Highlight Reel – 20 Tips to Improve Your Surgery Center

Highlight Reel – 20 Tips to Improve Your Surgery Center

Here’s what to expect on this week’s episode. 🎙️

This week marks our 100th episode of This Week in Surgery Centers!

We are beyond grateful to everyone who has tuned in and our 80+ guests who have come on the show over the last two years. Our episodes have accumulated tens of thousands of listens, and it has been our privilege to share such important information and expert advice with the industry.

Now, let’s celebrate!

At the end of every discussion, we always ask our guests, “What is one thing our listeners can do this week to improve their surgery centers?” For today’s 100th episode, we took the last 20 answers we received from our guests and turned them into a 25-minute highlight reel.

This roundup features, in order: Michael McClain, Bruce Johnstone, Gregory DeConciliis, Dr. Justo, Lindsay Schulte, Janet Carlson, James Calligan, Jeff Peo, Mike Ferguson, Sayword Hill, Erica Palmer, Marie Yarborough, Suzi Walton, Matt Cavanagh, Matt Lau, Chuck Brown, Joan Dentler, Mel Gunawardena, Kara Newbury, Kristin Pegram, and Rita Reyes-Williamson.

A huge thank you to everyone who has supported This Week in Surgery Centers. We hope you enjoy this roundup, and here’s to the next 100 episodes!

Episode Transcript

[00:00:00] Welcome to this week in Surgery Centers. If you are in the ASC industry, then you are in the right place every week. We’ll start the episode off by sharing an interesting conversation we had with our featured guest, and then we’ll close the episode by recapping the latest news impacting surgery centers.

We’re excited to share with you what we have, so let’s get started and see what the industry’s been up to.

Erica: Everyone, here’s what you can expect on today’s episode. This is a very special week because this is our 100th episode of This Week in Surgery Centers. Now if you’re watching on YouTube or on video, I’m using this really cool Google Reaction. There’s confetti everywhere. We launched this podcast back in October of 2022.

Erica: So a little over two years ago, and while I was so excited to do it, I really wasn’t sure how it would be received by the industry or if people would listen [00:01:00] in, or if this format was the best option to help provide free education to ASU leaders. But now I can humbly say that we had no reason to worry.

Erica: And it’s really all thanks to our wonderful listeners, Whether you tune in every week or just based on the topic or guests, I have so much gratitude for any time that you have spent with us. And speaking of gratitude, we have had roughly 80 different guests come on over the last two years, and I am just beyond grateful for the time they dedicate to sharing their expertise with all of us.

Erica: It’s just been so much fun learning from everyone and getting to know their unique points of view, um, and I’ve really just have had a blast running the podcast with all of you. All right. So what are we doing to celebrate? As you hopefully know by now, at the end of every discussion, we always ask our guests, what is one thing our listeners can do this week to improve their surgery centers?

Erica: So for today’s 100th episode, I took the last 20 answers we received from our guests and turned them [00:02:00] into this week’s recap episode. So there’ll be no full guest interview, no news or data segments, anything like that, but instead just a 25 minute highlight reel of all the great advice our most recent guests have shared.

Erica: So without further ado, I hope everyone enjoys the episode and for the 100th time, here’s what’s going on this week in surgery centers.

Michael: Oh, one thing this week, you told me this was coming. Okay. This is a personal one for me.

Erica: Okay.

Michael: One thing that I’ve done in every facility I’ve ever owned is I personally hate what I call the cattle call, which is someone opens a door.

Michael: And they call out a name. Erika! And they bring you to the back. I think a great thing that you can do in your ASC is create a process out front where the receptionist grabs the name of the person, writes down [00:03:00] where they’re sitting, and so when the nurse comes out to get the patient, they see the note, they walk over to the patient and they say, Hi, are you Erika?

Michael: I’m Michael. I’m going to be your nurse. Come with me. I think that sets up your experience and the patient’s experience to be phenomenal because it’s personal. It’s not the cattle call. That’s my personal advice that somebody can do today.

Erica: I think that’s great. And I think it’s those little personal touches, as you mentioned, that you’ll see on the satisfaction reports, just making them feel comfortable and at home.

Erica: So that is great advice.

Bruce: Yeah, I guess we’ve been talking about workflows and that sort of thing. Best in practice design, et cetera.

Bruce: I guess the thing I would encourage Physicians and surgery center administrators to, to do is carefully examine all existing workflows staff, patients identify potential bottlenecks that exist and daily [00:04:00] movement throughout the facility. Might be placement of equipment storage equipment, might be location of supply, storage, might be lack of adequate signage, so wayfinding might be a challenge but conduct a thorough assessment and document any bottlenecks, anything that pops up as a potential bottleneck, and what that’ll do is it’ll create an opportunity for immediate improvement, you’ll kind of come away with ideally you’ll come away with a short list of things that look, they could be accumulating to workflow inefficiencies.

Bruce: So if we just address these items, it’s a very simple, simple sort of task that can be assigned to administrators to, to go through. And yeah, just create a more efficient and organized environment, reduce stress for staff, minimize delays. Really at the end of the day, we’re looking to improve that over overall patient experience.

Bruce: So there should contribute to that. So that is one thing that you all can take away and, and hopefully improve without too much burden on your team.

Greg: You said you were going to mention this, so I, I thought [00:05:00] about it. I’m like, I think you, I wonder if people always mention the thing they probably do the least or they wish they did more, I should say. I, you know, I mentioned, I just mentioned that this takes up so much of my time and I feel like we had a really good center and a really great culture.

Greg: And maybe for me, it’s just, I feel like I’m not as in touch with everybody as I used to be because I don’t, I’m not up and about. Moving as much. And so my one thing I’d say now is again, get out there and meet with the staff and just see how they’re doing, see what their issues are, see what, what’s bothering them.

Greg: And we just had a staff meeting this morning and we had really good turnout and really good conversations. So I think the FaceTime is really key. If you’re in my spot as administrator, it shows you, you’re, you really care. Stop. It’s not just a breeze through. It’s a stopping, seeing what people are doing.

Greg: If you’re clinical. Maybe spend some more time in the business office that if you’re business oriented, spend some time in the clinical staff, see what they’re doing, see it, learn, you know, I think it’s important. And the face time for the docs is also the surgeons that are there. It also shows how much you really care.

Greg: So building that time, if you can, I think that you can do that right now, right? So that doesn’t take much just to get up and [00:06:00] get moving around. And that’s my one tidbit.

Dr. Justo: Eric, I think that the main thing they can do is to really think outside the box, right? As physicians, sometimes, and I’ve been guilty of this time and time again, my wife even tells me that sometimes I think too much inside the box.

Dr. Justo: You really have to think outside the box. What is it that I could do differently? Could I bring a new procedure? To my menu of services again, I keep referencing the laser blepharoplasty because that’s my gig, but there could be something different that maybe you could bring to the table and learn something that can be learned postgraduate.

Dr. Justo: if you will, which is how I learned many of my other procedures that I’ve done over the years, such as facelifts, liposuction, endoscopic brow lifts. I learned those all postgraduate. The blepharoplasty I learned during my residency, but, but think outside the box as a physician, consider learning [00:07:00] a new procedure.

Dr. Justo: Get some continuing medical education credit while you’re at it and then consider bringing it to your surgery center. Discuss it maybe with the surgery center administrator, see how it can be a win for both of you to again, bring. Patient satisfaction and enjoyment bring financial revenue to both the practice, the surgeon, as well as the surgery center and, and, and help decrease some of the stress and burnout that some physicians experience by doing the same thing over and over.

Dr. Justo: Just think outside the box and let your imagination just take you wherever it wants. That’s my advice.

Lindsay: Great question. And with the ever changing landscape of the ambulatory space, you have to be really sharp on operational efficiencies. So that would be my recommendation is [00:08:00] to always be thinking about optimizing operational efficiencies. You’ll see that in labor when you can cross train or stagger staff.

Lindsay: And then also like we talked about earlier, leveraging technology can save both time and resources.

Erica: Honestly, I think

Janet: just opening Your worldview, willing to think outside of the box on established, often practice status quo.

Janet: There’s my least favorite saying when I seek to understand a process and I’ll ask, can you tell me why you’re doing it this way? I’d like to understand, give me the history behind it. Tell me the why. And of course. The response typically is, this is the way we’ve always done everything. This is the way we always do it.

Janet: And I, that just, that really is not the answer that my favorite answer, frankly. So I guess what I’m saying is be willing to challenge the [00:09:00] established status quo because they’ve always done it that way, doesn’t necessarily mean they should continue to do things that way. Not saying their way isn’t effective, but there may be a better way to operate More on a lean scale where you can save some resources here and you can pick up synergy here by doing something different.

Janet: It’s just. Never too late to learn and adopt something new. And I find when I talk to other leaders in the ASC space, it’s wonderful to hear what they’re doing because you get an idea and you’re like, Oh, I’ve been trying to solve for that. And somebody has already solved for it. So you should be willing to be open to these new processes or.

Janet: Policies or procedures for a better way of improving your clinical operations in your A. S. C. I’m always open to learn something new. I thrive on that. And I’d like to always be in a process of a [00:10:00] mindset of continual improvement. But the other way to. Besides thinking outside the status quo is to listen to your teammates and their feedback.

Janet: Their suggestions are always welcome and they’re much appreciated. I’ve had multiple examples over my career where people come and bring me cost saving ideas and time saving ideas and I’m Just so grateful for it. I like to recognize and reward that feedback as well, because it’s so helpful. So those are just a few of the suggestions, but just don’t accept the status quo as well, the only way we’ve done it and it’s the best way that you may learn this, there’s actually another way, or you could amend your ways and add something to the process to make it more streamlined.

Janet: So that’s my advice.

James: Yeah, that’s a great question.

James: I love that you guys do this. I think. Giving appreciation to staff. I’m going to go with that one. I think just understanding that it’s such a, it can be a stressful [00:11:00] environment inside the O. R. And just physicians, leaders, being able to recognize staff and, and praise them for their efforts and just their The work that they do for patient care, like it’s bigger than just a job.

James: And I think if we treat our people well, I think we, we see that return on, on the other side.

Jeff: I think the most important thing is to start case costing now, even if it’s a simple way, even if it’s a simple thing, but not a sophisticated model.

Jeff: You can get more sophisticated. You can have huge spreadsheets that determine everything. But just start, even if it’s just simple case costing. So you know what each case is costing you, what you’re being reimbursed for those cases, and if it’s profitable or not, it’s not profitable, then you really have to look into if you should do the case or not.

Jeff: And that’s, I think the number one thing. And if somebody is. Not sure how to start it in a simple case costing program. I’d be happy to shoot them an email and give them a couple ideas. And I’m not going to give you some huge [00:12:00] long thing, but you need to do something and I can give you a couple ideas. I’d be happy to help.

Mike: How about if I give you three quick answers? Billing, Billing and coding is the first one Billing and coding is the lifeline of a, of an ASC. Making sure that the billing and coding and really the revenue cycle management, I’ll tie both those together.

Mike: So I’ll just give you two answers. The billing and coding and revenue cycle management part of that, of any ASC is the lifeline, the lifeblood of that ASC. Making sure their billing and coding is being done accurately. And that they’re not getting a. Exorbitant amount of denials, and if they are getting denials, making sure that they’re being promptly followed up on so that those denials can be flipped if possible.

Mike: But what I see typically, a a one man, a SC, or two man, a SC, that may have a million dollars in denials, that’s, that’s a gut punch to that asc. You have a million dollars sitting out there and you still have payroll and whatnot. We do get a lot of calls from [00:13:00] positions, maybe not wanting to partner with us as far as investors, but want some help on this, the billing and coding and the revenue cycle management to better understand why their business is struggling.

Mike: And then the second part of that answer, I would say payer contracts, they’re difficult to get a handle on having ASC with that kind of expertise and making sure that those payer contracts. Are paying what should be the fair market value of those contracts. So you’ve got to constantly have somebody negotiating with them.

Mike: That’s a key part of our business here at horizon solutions. And we constantly stay on top of these big payers to make sure the payer contracts are set up in a fashion to where everybody can win. So without, without proper billing and code and revenue cycle management, without the proper. Pay your contracts.

Mike: You’re really putting that you’re, you’re really putting your ASC at risk.

Sayword: So obviously I come from the revenue cycle side. So one of the things that I consistently see that, that we always [00:14:00] watch is to have the surgery center really work with their physician groups on the scheduling process, making sure what CPT codes that they state they’re scheduling at the surgery center is actually the procedure.

Sayword: That they end up performing because if the authorization is done on what they scheduled, which just happens to be a CPT code attached to the procedure and it’s not just right, it’s the difference between you getting paid and getting denied because one digit off. So my suggestion is to spend just a little time with each of those surgery clinics and make sure that information is valid and it will decrease so many denial issues on the back end.

Nick: Fantastic. I love that. And what one follow up for you, if I can, what have you found is the best time or place in the patient life cycle to, to double check? That’s CPT code at [00:15:00] time of scheduling.

Sayword: So the best time to check that as prior to the patient actually having the surgery for obvious reasons.

Sayword: But if we find that the patient actually has a different surgery, if you’re doing that within 24 hours of the actual surgery being performed and validating or making adjustments to it, that is. It’s the best time to at least adjust an authorization. If you have that opportunity.

Nick: If you do need to adjust, time is of the essence on that.

Sayword: Yep. But obviously if you work on the back end with it, you can look at your data for a time frame. You can see trends. You can go back to your surgery center and say, Hey, I need you to work with this clinic group. I’m noticing this CPT code versus this one, and then let’s work with them. And it may just be updating the scheduling format.

Sayword: But for them, the office then can at least call the auth on the correct CPT code at that point.

Erica: Okay, my [00:16:00] advice for surgery center leaders who are listening would be to pay attention to your surgery center’s brand and marketing efforts. Most ASCs kind of skip this because you know you’re going to get business from your physician, so what does it matter if you have strong marketing? But it really does make a difference, and it’s more than just your logo, your colors, your fonts.

Erica: Those things matter, but it also Mostly includes how you translate your mission and your core values into real life. So it includes, you know, what makes your surgery center different than the surgery center up the street. It includes your website, your social media presence. How do you engage and support your local community?

Erica: Um, what is your internal culture like? And so many more elements. It’s, you know, it also includes your, your lobby. What is their first impression when they walk into your surgery center? It includes your scrubs, your, the paintings on the walls, your, you know, your overall aesthetic will impact the patient experience and their perception of you.

Erica: So it’s totally worth your [00:17:00] time to take a look at these things that impacts patient, physician and staff satisfaction. So ultimately your bottom line.

Marie: Make sure you’re always have the latest news on information, such as patient collections, listen to podcasts like this one, read articles, make sure that you always are staying on top of everything.

Marie: I know it’s a lot of information and it’s the saying goes, how do you eat an elephant? One bite at a time. So, yeah, that’s my biggest takeaway from that.

Erica: Yeah, I think that’s great advice. I’m always a huge advocate of the state associations. Ask all these communities. Everyone is dealing whatever issues you’re struggling with.

Erica: Someone else is struggling as well, or has already gotten through it. So building that community is huge.

Suzi: So my biggest thing that I talk all the time at the surgery center, and they’re sick of me saying is the power of conversations and the power of conversations. Every single conversation you have, whether it’s at your surgery center or home has [00:18:00] the ability to either enhance a relationship or diminish it.

Suzi: a little bit at a time. So if you’re not having critical conversations, that’s just as critical. If you’re having them, the tone, the inflection, how you’re listening, all of those things are super important because you can destroy or enhance that relationship a little bit at this time. So that would be my one thing is concentrate on your part of conversations and start elevating them in your surgery center.

Erica (3): It’s great advice.

Matt: It’s rather ironic. You said that Susie, because and we did not talk before this all about this question. So Erica, you threw that one on me. I knew you were going to ask the question, but Susan and I did not talk about it. I actually, I did a different approach. AI is huge right now and everything, right?

Matt: So I actually went into online and the AI and I asked the question. Give me an improvement idea an ambulatory surgery center could implement this week. And it came up with [00:19:00] enhanced patient communication.

Suzi: There you go. There you go. And when you take a step

Matt: back, it’s everything that we do at the surgery center, what it really comes down to is patient care.

Matt: And it’s a reminder of how important it is to have those communications with the patients, make sure they understand what’s going on, and really provide great patient care. Because if we can do that, that’s one of the best things that can lead to success in the surgery center.

Suzi: And I’m going to tag off real quick off of that AI.

Suzi: Because we are all over this at the Surgery Center AI, and we’re using it in really funky ways. But one of the things that we’re doing is when we don’t have the emotional intelligence to not diminish a relationship, when we’re wanting to communicate something, we’re going into AI and going, Can you please make this professional and clean it up for

Erica (3): us?

Erica (3): Love

Suzi: it. It closes the gap of the bandwidth. For us to get in a better head space to actually try to solve and part co partner with our physicians or whoever it is to do that.

Matt (2): It’s a great [00:20:00] question. You know, the one thing that always pops out to me, and again, accountant, financial analyst, going way back, the one thing that always pops out to me when I look at somebody’s financial statements and ASC’s financial statements, the labor line is almost always, it’s one of the two largest expense line items.

Matt (2): For every a SC that I’ve ever seen and how do we control, get a better handle around our labor costs? And one of the things that, that I learned over the years, and again, I’m not super into operations, but operations and finance talk to each other a lot. And one of the things that I thought, it’s super simple.

Matt (2): It works. is just on a weekly basis, do simple staff planning. And what I mean by that is take your schedule of cases for, we get to Friday, take your schedule of cases that you have on the [00:21:00] books for the following week and compare that to your staffing schedule for the following week, day by day. And when you just line those two up, okay, Monday case volume schedule versus Monday staff schedule.

Matt (2): Friday, next Friday, case volume schedule versus staffing schedule. You’ll be able to see what days are we light on cases. Do we need to, to bring in a full clinical team for that day? Do we think about potentially cancelling the 1 or 2 case that they’re moving into Thursday and not even have the clinical staff come in on Friday?

Matt (2): If we’re going to be done by noon, can we send folks home early? Oh, we’re going to be super, super busy on Tuesday, maybe we need to bring additional teams in that day, but that simple process of marrying up and matching [00:22:00] up your surgery schedule for the following week to your staff schedule for the following week, day by day, that simple comparison.

Matt (2): On the Friday, the Friday preceding that week makes a huge difference in your labor efficiency, and it could really turn into a lot of dollar savings on your labor line item when you take that weekly process and extend it. Out a month, three months, six months, a year. You can really see how that one simple thing can yield to significant cost savings long term.

Chuck: Yeah, I think a lot of surgery centers, in fact most that we evaluate, do not have a line of sight into their accounting, tying their accounting to revenue, to volume, to really their patient accounting system. And we’re talking about budgeting properly, estimating revenue properly, accruing.

Chuck: So that you can really see your expenses and revenue in the period. And you [00:23:00] can understand your business and how it reacts to the different levers that you pull. And so only then, if you’ve got all that tied together, can you truly know if you’re being efficient and optimizing your ROI,

Joan: The thing that I would just say is, we just had an election.

Joan: It’s changing as we speak. We just got a proposed name of the head of CMS. I think if there’s one thing that will probably come to fruition between a drive for lowering costs and a friendly Senate to this, it’s going to be site neutrality. And so I would say the one thing that everybody should be doing is really paying attention to the news.

Joan: Because I think that and getting ready for the fact that hospitals and ASCs will no longer have this big variance between how much they charge for outpatient surgery. And that can be both good and bad for both hospitals and ASCs. It’s going to change the landscape a lot. So I think just really staying abreast of [00:24:00] that because I think.

Joan: It’s been put in many bills and that haven’t passed up to this point. So we’re assuming it’s probably going to be one of the first things in January. So it’s not this week, but I would say in the coming weeks, get ready. It’s coming.

Mel: Yeah. So if there’s one thing that to be done, I would make sure that they’re tracking and trending and reporting the most important KPIs for the RCM operations. And we believe in the statement that you cannot manage what you don’t measure, right?

Mel: So it’s really important that you’re tracking your data. So, as I mentioned earlier some of the KPIs are days sales outstanding that ESO total ar, and over 90 days. It’s, it’s a good benchmark to look at paid claim percentage, bad debt percentages, collection percentage of net revenue, and then denial trending, right?

Mel: As a percentage, as well as trending, you’ve got to be able to trend it to understand what the root causes are. And then finally profitability per case. It’s really important that you are tracking and trending that information. And I would say [00:25:00] by measuring you can really determine the root causes and focus on the areas that you may be having challenges.

Mel: And then. Based on that, you can really transform your RCM operations.

Kara: I would actually recommend that you contact Maya Kunkel on our staff. I’m sure she’s going to be happy if she gets bombarded with people, but and try to schedule a facility tour. So with the start of a new session of Congress, there’s a lot of new members and really just making sure that the elected officials.

Kara: That we have elected know who we are, because if they don’t know who we are, then they could potentially act against our best interest. It can be an in person tour, it can be a virtual tour we have, you can come to our fly in the fall, but please, I do encourage everybody in whatever way that you can to get involved, and really, that’s a great way to help your ASC succeed.

Kristin: If you’re not already doing this, I think it’s always a good idea to go through all of your contracts and make sure you have all the [00:26:00] right copies. Even after doing this for five years, and gosh, all of the contracts that we have, I’m still surprised that some of the smaller ones that maybe we don’t have a lot of volume with, it comes up.

Kristin: randomly as a conversation or a question because something happens. And I’m like, wow, I just realized I don’t have maybe the original copy or I have the original copy, but I don’t have the, all the amendments that have been made. So if there’s one thing that I would suggest that you could start today, it would be to make sure you have all of the copies of all of your contracts, even the smaller ones, and be mindful that sometimes amendments are Made maybe from someone who was in the position before you or just a change was made by the payer themselves It should not happen without the providers being notified But I think that would be the best thing to do is to just make sure you have copies of everything That you could possibly need so you feel secure and being [00:27:00] able to answer some of those random questions because they all happen And being able to know contractually what you are allowed and what they are obligated to provide.

Rita: I would say double check to make sure that you understand what your costs are per case. And so that involves the cost of implants because that’s something that we can get paid back on. Just making sure that your surgery center staff are capturing implant costs properly is going to be really critical.

Rita: To negotiating proper contracts going forward.