This Week in Surgery Centers: LIVE! Four Stories from Real People Changing the Industry

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

This Week in Surgery Centers held our first-ever LIVE episode!

Four industry leaders got together to talk about the four pillars that are top of mind for every surgery center right now: Patients, Physicians, Payers, and People. In a panel format, they shared 2023 trends, actionable tips, and first-hand experience on what they’re doing at their respective facilities. Listen to the full episode to hear from:

➡️ Eliza Alberto-Widdowson, Director of Nursing, Mann Cataract Surgery Center
➡️ Jeffrey Flynn, COO, Gramercy Surgery Center, Inc.; NYSAASC Vice President
➡️ Kris Kilgore, Executive Director, Surgical Care Center of Michigan
➡️ Kayla Schneeweiss-Keene BSN, RN, CASC, Administrator, Mann Cataract Surgery Center

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details!

0:00
welcome to this week in surgery centers if you’re in the ASC industry then
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you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
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our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
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to share with you what we have so let’s get started and see what the industry’s been up to [Music]
0:27
hi everyone here’s what you can expect on today’s episode last week HSC
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Pathways held our first live podcast event titled four stories from real
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people changing the industry the discussion was focused on 2023 Trends and then did a deep dive into the
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four pillars that are top of mind for every Surgery Center patients Physicians people and payers
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using their own experiences four ASC leaders joined the panel Elisa Alberta
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widowson Jeffrey Flynn Chris Kilgore and Kayla schnew ice Keen with each focused
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on one of those four pillars the discussion was filled with great tips and real actionable items to help ASE
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leaders continue to succeed so I think you’ll find the content informative and interesting hope everyone enjoys the new
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format for this episode and here’s what’s going on this week in surgery centers
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[Music] thank you all so much for joining us
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this afternoon I’m Erica Palmer from HST Pathways and I’ll be moderating today’s
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discussion uh before we jump into the content we put together for you I just
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wanted to share a few housekeeping items first I know everybody says this but we
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do really want today’s discussion to be as interactive as possible so please
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feel free to use that q a box at any time if you have questions
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um and I will make sure to get your questions in front of our speakers at the right time and if we have enough
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time at the end we can definitely stay on to here at any other questions you might have
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um and second you are all part of a little history today as this is the first live event we’re hosting for hst’s
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podcast called this week in surgery centers so this will be recorded and the
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episode will be released this Tuesday and you’ll be able to find it on Spotify apple and YouTube
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um and lastly just a huge thank you to ask a further partnership and helping um and spread the word about today’s event
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so what are we looking at so today uh we’ll do some quick introductions um we’ll do a quick recap of uh looking
2:45
into 2023 and what can we expect and then we’re really focusing our
2:50
discussion today on these four pillars so uh patients Physicians people and
2:57
payers so we’ll spend the majority of our time kind of diving into those four
3:02
different pillars and see what our panel is up to what they’re expecting and going into 2023 and kind of what trends
3:09
we’re seeing and what they’re doing at their own surgery centers foreign
3:14
so who are today’s speakers um I am so grateful so appreciative to
3:20
have these four ASC leaders um on with us today we have Lisa Alberta
3:26
widowson from man cataract surgery center who’s going to talk about patients we have Jeffrey Flynn from
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Gramercy Surgery Center who’s going to talk about Physicians we then have Chris Kilgore from surgical
3:39
Care Center of Michigan to talk about people which is which is staff I just had to stick with my my P alliteration
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um and then we have uh Kayla schnewise Keen who’s going from manic cataract surgery center is going to talk about
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payers so I’m really excited to eventually hand the floor over to them
3:59
very shortly so looking to 2023
4:05
um there’s obviously a ton of stuff going on in the industry I tried to shy
4:11
away from anything in this slide specifically that our speakers would be touching upon later so these are just
4:17
some other trends that that we can expect and a lot of these are obviously weave into those four pillars that that
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we’re talking about later on um but just at a high glance a couple things that
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um we’re seeing um come up a lot in questions and discussions the first would be growth so
4:36
looking into the new year um it seems like growth is something we can all anticipate
4:42
um a couple of reasons why ASCS are reporting that they still have a backlog of cases and patients from the pandemic
4:49
that need to be performed um and then Kayla will talk a little bit more about this as we get to the payer
4:55
section but we are expecting payers to continue to push more procedures to the outpatient setting for various reasons
5:02
and then three Specialties that are expected to see the most gross this year are total joints spine and
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cardiovascular a second Trend that we’re anticipating
5:15
is more value-based Health initiatives so this is something that has long been talked about but it’s finally time for
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ASCS to really shine here we have the tools to do so um and really think about how they can
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capture and track as much usable data as possible
5:35
another Trend that is just going to continue to develop has been a trend for a while now is is this idea of price
5:42
transparency so hopefully everyone is well versed by now on what kind of this
5:47
piece of legislation is and how ases can comply because it’s only going to continue to expand and despite some of
5:55
the lawsuits that are flying around right now mostly on the hospital side I don’t believe they will make much of an
6:02
impact in the short term or long term so um definitely keep an eye on price
6:07
transparency and kind of lean into into that Trend with your patients
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a next Trend that we’re seeing and talking about a lot is kind of the anesthesia component when it comes to
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surgery centers um now even I have to admit this is the relationship between a surgery center
6:25
and an anesthesia group uh is probably the area I personally understand the
6:30
least or just have had the least exposure to um but my understanding is that historically the majority of people who
6:37
work in a surgery center don’t fully understand that surgery Center’s relationship with their anesthesia
6:43
provider um whether that’s you know not considering your anesthesia group when you’re scheduling cases not really
6:50
considering them a stakeholder um and also not fully understanding how
6:56
these anesthesia groups receive reimbursement and the reason why we believe this is
7:01
important is given the challenges the industry is facing around Staffing shortages and Rising costs working
7:08
closely and kind of becoming best friends with your anesthesia group is going to be extremely important just to
7:14
make sure they can cover your cases and that everyone is profiting
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another Trend here would be interoperability so again nothing new we’ve heard this kind of buzzword a lot
7:27
recently but in order to compete with hospitals and make surgery centers the
7:33
Premier Choice ases have to kind of step up their technology game still now this
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does not go for every Surgery Center um you know most surgery centers we
7:43
encounter have some level of Technology woven in and understand the importance of kind of leaning in more but by
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adopting technology throughout the entire patient Journey your patients staff surgeons will have a better
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experience improve workflow get rid of silos all the things that kind of get
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you to that ideal State um I certainly know the price tag can be intimidating and change is always hard
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um but it is time um another Trend here that I personally
8:14
don’t think that’s talked about enough is lobbying um I would be curious if we did a poll
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right now to see how many of us on the call would consider
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um ourselves politically active when it comes to advocating on behalf of the surgery Center’s role in the overall
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Healthcare ecosystem you know ASCA and all the state ASE associations obviously do a ton of
8:38
lobbying for the industry but I think it’s just critical that everyone is doing something and the best part is
8:45
that you don’t need any experience or training or education and politics to make a difference uh it could be as
8:51
simple as picking up the phone and connecting with your legislators inviting them to your facility for a
8:56
tour um unfortunately most legislators don’t understand what an ASC is and how they
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differ from a hospital so a little education can really go a long way so highly recommend kind of leaning into
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lobbying this year and doing your part and then lastly robotics I always think
9:15
this part is super cool um I don’t have a clinical background so whenever I’m reading about robotics I’m always
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fascinated um and my understanding is that you know accessibility of surgical robots is
9:27
getting better um as they become more common and more competitors enter the space prices are
9:32
dropping and there are more and more options available to surgery centers so I encourage everyone just to keep an eye
9:38
out for what options might be out there that could work for you
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okay so now I’m going to hand things over to Elisa who’s going to talk about the patience pillar
9:55
foreign oh you’re just on mute
10:02
it wouldn’t be a webinar if one of us didn’t do it
10:07
good afternoon everybody so um what I’m going to talk about is how
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important patients experiences um in order
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for for them for us to attract more patients to go to Ambulatory Surgery
10:24
centers versus hospitals so patients we need to look at them as consumers
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um also think of them like shoppers picture your process of choosing a new
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restaurant you might go online to research reviews and look at photos or you might call a friend for
10:42
recommendation which I often do that I would call someone and say have you been to this place or it
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doesn’t even matter where it’s a hair salon or or a place a restaurant right we
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ask our friends or or anybody our co-workers you know what for their
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opinion the same thing with patients they will ask their friends or relatives to see for their opinion regarding an
11:07
ASE or a hospital or a physician so you better believe patients are doing this while choosing where to have a procedure
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done and the most basic form of marketing is Word of Mouth which is very effective
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from what we’ve experienced Kayla can vouch um for this too uh they’re providing
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each patient with great experience will motivate to recommend the ASE to others which is great marketing additionally
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with almost everything being posted online prospective patients are always
11:40
looking for good and bad reviews regarding an ASE before making their decision
11:46
whether if it is the right facility for them hence this is why it is important
11:52
for employees to give every patient and their families the best experience from the minute they walked into your
11:57
facility because this will not only promote patient satisfaction but will also
12:03
benefit your AC because it will increase your case volume
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next slide please Erica price transparency
12:15
surprise transplants will be expected payment issues from patients usually arise when the patient does not
12:22
understand the payment schedule therefore price transparency is a must
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um it is important that we give patients full disclosure
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of how much who are they paying what are the service Services being
12:39
rendered to avoid um any stress during the day of surgery
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we work closely with our also with our medical practice and both the practice and our Surgery Center give the patients
12:51
an accurate Financial estimate in advance before their surgery
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it is important because to disclose the patients what services are being provided
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because it does build trust and promote effective communication between the patient and also the
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facility this also allows the patients to be better prepared to meet their financial
13:14
obligation for their surgery without any surprises hence the no surprise act
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which we need to be compliant or stay compliant we are also planning
13:25
on transitioning to taking payments prior to the day of surgery which we believe will be very beneficial to all
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ases if they do this because this will definitely alleviate some of the stress on the day of surgery and will also
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reduce the burden on your administrative administrative staff in our facility some of the issues that
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we encounter we have patients coming in who’s using Care Credit or alpha or I’m
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sorry um other um financing
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um sources and sometimes we’ll have issues with
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not being able to find their account number or they don’t have um enough to pay for surgery all of
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these can be avoided if we transition on taking the payments
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in advance also remember you can Prov provide the patient an excellent outcome
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but it doesn’t matter because overall
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when there are issues or miscommunication with with payments this could lead to an overall bad experience
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from a patient’s perspective for example a patient can have
14:42
someone who had cataract um surgery seeing perfect 20 20 vision
14:48
and then 30 days later receives an anesthesia Bill and this has happened before they command a facility they
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thought they’ve paid everything already on that day of surgery and here here they are questioning what what is this
15:02
fee that that they’re being that they received in the mail so this is really important that we explain to the
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patients prior to surgery how much it will cost for their
15:14
procedure if there’s going to be other fees position facility fees anesthesia etc
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those are very important to disclose to the patients so to promote
15:26
better patient experience next slide please yes I just have one
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question for you there too I’m curious um this goes for the panel would you say in your patient satisfaction survey is
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like what out of the negative reviews and feedback would you say the majority the ones you get are around
15:47
Financial concerns and frustrations there um yeah a lot of frustrations
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or the miscommunication with special the anesthesia fee in the past which right
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now we’re trying to streamline um like I said like collecting the payments
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in advance but we’re still in the process one of the most
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in on our patient surveys that are that is a concern um
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are patients having to swipe their cards multiple times instead of just one payment
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s are wishing they could just make one payment instead one payment for anesthesia one payment for facility one
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payment for Physicians so now I know a lot of um or Healthcare organizations or ases
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have tried to streamline and just collect one payment but it’s important that you stay compliant
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you can’t just collect a whole payment and then say Oh I’m you know I’m going to pay the physician it has to be
16:53
separate sure makes sense thank you
17:02
all right patients expect high functioning technology but
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it also depends on patients demographics which is very true where
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the AAC facility that um that I’m in the demographics that we
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have you we get a lot of um rural areas patients that do not have
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access to computers for example or not tech savvy okay but overall
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what Erica pointed out this just a few minutes ago it is important
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that we stay competitive with the hospitals and that’s how we’re going to attract all of these patients to come to
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our ASE um one thing that was a game changer for us was online pre-assessment forms which
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patient portal system um what it did is it facilitated
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patient engagement in healthcare decisions it improved our communication with the patient and also with this
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patient portal system um our patients can access pre and post-op care before their surgery
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patients can also fill out their forms on their own time in the comfort of their own home
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the implementation of our patient portal system played an integral part on increasing the efficiency and
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productivity of our surgery team so such as a high volume AC just like what we
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have here in Houston Texas um you can definitely benefit from it
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because it will save a lot of time for your staff before we transition to the patient
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portal system in the pre-assessment forms one nurse will spend about 20
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at least 20 or so minutes per patient so if you have 20 to 40 patients in that
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one day that’s a lot of hours that you’re spending on pre-assessment calls
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so when we did the calculation and the study on this we after a year we’ve
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calculated that on average we are saving at least one FTE per week since we implemented the the
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patient portal system now with the EMR system electronic patient satisfaction surveys
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text notifications and especially credit card which our
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facility currently are not taking cash to avoid any other conflicts this just
19:35
makes it more streamlined and just a lot better for for the patients
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um having said that with the high functioning technology
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um it is important to accommodate these patients the ones that are not tech savvy like I mentioned because they do
19:54
need assistance on filling out those forms and what we do with those patients
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um other we’ll have them come in early before their arrival time so then we can
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have a one-on-one um with the patient and help them out on the day of surgery or the day before we
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would try to call them um and and help them out with their
20:19
or pre-assessed them pre-assessment form
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enhancing patient experience in the AAC this is actually my favorite topic
20:35
um patient experience is very important um this I would call this the essentials
20:41
so to speak for improving patient experience in the ASE
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so number one for me is employing professional friendly staff okay
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you need to employ someone who’s professional friendly staff who are informative helpful courteous to all
20:59
because it is a must they are the ones that shapes the patient’s first impression of the facility so as soon as
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the patient walks in those are your front desk coordinators so they need to be smiling and very welcoming and and
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that gives the patients already um a peace of mind
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second is setting expectation with patients establishing expectations for patients
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and their families for all steps of the surgical process such as scheduling details Financial Obligations procedure
21:30
day flow and post-op care is essential they’re all essential this allows them
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to know what to anticipate and prepare accordingly effective communication is
21:40
the key price transparency is the third one being a front especially regarding
21:47
financing is important this avoids any billion surprises down
21:53
the road of patients patients knowingly exactly what they will need to cover helps reduce their stress and fear
21:58
making for a more pleasant surgical experience
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fourth one is staying organized being organized around the patient’s schedule and other operational aspects of the ASC
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gives the impression of Competency amongst the staff and organize ASC also
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reflect attention to detail cleanliness and care
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also patients will feel safer getting a procedure done your family than a hospital as the environment will
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reinforce that they are in good hands the next one is effective communication
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and pre and post-op care communicating post-op instructions to patients and their families before leaving is
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imperative to customer service and compliance this ensures they know that they should
22:46
and should not what they should and should not do at home to achieve the best outcome
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also follow up with a post-op call later to make sure recovery is going well
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which is it makes the best patient experience for everybody then
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um than a successful outcome when we call this patients at the end of the day and just checking on them
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they actually they’re very surprised because it’s not very common anymore as from what I this
23:20
what I am hearing from the patients that that’s not a very common practice that that doctors or or other places will
23:29
call them after a procedure just to check on them usually they’ll call them a week or or a month later just to check
23:35
on them but in our facility we checked them on the day before just to make sure that they’re not having any pain or any
23:40
discomfort and making sure that they understand their instructions
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um last one is Staff satisfaction nothing influences the patient experience boards and staff happiness
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because happy staff needs happy patients staff happiness comes from leadership
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support Surge and appreciation and the ability to learn and celebrate successes together
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satisfy staff who enjoy their work and offer specialized one-on-one focused patient care
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and it also creates a positive experience and spreads happiness to patients
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um some of the things that we do at our ASC to appreciate show appreciation to our staff is celebrating each employee’s
24:23
birthdays uh bringing Donuts in the morning for treats uh we started doing a quarterly
24:29
trip to a restaurant with a whole surgery Team every time that we when we have a day that we finish early
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or even just a simple thank you goes a long way so just make sure you show
24:41
um appreciation to your staff and that concludes my presentation
24:47
thank you so much so many great tips in there and obviously patients are
24:52
extremely important to the to the workflow of the surgery center all right Switching gears to the
24:59
Physicians pillar Jeffrey I’ll let you take it away great
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um I’ll just briefly give you a little history um where we started in a very different
25:10
way but this relationship aspect for Physicians is a really great way to for long-term
25:17
relationships grammar see when it started was not physician done so the Physicians truly were the customers
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um you could only really do that in New York City because we had such an oversaturation of doctors here but
25:30
separately we’ve grown we’ve had satellites we’re significantly position owned now but we’ve also developed a
25:37
management company so we’ve actually created other centers that are completely positioned on but I want to
25:43
talk to you about how it is in developing the relationship because the relationship needs to be for the long term
25:48
one of the key things right off the bat is to find out your what is your surgeon’s plan both their short-term and
25:55
long-term plan and I want to give two examples I had somebody start with me over 20 years ago
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here uh I’ve Gramercy started 20 and a half years we’re now 20 years and six
26:07
months old but what happened was interesting was um somebody was just
26:13
starting their practice renting exam rooms rushing around but
26:18
needed a place to develop and do surgery and part of the issue was in the
26:23
hospital he just didn’t have the numbers or anything else so guaranteeing a positive relationship wasn’t going to be
26:30
there so him finding Gramercy he always felt was a great opportunity 20 years later this doctor is one of my
26:38
busiest surgeons and he has six doctors working for him we worked with him and he always
26:44
attributes back to Gramercy that if he didn’t have the time and the surgical experience a lot of the stuff that
26:51
um Elisa just said in that whole area to build his own practice he made
26:58
the Gramercy team his own team extension when he was here and that was something we knew with his short-term and
27:04
long-term plans were we were able to help him in the short term to build his own practice and now he’s one of the
27:11
most significant contributors here to our income because he has developed a successful practice and did it really
27:17
around the surgery there’s also some short-term things you can do I’ve actually had a number of the chiefs of
27:23
different hospital programs come to me and say the last two years I just want to do a little bit of stuff I
27:29
want to do something simple and then I want to ride into the sunset is grammar see a place I can come and some of these
27:36
people turned out to be the most renowned doctors in in the country but they just wanted to like Edge out into
27:42
retirement and there was a place for that here too so we were able to find those different ways for that to happen
27:49
but when meeting the surgeon right off the bat I think the person is finding out what their um what are their current
27:55
pain points what’s not going well in their practice in their surgery aspects
28:01
what can and what can you do to solve it do you have a time that you can give them our turnover times we know are
28:06
notoriously better than the hospitals but is that something that really gets to the doctor is it the day that he’s
28:12
using is that part of the situation you’ve got to talk with the doctor and understand what his situation is and her
28:20
her situation is and then on top of it um determine whether you can help them or not and as
28:27
I say bring them into your world I think and again going back to elise’s
28:32
situation about the staff being happy and being part of a positive environment
28:37
around is what that’s what the surgeon wants to come and have a simple Day Surgery tends to be their favorite day
28:44
because they were able to kind of go through they’re not dealing with the you know the minutia of their practice you
28:50
know the patient we all know is asleep for most of the procedure so they’re coming in and they’re really doing and
28:55
really um performing what they’re best at
29:01
but also to understand um and this is the key factor is if you can’t promise them something and you
29:08
can’t deliver on that make sure you’re really upfront about that and I can tell you doors open down the road
29:16
um we’ve opened centers for doctors that we just weren’t able to accommodate them at grammarcy we opened an IVF GYN Center
29:23
in New York City we were never going to be able to house that at Gramercy they had to go out and do it themselves but
29:29
we could be part of that process and help them to do it and it allowed us to grow and get more involved in everything
29:36
but it was important to know that I couldn’t fit that here and I didn’t want the doctor to understand and you have to
29:42
realize so many of them come back to you and everybody’s kind of heard it the hospital promised me this when I got
29:49
there and then three months later six months later two years later they completely took it away and there’s
29:54
nobody I can talk to about it that’s something that this is where it’s our
29:59
place we do our best here because we’re able to deliver if we’re able to be up
30:06
and again that developing that relationship with the doctor Erica if we go to the Next Room
30:14
okay one of the best aspects and it provides for a positive
30:20
environment is listening to the doctor on new ideas and new technology that’s really where you learn it a lot
30:27
of times they’ll learn it from a rep but coming forward through is kind of listening to them is this something that
30:32
you can do I’ve gotten certain devices at the center to say that sometimes it’s used
30:37
in the practice sometimes it’s used in surgery centers but I simply can’t afford it in my center but if you got
30:43
all of the doctors together in that specialty is that something you can afford at the center to offer us
30:49
and you know sometimes it’s been yes sometimes it’s been no the best part
30:55
about that is to really make sure the doctor is part of the feasibility that
31:00
you’re doing you’re keeping him involved in we’re going to look at the price we’re going to look at the reimbursement we’re going to look at the safety
31:07
aspects and this is this something that we can deliver for you and is this a new line of a procedure that we can do
31:14
if they’re involved from start to finish and you really over communicate because if it’s something that you find that you
31:21
really can’t do they’re more accepting of it if they’re looking at all the numbers if they’re actually seeing it on paper I mean let’s
31:28
face it they’re scientists first so they really are seen on paper what’s actually
31:33
the the situation and and how to go forward and then there’s the other parts of
31:38
going through is when an issue arises with a doctor or issues arise for the center that you need to talk with the
31:44
doctor you really need to talk to them as a problem solver that you’re coming to them and speaking to them about an issue
31:50
or an issue they are upset about you don’t want it to be us against them that’s always the way it is in the
31:56
hospitals and we always see that and we hear that consistently this is where we can be as I put it the UN Hospital
32:03
we can really focus on let’s look at the situation there’s certain things like in
32:08
our data shows and there’s a lot of um from technology certainly with HST and
32:13
others is that specifically you really can get down and dig into the data and do some analysis to say that like for
32:20
instance this particular situation or this particular implant is just not affordable it’s it’s not reimbursed for
32:28
a significant part of your payers but there are some other Alternatives that we can look at and if you’re showing them those that particular information
32:35
and you’re providing them Alternatives they actually believe in the relationship and the long-term
32:41
relationship that you have and that’s what I think is very killier don’t avoid them when there’s a problem
32:47
make sure you’re right there and right there to hear what they’re saying if you are the Age of Reason and you’re
32:53
the one who can take the deep breath and go through the conversation then they
32:58
leave feeling that at least they were heard they were validated and if even if it turns out to be something that their
33:04
answer isn’t going to improve that’s the case there if it’s something that your staff has done and it’s something that
33:11
you can actually say well let’s talk with the staff and see what we can do to do better in a team process the doctor
33:16
feels better about it and also doesn’t feel like they’ve just thrown the staff over the over the cliff they really do
33:23
if you really can sit there and say okay this day didn’t go well let’s let’s do a
33:28
little Monday Morning Quarterback to find out why it didn’t go well is there something we all could have done differently in this process could the
33:35
doctor have shown up 15 minutes early could you know was there something in that day did the patient show up later
33:41
is like really dive in and give them Solutions of where we can go we’re finding that some of your patients just
33:47
simply aren’t coming or your staff’s communicating and our staff communicating differently we need to get
33:53
the staffs together so that they’re sending the one message to them and that’s where it comes down to
33:59
creating the positive atmosphere and especially what a lot of what Elisa said but the positive atmosphere with the
34:05
doctors is at the end of the day and I hope all of you are sharing different jobs and ASCS and stay in
34:12
Ambulatory Surgery um I’ve been it for the long term because I really feel that we are
34:17
providing something that’s we are it’s our time and we are the future here and
34:23
the one thing looking back I was just at a conference this past weekend with a number of my doctors and just hearing
34:29
them and realizing I’ve known you for 20 years I’ve watched you get married I’ve watched your kids
34:35
grow up I’ve watched your kids graduate you know we we have a connection and we have a friendship that we’ve developed
34:42
because we’ve known each other for this many years and I have to tell you with that our doctors become our biggest disciples to
34:49
you know we need to build somewhere else we need to you know there’s another part of New York we’re actually in the
34:55
process of building a surgery center in Staten Island because there isn’t one there but it was you know my doctors are
35:02
from Manhattan Queens some are from Brooklyn but the issue is that these doctors out there didn’t have one it was
35:08
my Manhattan queens and other doctors that came forward and said you know we really need to have a center out here
35:13
why don’t you talk to The Gramercy people about what they can do and that’s one of the things that that’s
35:19
the greatest compliment when your doctors are actually recommending you recommending your Center going forward and then again it ties in as I keep
35:28
saying back and forth with what Elisa said is that if the staff and you’re
35:33
creating kind of a community and family setting and I think you can do that even as you grow you can do that in each
35:39
individual Center you’re doing it if you’re true to the same points that you’re always going to be available and
35:44
understand what the doctor needs the one factor I say and just underline even if it’s a doctor with a high volume
35:51
if you absolutely can’t deliver it don’t promise them that you can because the issue is it’s just going to be a bad
35:57
relationship going forward but as I said doors open later on and that happened in
36:03
our situation with the surgery center downtown that we were able to create the surgery center for them and we were able
36:09
to build in and participate in that Center and bring other doctorates to the center which we just simply weren’t
36:14
going to be able to accommodate at ours so I think overall that relationship
36:19
just remember the doctor’s relationship is long-term you want that doctor to be a disciple for your Center and the only
36:26
way he’s going to do that is if he feels he’s validated treated with respect
36:33
and um realistic expectations and I think long term those realistic expectations
36:40
develop a deep relationship that you can have for many years to come
36:45
that’s kind of my presentation that’s awesome Jeff thank you a lot of great tips in there we did have one
36:51
question come in um someone said Jeff appreciate what you’re doing in New York how do you
36:58
recruit Physicians it’s one of the best things to do is
37:04
the easiest thing to do you all have good relationships with your reps that come in let them go into the staff room
37:11
don’t make them wait in the lobby don’t be adversarial to them if you bring them in they’re going to tell you about
37:17
surgeons because I can tell you right now especially this is one tip with there’s a few things I can suggest but
37:22
with reps for instance if they think they’re going to get in and out of your surgery center very quickly and it’s a
37:29
pleasant experience they’re going to recommend other doctors especially when they go into the hospital for your
37:34
Center I found that count countlessly with several reps have have literally
37:39
brought me doctors because you know they don’t want to wait an hour between cases at the hospital but at the
37:45
same rate when they came in they were welcome to come right in they signed in they changed into scrubs they weren’t
37:50
made to wait in the lobby they go go to the staff room have some coffee let’s you talk with your doctor going forward
37:57
that’s one area and that’s a key way to get people faster the other thing is in your community is asking your other
38:03
doctors around you is like who who are who’s who’s busy at the hospital
38:09
finding out who’s efficient those types of things go and visit those offices a
38:14
lot of times you won’t get through to the doctor but if you’re actually formulating that relationship to go and
38:19
visit with a doctor that’s a key factor I have a special thing I do at the beginning when a doctor starts here I
38:26
make my scheduling and patient admission team has to physically go with me to the
38:32
doctor’s office they have to meet the doctor’s staff and understand that we’re now on the same team and this is why we
38:39
called for this meeting together and then separately I have our scheduling manager not only checking in via phone
38:45
and now obviously Zoom often but also occasionally once a quarter just go out
38:51
these next two days and just swing through all the offices and visit them just ask how things are going show up
38:56
show up with something cookies donuts or anything but let’s make sure that we’re meeting all their needs and let’s make
39:02
sure that they understand that they matter to us and by showing that presence the doctors
39:09
um because very often let’s face it um if the staff has a choice to book cases
39:15
they’re going to book it at the the least of resistance whichever is easier for them to book a case that’s where
39:21
they’re going to book it if it’s left to them and very often in busy practices it is left to scheduler to decide where that
39:28
patient is going to be done and you have the opportunity there to make it that you’re the favorite place
39:34
to be done perfect thank you great great tips there
39:40
thank you Jeff that was awesome and Switching gears to Chris to talk
39:45
about people I’m sure no one’s worried about Staffing right now
39:53
hello everyone um you can change the slide
39:58
so we’re going to talk about unfortunately burnout you know we I think we all by now had hoped that the
40:05
situation with our staffing issues would be over unfortunately I think going into 2023 we’re still seeing issues with
40:13
Staffing and it’s not just finding the right staff it’s training of the staff I
40:18
think it it’s and again like Jeff said as we increase our technology there is a
40:24
lot more training that is involved and so I just think that burnout is still a
40:29
real issue and I put a couple of definitions you know burnout can ruin someone’s health or become completely
40:37
um exhausted through overwork I know in our area we’re still seeing a lot of
40:42
illness we’re seeing um still seeing a lot of cold influenza
40:48
I think some of the health care team doesn’t take care of themselves because they’re running on the the little
40:55
um rats wheel you know by trying to be more efficient trying to be fast paced
41:00
so we’re seeing you know a lot of issues with mental health in my area so I’m in
41:06
the state of Michigan um I think we saw what did they tell us 20 minutes of sun in the month of
41:11
January so we deal with a lot of seasonal depression as well and it and it’s just another contributing factor
41:17
when you’re also expecting a lot of your employees or your staff at in the
41:22
workplace um another thing that causes burnout could be doing one task for too long
41:28
um we try to do assignments of our health care team where their staff or
41:34
their assignments on a daily basis or a weekly basis are varied and we cross
41:39
train so that you don’t have one person doing the same job over and over at times that can become very monotonous
41:46
and lead to that again burnout and a negative feeling and the third definition there is
41:51
fatigue frustration apathy resulting from prolonged stress overwork or
41:56
intense activity these all these things also affect your staff morale you know we’re in a world
42:03
where we’re trying to retain staff and so we need to be pay attention to these
42:08
things and and how do we avoid this um and so the next few slides we’ll talk
42:14
about that so next so I think some of the causes of burnout
42:20
that we’re seeing in the in the world that we’re living in today is our patient Acuity is at a higher level you
42:27
know used to be the ASCS had their patients were the healthy patients they
42:32
were coming in having a procedure done going home everything was great I do think now we’re seeing a higher ASA
42:39
classification of patients I think that our acuities have become higher we’re
42:45
dealing with a lot more issues with our patients I also think that Physicians do
42:50
they do like our ASCS and we work in a block time model but yet we always have
42:57
those that push the envelope and I just got to put one more case on it’s only going to take me so long but that adds
43:03
to the staff burden of staying later coming in earlier we’re seeing a lot of
43:09
ads and cancels which sometimes you think ah what does that mean but it really affects the team when they the
43:16
night before go home and think okay tomorrow we’ve got 18 patients and all of a sudden they come
43:21
in and now they have 22. so I think that that does affect the staff it is it
43:27
affects the receptionists that that have to prepare all the work the charts and
43:32
get all the paperwork ready repetitive patient care assignments that can also lead to burnout we’ve tried very hard to
43:39
do a lot of cross training so we’ve looked at how do we split those
43:44
assignments how do we make it so it’s not so repetitive I’m in a single specialty Ambulatory Surgery Center so
43:51
you do tend to have a lot of repetitive tasks and so we’ve also looked at our staff mix let’s let’s add in some LPNs
43:59
some nursing assistance we have scrub text obviously our RN staff and how do we all work together to take
44:06
some of the burden off and and no task is beneath anyone else so all of our
44:12
tasks nothing is too small or too big for us to handle so we help each other out in whatever way that we can
44:19
another issue that that we’re all facing still is Staff turnover step turnover leads to negative attitudes it’s
44:26
expensive for the Ambulatory Surgery Center because now you’ve have to recruit and train and so we really need
44:34
to look at how do we prevent that staff turnover and one of the things that has really helped us too when we look at our
44:39
recruiting of of staff is we ask the staff that’s working with us and say hey do you know of anybody
44:46
um we try to to give the positives of the environment you know Monday through Friday we’re not on call we don’t do
44:52
weekends no holidays so we’re trying to do some of those things too to help us recruit some new team members and again
45:00
another cause of burnout can be the continual training you know do you use
45:05
one or two preceptors that that get burned out of having to always be the trainer we’ve tried very hard to
45:11
recognize the strengths of our employees and say okay let’s split up the training so it’s not only one or two people who
45:18
shoulders it fall awesome next
45:24
so I wish I had all the answers for all of you I have a few pearls to give you
45:30
to help prevent staff burnout again cross-training of Staff look at the jobs
45:35
within your organization and how do you cross-train my scrub techs now are
45:40
learning how to work in the recovery area so that they do get something a little bit different we’ve created some
45:46
different positions we have what we call a go-between which helps turn the rooms
45:51
over um and that’s kind of a nice break and it usually one of the scrubs it’s kind of a nice break from scrubbing day after
45:58
day um we’ve also created a what we call a CRNA position and that nurse works in
46:07
the pre-op area and helps keep the flow going for that day so she helps move the patients she’s kind of the logistics
46:13
coordinator of the pre-ap area another thing to make sure that you’re doing is providing staff breaks I know
46:20
in this busy world it is hard we have one person uh nurse that comes in and and her assignment for the day is Staff
46:27
breaks and boy does that make a difference and then uh that goes along with stat breaks is what’s the
46:33
environment for your staff to take a break you know have you in nice weather have you put out a picnic table or
46:40
something outside so that your employees can just take a break from the inside and be able to get outside we’re
46:46
fortunate that we have a botanical gardens across the street from our facility and so sometimes the staff will
46:52
go over there and just just walk for their their uh lunch break again
46:58
um both of the previous speakers alluded to positive reinforcement and positive reinforcement doesn’t have to be huge uh
47:05
a truly heartfelt thank you from members of the health care team especially the
47:10
Physicians and the anesthesia providers for a job well done great day I try very
47:16
hard to do um personal written notes I do think that
47:22
that a written Note versus an email says a lot it speaks volumes
47:27
um we’ve got in our organization we call it an employee engagement committee where they do four things throughout the
47:34
year and one of the things that was a huge impact is every employee was given five thank you cards and a pen and we’re
47:43
challenged to write a thank you note to five other employees and I had one
47:48
employee that had given her termination and after that activity when she started
47:54
thanking her team members she realized she was in the right environment for her to work and so she took back her
48:00
resignation so we saved one and then again what are what are your staff retention techniques you know do
48:07
you offer a bonus are you giving a sign on bonus um do you offer tuition reimbursement I
48:14
know that an Ambulatory Surgery Center some of those things are hard to do so how do you retain your staff I think for
48:20
us in our environment it’s the team my team steps up to the challenge they help each other they look around and they can
48:26
see someone that’s struggling and they’ll jump in and help I myself as the
48:32
administrator and my charge nurse we both take patient care assignments
48:37
um to help the team members one of the other things is where my office sits I can look right out my window and I see
48:43
my pre and post-op area and I can see when they’re struggling and I can jump up and help them so I think it’s all
48:49
about the team we need to be a strong team and again um Jeff brought this up too is your
48:55
anesthesia providers you know they’re part of the team as well and utilize them to help make a positive influence
49:02
and reinforce enforcement of the rest of your team so I wish you all luck in helping to prevent burnout for your staff and to
49:09
think of creative ways to keep the staff and to motivate them thank you thank you Chris that was awesome we did
49:16
have one question um you kind of alluded to this a little bit but have you ever tried giving a
49:22
referral bonus to current staff for referring a new employee yes thanks for bringing that up we do
49:29
offer that we do have a referral bonus and it’s paid out in two segments so
49:35
they get the first half when the employee starts and they get the second half after the employee has been with us
49:42
for six months so yes thank you for bringing that up we have done that and we continue to do that
49:49
perfect thank you so much all right switching to our last pillar
49:55
here but certainly not least is payers so Kayla go for it I think you can go
50:01
and go to the first slide please yes um so ases can offer serious savings for
50:08
the payers and this plays in part Africa plays a part in this in your
50:14
state organization State organizations play a part in this because they do a lot of lobbying to
50:20
show that Medicare and show payers that ASCS do help save them millions and
50:27
millions of money um some of the the cost treatments can be 40 less than ASE compared to the
50:33
hospital I know for cataract 66984 Medicare on the Medicare website on the
50:39
procedure price lookup uh website it’s they’re they’re paying almost double
50:45
what they’re paying they’re paying hospitals almost double what they’re paying the surgery centers so I’ve added
50:50
on here the Medicare website it um if everybody hasn’t seen that yet so Medicare has a website that you can go
50:56
in and type in patients can go in or the surgery centers and go in and type in um the procedure code or the procedure
51:03
name and they can see what the patient’s going to pay and then they can do a drop down for more details to see what the
51:10
the payer the Medicare or the payer is going to be paying the facility so that’s a good information to have
51:16
um and then payers Will Will Bill High out-of-pocket expenses so if a surgery can be done safely in the surgery center
51:23
but instead is being performed in a hospital those patients are going to expect a higher bill
51:28
um so and payers are denying some coverages to help push those surgeries to the surgery centers for example in
51:36
Philadelphia we’ve got reported an ASE leader reported that insurance companies
51:41
are no longer paying for colonoscopy screenings in the hospital so that helps us as an ANC because it pushes it
51:48
towards the towards the ASCS next slide please
51:54
um just some real examples here so um Empire Blue Cross Blue Shield in New York began requiring a medical necessity
52:00
review to have certain procedures performed in an outpatient hospital setting instead of an ASE the United
52:06
Healthcare Group made a commitment to push more surgeries to ases according to the company report the group aims to
52:13
have more than 55 percent of its members outpatient surgeries and Radiology Services
52:19
delivered at a cost-effective site of care in 2030 which means directing me
52:25
patients to ASCS which is good for us and I really hope we do see that moving forward next slide please
52:33
um value-based payment models this is important and this is what we were talking about earlier so as he’s need to
52:40
arm themselves with powerful data so value-based payment models what is a value-based payment model so a
52:46
value-based payment model is where the ASCS give value to the payers showing that they’re providing value to
52:53
the patients so for example we’re we’re collecting data on return to ORS and of
52:58
course our infection control and then we can also give data to prove that our technology that we have for example we
53:05
view cataract surgery here so we have the femto second laser that does laser cataract surgery and that gives patients
53:12
a better outcome because we’re it’s able to reduce the swelling in the eye which
53:18
also helps faster recovery for the patient so when you can give that data to your payers
53:24
they will help work they’re happy to work with you so bring um your room to give you better
53:29
reimbursements um so without that data you’re not going to have anything to come to negotiating tables and some of
53:36
the emrs out there um I know like HST will allow Asus to collect all the data they need to
53:42
successfully move to value-based care which is very helpful for us right now
53:47
we’re just using a simple Excel spreadsheet it makes it it makes it easy and you can get put that data together
53:54
I’ve been working with our contract Personnel here she works in accounting and a couple weeks ago I just gave her
54:02
all of our value-based data because she’s actually currently helping us renegotiate our contracts
54:09
next slide please when it comes to the to renegotiating
54:14
contracts here’s what we can do and and be involved with so you want to build a
54:21
relationship with your payers um I know we a lot of us look as payers as villains
54:27
um that they don’t want to give us our money um but we want to build that’s not really true we want to be able to build
54:33
a good rapport with our payers and connect with them regularly and they want to see that we’re involved in
54:39
looking at our contracts and so if we can build a good rapport with them they’re happy to work with us and so a
54:45
few tips if you want to look at your contracts annually you want to review them against
54:51
your Medicare rate calculator and your commercial payer fee schedules all your fee schedules some will change quarterly
54:57
so if your procedures um well let me back up so for example medicare’s rate
55:02
calculator and fee schedule comes out once a year it just came out in January but some commercial feed schedules they
55:10
will come out and change quarterly so if you’re working in like your procedures are in groupers those groupers can
55:17
change quarterly so if you’re not keeping track of those quarterly you can miss out on that reimbursement so you
55:23
want to make sure that you’re you’re checking them quite often and um and guys I understand it is a lot of work to
55:29
keep up with contracts and and to look at renewing them um so you want to if you don’t have time
55:35
to this this is where you can hire a consulting company to come in and help you
55:40
renegotiate your contracts um trust me it will pay for itself on the end you
55:46
can if if you haven’t renegotiated your contracts in quite some time you can
55:52
potentially bring in an extra 20 to 30 percent Revenue per year for your
55:57
facility so you may you want to make sure you look at your contract quite often another tip would be considering the
56:04
impact of inflation we all know inflation right now is is skyrocketing um so you want to consider the impact of
56:11
inflation on your business and compare it to your rates that are right now and then you can bring that to the negotiating table to your payers as well
56:19
and when you’re adding on a service you want to make sure you make sure that they’re on your fee schedule before
56:24
starting that service otherwise you’re gonna have a very difficult time getting paid for it
56:30
I want to make money short so we can have time for some questions so thank you guys
56:35
thank you Kayla we did have one question um what payers have you found to be open
56:41
to a value-based model is it the smaller ones or the big dogs on the bigger ones
56:48
get the most common ones um and oh and also a good tip is making sure that you
56:53
know you want to contact your payers and make sure that you know how your payers want the procedure to be built do they
57:00
want it to be built on one line item or they do want it to be building two line items because if you’re if you’re
57:05
building it on two line items but they want to build on one line item they may think you’re double billing and they
57:11
won’t get you won’t get the correct reimbursement for it so you want to make sure you contact your payers and know how they want your procedure to be
57:18
billed and all of them are not the same so you want to be able to contact all of them and find out how they want that build
57:27
perfect thank you welcome we don’t have any other questions at this time I’ll
57:32
give everybody another minute but um any other insights from any of our our
57:38
panelists here that we wanted to add or you all did a great job great insight
57:43
into to all these different pillars okay so we will wrap it up uh thank you
57:50
all again so much for joining us today especially to our speakers we’re so grateful for your time and and expertise
57:57
uh we will send everyone um an email on Tuesday uh with the link
58:03
so everyone can listen to this if they want to again and share it with their colleagues we’ll give you the slides and
58:09
and all that good stuff um and thank you again and hope you all have a great day
58:15
be so alone [Music]