to looking at supply costs, payroll costs also receive close attention by Hunara. “We staff to the needs of the center," she says. “If we finish early we turn off the lights and go home. Staff are made aware from their date of hire that hours are not guaranteed and that some days will be longer or shorter than others."
As reimbursement remains a constant focus in her day, quality is also always on the forefront. “Although ASCs are not yet required to report quality measures we still collect data each month to not only benchmark us against other centers, but as a way to determine what process improvements we need to focus on to provide the safest and most effective environment for our patient," Hunara states. Using the seven national quality indicators (medication variation, hair removal, SSI, patient transfers, antibiotic administration, patient burns and patient falls) Hunara and her team are able to ensure that the center is in compliance with all state and federal regulations, as well as target areas for improvement.
With the potential for an increase in government-sponsored insured patients, Hunara says time will tell. “We have not yet begun to see the impact the changes of the healthcare bill will have on our center," she says. “Our focus in 2011 will be to keep our volumes up, our costs down, and provide the highest level of service to both our patients and physicians- and when possible, have some fun doing it."
