State of the Industry Report: Best Practices & Industry Benchmarks for Optimizing ASC Operations

Patient Journey: Pre-Day of Service

1. Patient Begins to Research Surgery Center

Best Practices

When a patient learns they will need surgery, a million questions start racing through their mind. To get answers to those questions, they will begin researching – both online and offline – about the surgery center and what they can expect. To put their mind at ease and start their experience with you off on the right foot, they need to be able to find answers to all their questions on your website.

A website that is built correctly will cover the spectrum of the most common patient questions: How much will my procedure cost? What is the parking situation? Will my family be able to stay? How can I fill out the necessary paperwork? And so on. Your website should also allow patients to generate a financial estimate to see exactly what they will owe without proactively contacting you or, even worse, waiting for you to call them.

Covering these topics on your website will build patient trust, reduce redundant patient phone calls, and improve the overall patient experience.

Key Process Steps

Key Performance Indicators

01

Monthly website visitors

02

Website traffic referral sources

03

Monthly page views of your price transparency calculator

04

% of patients who scheduled surgery after generating a financial estimate

Benchmarking Data

Here’s how an online calculator directly translated into increased case volume and revenue for a four OR, multi-specialty facility in Greenville, SC.

 

Patient Journey: Pre-Day of Service

2. Doctor’s Office Communicates with ASC to Schedule the Case

Best Practices

The more harmonious and seamless communication is between the doctor’s office and the surgery center, the easier it will be to drive case volume effectively. As a best practice, you do not want to communicate with a doctor’s office via phone or fax. These antiquated workflows consume precious staff time, typically end with phone tag, and cause countless hurdles.

Alternatively, your surgery center should use technology that allows you to broadcast your OR availability to all your physician offices. Providing your partners with 24/7 access to your OR availability will simplify the process for them to electronically submit a request for a specific operating room on a particular date and time. Your team can then review the request and either confirm or provide a suggestion.

To improve OR usage, specifically block time usage, ASCs should remind physicians and their schedulers to release unused block times through automated emails, require unused block times to be released at least 72 hours in advance, and publicly recognize those who efficiently use their allocated block times, striving for 70% usage.

Key Process Steps

Key Performance Indicators

01

Time spent scheduling per case

02

OR utilization per physician

03

OR downtime

Benchmarking Data

On average, 44% of scheduled OR time is unused.

 

Patient Journey: Pre-Day of Service

3. Doctor’s Office Verifies Insurance Eligibility and Prior Authorization

Best Practices

Verifying insurance eligibility and obtaining prior authorization are critical steps in ensuring seamless patient care and preventing potential financial issues.

The doctor’s office should verify insurance eligibility first to confirm whether the patient’s insurance is active and covers the proposed procedure. Even after the doctor’s office completes this crucial step, your surgery center needs to re-run verification at least twice – the first time should be immediately after accepting the case, and the second time should be the morning of the procedure. You should also get into the routine of re-running verification on the first of the month for the current month’s cases to ensure coverage has not lapsed. Integrated payer technology must be used to verify coverage so that team members do not spend unnecessary hours on the phone with payers.

Insurance companies often require prior authorization for certain medical procedures. Obtaining prior authorization prevents denials and delays in reimbursement and ensures that the insurance company has approved coverage before the patient undergoes treatment. Your surgery center must verify any prior authorization obtained by the doctor’s office so you can mitigate the risk of performing a procedure that you will not be reimbursed for.

Key Process Steps

Key Performance Indicators

01

Time spent per verification

02

Pre-authorization rate

03

# of procedures that required pre-authorization but it was not obtained

Benchmarking Data

Patient Journey: Pre-Day of Service

4. Manage Case Until Date of Service

Best Practices

After a case is scheduled, it’s important to maintain contact with the patient, physician, and vendors to ensure the case stays on track. In the rare instance the case needs to be canceled or rescheduled, you can reach that conclusion with as much lead time as possible.

The key to seamlessly managing a case is centralized management. Using technology, you can oversee each surgical case from start to finish in one location accessible by the entire care team. Your front office staff, surgeon, anesthesia group, supply coordinator, and other vendors should all have access to this centralized location so they can provide updates, discuss any special requirements, share patient considerations, and ultimately prevent last-minute cancellations and potential delays.

Proactive and effective patient communication will also help ensure the cancellation or rescheduling is not initiated from the patient’s side.

Key Process Steps

Key Performance Indicators

01

Case cancellation

02

Case reschedules

03

No shows

04

Cancellation reasons

Benchmarking Data

ASCs are experiencing, on average, a 21% case cancellation rate.

 

Patient Journey: Pre-Day of Service

5. Review Case for Profitability & Implants

Best Practices

Before proceeding with any case, surgery center administrators must understand how much the center will profit (or lose) from the procedure. Surgeries are complex events – payer contracts are complicated, overhead needs to be accounted for, and costs vary significantly by procedure, especially when implants are involved. Analyzing case profitability well in advance of the date of service ensures that the center can continue to provide high-quality services without compromising financial health and that no one is blindsided after it’s too late.

While staff experience and custom spreadsheets are how most surgery centers identify potentially unprofitable cases, leading surgery centers use advanced software, such as HST, to automate the profit estimation process. By identifying your costs per OR minute, flat supply costs, and what percentage of revenue you expect, your predetermined auto-flagging settings (e.g., when an implant is needed) will highlight potential concerns and provide you with the data you need to accept, deny, or modify confidently.

Key Process Steps

Patient Journey: Pre-Day of Service

6. Send Pre-Assessment Form to Patient

Best Practices

Pre-assessment forms provide a comprehensive overview of a patient’s medical history, current medications, allergies, and other relevant health information. They are pivotal in surgical planning, risk mitigation, and patient engagement.

The most efficient way to collect this information is by communicating with patients in a way they prefer: texting. By texting patients a secure link to complete the pre-assessment form, they can do so privately and on their own time. This will enhance the accuracy of information, reduce paperwork, and improve the overall patient experience.

It is recommended that your forms have a user-friendly design, provide patients with clear guidelines and help features, are available in multiple languages, and are accessible to patients with eyesight limitations.

Key Process Steps

Patient Journey: Pre-Day of Service

7. Generate & Send Patient Estimate Prior to Date-of-Service

Best Practices

The financial aspect of surgery often causes just as much anxiety for patients and their families as the procedure itself. Trying to navigate the complexities of how much insurance will cover, what will need to be paid out of pocket by when, and hoping surprise bills don’t show up weeks or months later is extremely daunting for the average consumer.

Providing patients with an accurate financial estimate before their date of service (ideally 1-2 weeks out) allows them to plan better and prepare, ultimately enabling you to build trust, collect upfront, reduce last-minute cancellations, and improve patient satisfaction scores.

Using proven technology, you can generate accurate patient estimates in minutes, send the estimate to the patient via text or email, and allow them to submit payment. The estimate should be easy to read, devoid of medical jargon, and include a payer versus patient responsibility breakout.

Key Process Steps

Key Performance Indicators

01

Accuracy rate of estimate

02

Upfront collection rate

03

Pay in full vs. payment plan

Benchmarking Data

A typical ASC is only collecting 51% of expected patient deposits at time of service.

 

Patient Journey: Pre-Day of Service

8. Communicate Appointment Reminders & Pre-Op Instructions via Text

Best Practices

Sending patient appointment reminders and pre-operative instructions via text message is a modern and efficient way to ensure effective communication and patient preparedness. To have timely and effective dialogue with your patients, you must communicate with them how they prefer instead of forcing them to communicate with you in ways that don’t fit into their everyday lives.

Using text messages to send appointment reminders and pre-op instructions will reduce appointment no-shows and cancellations, increase patient compliance with pre-operative instructions, and enhance overall patient satisfaction. The most successful texts are timely, clear, concise, personalized, and allow for two-way communication. Plus, using readily available technology, you can build and automate your texting cadence so that it’s automatically set up for every new scheduled patient.

Key Process Steps

Patient Journey: Pre-Day of Service

9. Pull Supplies from Supply Room the Day Before

Best Practices

Ensuring that the necessary supplies are pulled from the supply room the day before a patient’s surgery is crucial for efficient surgical operations and patient safety. This will help to guarantee there are minimal to no surprises on the day of surgery.

As a standard practice, you should train all staff members to be able to pull supplies. This will help make sure there is accountability and consistency in the process. You can also develop standardized procedures for pulling supplies based on the surgical procedure. To maintain the highest levels of quality control, staff should regularly audit the supplies pulled to ensure they match the requirements and are within their expiration dates.

Key Process Steps

Patient Journey: Day of Service

1. Check in with the Front Desk & Meet with the Registration Team

Best Practices

Patients arriving for surgery with their loved ones are undoubtedly nervous and filled with questions. The check-in process is likely their first time stepping foot in your facility and interacting with your staff in person, so it’s critical that this first touchpoint is smooth and sets the right tone. Your front office team should greet patients with a friendly and empathetic demeanor. Having a designated area for check-ins will maintain patient privacy and prevent sensitive information from being overheard. Lastly, you’ll want to communicate the next steps, timing, and expectations to the patient and their family/ride home.

Leading surgery centers are also exploring patient kiosks to assist with patient check-ins. For the patients, it offers faster check-ins and shorter wait times; for your staff, it provides automated workflows and accurate data and reporting. Your front office team will always be there to answer additional questions, but this process will allow for automation and improved patient flow.

When your team is ready to bring the patient back, avoid standing in the doorway and calling out the patient’s name. Instead, the receptionist can note the patient’s name and location in the waiting area, and when the nurse comes to get the patient, they can approach them directly, introduce themselves, and personally escort them. This small change creates a more personalized and positive experience for both the patient and the staff, setting the tone for exceptional care.

Key Process Steps

Patient Journey: Day of Service

2. Collect Outstanding Balance from Patients

Best Practices

The art of collecting outstanding balances from patients on the day of their surgery is entirely contingent on how you have communicated with them up to this point and the level of price transparency you have shared.

Patients should never hear how much they owe for the first time on the morning of their procedure. This will only add to their anxiety and make them feel overwhelmed and blindsided. In a previous chapter, we discussed the best practices for generating and sending an estimate as early as possible (ideally weeks before their surgery). Your day-of-collection success is strongly influenced by how that step was handled.

Regardless, on the day of, you will need to have a financial discussion with the patient, clearly laying out an itemized breakdown of any co-pays, deductibles, or out-of-pocket expenses for them. You should be prepared to accept payment via credit card and provide a receipt. Your staff should then update the patients’ records to include payment transactions, dates, amounts, payment methods, and payment plan agreements.

Key Process Steps

Patient Journey: Day of Service

3. Prepare the Operating Room, Equipment, and Supplies

Best Practices

Efficiently preparing the operating room, equipment, and supplies is critical to ensuring successful surgical procedures within a surgery center. Proper preparation not only promotes patient safety but also contributes to the overall effectiveness of the surgical team.

Properly preparing the operating room, equipment, and supplies is a multifaceted process that demands attention to detail, collaboration, and adherence to established protocols. Proper preparation not only promotes patient safety but also contributes to the overall effectiveness of the surgical team and better surgical outcomes.

Standardized checklists, collaborative planning, and proper inventory management are crucial to making this part of the workflow seamless.

Key Process Steps

Key Performance Indicators

01

OR turnaround time

Benchmarking Data

Patient Journey: Day of Service

4. Patient & Care Team Enter Pre-Op

Best Practices

The seamless entry of patient and the care team into the pre-operative (pre-op) area is crucial to ensuring the safety, comfort, and efficiency of surgical procedures. This phase sets the tone for the entire surgical experience, contributes to positive surgical outcomes, and enhances the overall patient experience.

The pre-op team should provide patients with clear and concise information about what to expect during the procedure. This includes explaining the process, addressing any concerns, and outlining the roles of different team members. At this time, it’s also critical that you verify that the patient’s consent forms are properly completed and signed and review the patient’s medical history, allergies, and any pre-operative medications one final time.

Key Process Steps

Patient Journey: Day of Service

5. Patient & Care Team Enter OR

Best Practices

The entry of patients and the care team into the operating room is pivotal in the surgical process, requiring precision, communication, and adherence to strict protocols. Surgery center leaders and staff must establish a seamless and organized approach, prioritizing patient safety, sterility, and effective communication.

When entering the OR, all care team members must adhere to the highest level of sterility within the operating room and enforce rigorous protocols to prevent contamination and reduce the risk of surgical site infections. For a successful surgical outcome, the surgical lead should ensure everyone knows the surgical plan, patient history, and any specific considerations. The OR nurse and surgeon must confirm that all necessary surgical instruments, equipment, and supplies are available and properly arranged within the OR. As a required practice, you’ll always want to verify that the patient’s consent forms are accurate, complete, and signed and that you’ve completed the surgical safety checklist and the Time Out checklist per center protocol.

Key Process Steps

Key Performance Indicators

01

Start time expected vs. actual

02

Surgery duration expected vs. actual

Benchmarking Data

Patient Journey: Day of Service

6. Share Patient Updates with Family/Friends

Best Practices

Keeping family and friends informed about a patient’s status during surgery is critical to patient-centered care. Effective, timely, and proactive communication comforts loved ones, fostering trust and transparency. If you do not set clear expectations with patients’ loved ones on when they can expect an update and how the updates will be shared, your front office staff will be inundated with family members approaching the desk or calling the front desk, ultimately distracting your team from providing care and working on other tasks.

To make sharing updates seamless, offer multiple communication channels, such as text messages or surgery boards in the waiting room, where real-time status updates can be displayed. These surgery boards provide a visual and immediate way for family members to stay informed without needing to inquire constantly. Train staff to communicate updates with empathy, sensitivity, and professionalism. Use clear, jargon-free language that non-medical individuals can easily understand. Lastly, develop a consistent format for sharing updates, including information such as the patient’s condition, progress, and any relevant milestones.

Key Process Steps

Patient Journey: Day of Service

7. Patient is Moved to Recovery Area

Best Practices

The safe and efficient transfer of patients from the operating room to the recovery area requires careful coordination, monitoring, and attention to the patient’s well-being.

The care team must continuously monitor the patient’s overall condition during the transfer and initial recovery phase. You’ll want to foster clear and effective communication between the surgical team, anesthesia providers, nursing staff, and the patient, double-checking that everyone knows the patient’s status and any pertinent details.

Prioritizing the patient’s comfort, dignity, and emotional well-being and promptly addressing any pain, discomfort, or concerns will improve patient satisfaction and overall experience. Lastly, keep family and friends informed about the patient’s transfer to the recovery area. Accurate and reassuring updates will provide relief from their stress and worry.

Key Process Steps

Key Performance Indicators

01

Post-op recovery time

Benchmarking Data

Patient Journey: Day of Service

8. Patient is Discharged

Best Practices

The moment the patient and their loved ones are waiting for – it’s time to go home! While this is the final step in the patient’s journey at your facility, it’s equally as important as the previous steps, and it’s critical that the discharge process is seamless and thorough.

Clear communication is the key to success. Straightforward guidance on medication management, wound care, activity restrictions, and potential complications helps prevent avoidable errors and adverse events during recovery. When done correctly, proper discharge instructions lead to optimal recovery and empower patients to take appropriate actions if they notice any signs of trouble.

It is recommended that you provide verbal and written instructions in your patient’s native language and that you use clear, jargon-free language that non-medical individuals can easily understand.

Key Process Steps

Patient Journey: Post-Day of Service

1. Check-in With Patient

Best Practices

Checking a patient’s health the day after surgery is vital in providing comprehensive post-operative care. Prompt and proactive follow-up will demonstrate dedication to your patient’s well-being and foster patient trust, satisfaction, and successful outcomes.

Your patient engagement software, such as HST, should present you with a clear, straightforward list of which patients need to receive a phone call and which already have. Implementing a process like this will streamline follow-up and make it clear to all care team members the status of each patient. It is also recommended that post-phone call, you communicate any additional post-operative instructions via text to your patients, allowing them to respond via text and have two-way communication. You will then want to maintain detailed and accurate records of follow-up interactions, including the patient’s condition, any symptoms, and advice given.

Key Process Steps

Patient Journey: Post-Day of Service

2. Review Chart for Completion and Close

Best Practices

Closing the patient’s chart the day after surgery is a crucial task to make sure all necessary documentation, including surgical notes, post-operative instructions, and billing information, is complete and accurate. This not only aids in providing coordinated and comprehensive post-operative care but also ensures compliance with regulatory requirements and helps minimize legal risks.

Using an EHR to streamline reviewing and completing the patient’s chart is a game-changer. Electronic charting helps guarantee that all necessary information is easily accessible and updated in real time and that charts are closed in a timely manner. It also allows doctors to review and sign from wherever they are (no more stalking them in the hallways trying to get them to sign off on a paper chart!) and can provide visual indicators of completed charts to stay organized.

Key Process Steps

Key Performance Indicators

01

Post-DOS chart completion rates

Benchmarking Data

Patient Journey: Post-Day of Service

3. Send Patient Satisfaction Survey

Best Practices

Patient satisfaction surveys are essential for surgery centers to assess the quality of care provided, identify areas for improvement, and ultimately enhance the overall patient experience.

The timing of when you distribute the survey is crucial. You want to send the survey while the experience is fresh in your patient’s mind, but you don’t want to send it too soon as the patient may still be experiencing side effects of the anesthesia or potentially in discomfort. Typically, 48 hours post-surgery is the perfect time to distribute. Distribution methods also play a huge role. Using email and text to send a survey link, versus collecting feedback over the phone or via mail, will keep costs down and increase response rates. Other ideas for success would be ensuring anonymity, keeping the survey concise and easy to read, and personalizing with the patient’s name.

Lastly, it is recommended that you build alerts and triggers into your collection software, such as HST, to notify the administration immediately if there are any words within the open-ended questions that may warrant immediate attention (e.g., infection, hospital, or pain).

Note: Once OAS CAHPS becomes required in 2025, you will need to ensure you are properly distributing, aggregating, and reporting results. Given that the OAS CAHPS survey consists of 31 questions, many ASCs may opt for the minimum necessary to meet the survey requirements. However, for the remaining patients, ASCs can offer a more concise and personalized patient survey. This approach allows ASCs to strike a balance between compliance and meaningful patient responses.

Key Process Steps

Patient Journey: Post-Day of Service

4. Perform Coding & Charge Entry

Best Practices

Accurate and timely coding and charge entry are fundamental to any facility’s financial health and operational efficiency. The process involves assigning appropriate codes for procedures and entering the corresponding charges into the billing system. This is crucial for reimbursement and compliance with regulatory requirements and maintaining a transparent and efficient billing process.

Utilizing EHR and practice management systems, ideally integrated with a clearinghouse, will help to streamline the process significantly. Human error is inevitable, but using software, such as HST, and employing well-trained coders who are well-versed in the latest coding standards and guidelines will help reduce denials and avoidable mistakes. When a denial occurs, it’s important to take meticulous notes and review to avoid the same errors in the future.

Key Process Steps

Key Performance Indicators

01

Time spent to make each entry

02

Charge lag (time between DOS and date charges are entered)

03

Denial rates due to coding errors

Benchmarking Data

On average, ASCs are taking 4.4 days to bill post-DOS.

 

Patient Journey: Post-Day of Service

5. Perform Claim Management

Best Practices

The financial sustainability of surgery centers heavily relies on an efficient and effective claim management process. Claim management involves preparing, submitting, tracking, and managing insurance claims for the services provided by the surgery center. Proper claim management ensures timely and accurate reimbursement, which is crucial for maintaining cash flow and operational efficiency. Furthermore, it also plays a critical role in compliance with payer requirements and regulatory guidelines.

Advanced technology, including EHR, practice management, and electronic claims submission systems, will streamline the entire claim management process. You will also need to regularly monitor the status of submitted claims to identify and address any issues, such as denials or requests for additional information, in a timely manner.

Key Process Steps

Regularly Recurring Operations: Daily/Weekly

Order Supplies

Best Practices

Ordering new supplies to restock the inventory room is a crucial part of operations. An adequate stock of necessary supplies ensures that the center can operate efficiently and provide patients with the highest level of care. On the other hand, inadequate supplies can lead to delays, increased costs, and even compromise patient safety.

Implementing best practices and following key process steps are essential for maximizing the efficiency and accuracy of the ordering process. Regularly checking inventory levels, utilizing an automated inventory management system, establishing minimum and maximum levels, implementing a standardized ordering process, building solid relationships with reliable suppliers, and regularly reviewing supplier performance are all critical steps. Proper attention to each process step will ensure that the surgery center always has an adequate stock of necessary supplies.

Key Process Steps

Regularly Recurring Operations: Daily/Weekly

Review Shift Coverage

Best Practices

Confirming adequate staff scheduled each week is essential for the smooth functioning of the center, maintaining high levels of patient safety, and ensuring employee well-being. Overstaffing can lead to increased costs, while understaffing can lead to delays, decreased quality of care, and employee burnout. Utilizing staff scheduling software, considering staff preferences, regularly reviewing staffing needs, and implementing a fair and transparent scheduling process are all elements of success.

With the nationwide staffing shortage, retention and satisfaction are more important than ever. Another strategy to consider is cross-training. Cross-training increases efficiency as tasks can be redistributed based on the workload and staff availability, increases job satisfaction as staff members gain new skills, optimizes staff schedules, and reduces overtime costs.

Lastly, leading surgery centers see success when they implement scheduling software that allows staff to see and manage their schedule, adding a sense of control and autonomy that leads to the work/life balance that works for them.

Key Process Steps

Key Performance Indicators

01

Coverage

02

No-shows

03

Late arrivals

04

Overtime hours

Benchmarking Data

Regularly Recurring Operations: Daily/Weekly

Review Collections, Outstanding AR, and Claim Denials

Best Practices

Regularly reviewing financial metrics is essential for maintaining healthy cash flow, identifying and addressing issues promptly, and ensuring the financial sustainability of your center. Successful financial management includes, but certainly is not limited to, having a strong denial management process, regularly reviewing payer contracts, using a proactive collections approach, and consistently monitoring financial metrics.

Leading surgery centers employ advanced practice management software, such as HST, that can track collections, accounts receivable, and denials in real time, generate reports, and provide insights into the center’s financial health at a moment’s notice. The most seamless revenue cycles utilize as much software and automation as possible.

Key Process Steps

Key Performance Indicators

01

Denial rate

02

Days in A/R

03

A/R Aging: 30 days, 60 days, 90+ days

Benchmarking Data

 

 

Regularly Recurring Operations: Daily/Weekly

Follow Up with Patients on Overdue Balances

Best Practices

Following up with patients on overdue balances every week is essential for maintaining healthy cash flow and ensuring the financial stability of a surgery center.

It is common knowledge that collecting payment upfront, before the patient’s procedure, is a best practice for a multitude of reasons. But it is also common knowledge that as patient responsibility continues to increase, upfront collections will become more complex, and more and more patients will delay payment and opt-in to payment plans. Your surgery center must be prepared.

Implementing a clear communication strategy, utilizing advanced billing and collections software, such as HST, implementing a structured follow-up process, providing multiple payment options, and training staff on effective communication are all crucial elements for successful follow-up on overdue balances.

Key Process Steps

Regularly Recurring Operations: Daily/Weekly

Reconcile Discrepancies in Posted Payments

Best Practices

Discrepancies in posted payments can lead to significant financial issues and headaches, including cash flow problems, inaccurate financial reporting, and strained relationships with payers and patients.

To improve the accuracy of your reconciliation process, your billing team should have access to advanced payment processing software, such as HST, that can automatically post payments, identify discrepancies, and generate reconciliation reports. Your billing team should also be knowledgeable enough to identify the root cause of the discrepancy to help avoid the same outcome in the future (such as incorrect procedure codes, insurance denials, internal posting errors, and so on).

Additional tips for successful reconciliation include implementing a standardized reconciliation process, regularly reviewing payer contracts, and maintaining accurate and complete patient payment records.

Key Process Steps

Regularly Recurring Operations: Daily/Weekly

Review Quality Outcomes

Best Practices

Ensuring high-quality outcomes is the #1 priority for any surgery center. Quality outcomes not only lead to better patient satisfaction and improved reputation but also can impact the center’s financial performance through payer reimbursements and avoiding potential penalties and lawsuits.

Every surgery center needs to implement a comprehensive quality measurement system that tracks various quality indicators, such as surgical complications, infection rates, burns, falls, and more. Between your electronic charting software and your practice management software, such as HST, there will be various locations for discharge nurses to input these data points and provide comprehensive analytics and reports for you to pull and review easily.

Achieving high-quality outcomes requires surgeons, nurses, anesthesiologists, administrative staff, and the rest of the care team to be engaged and proactive. To build a culture around improving outcomes, regularly review and update the quality indicators being tracked, share results, crowdsource ideas for improvement, and implement a continuous improvement process.

Key Process Steps

Regularly Recurring Operations: Daily/Weekly

Perform Audit of Medication Cabinets

Best Practices

The current methods used by most surgery centers for managing narcotics (double-locked cabinets and paper logs) present numerous vulnerabilities and create an environment that is highly susceptible to drug diversion. Due to these standard practices, an estimated 95% of drug diversion incidents go undetected [Source: MedServe].

To prevent drug diversion at your surgery center, leadership will need to conduct mock investigations to prepare staff, implement rigorous documentation processes, foster a culture where staff feel safe reporting suspicious activities, and require dual verification every step of the way. Digital narcotic cabinets offer the most secure solution for centers able to afford technology.

Regular auditing of medication cabinets is also essential to prevent drug diversion. Conducting audits at regular intervals, such as weekly or monthly, establishes a routine check that keeps discrepancies in check. Additionally, performing unannounced spot checks helps detect any irregularities between scheduled audits. By following these best practices, surgery centers can significantly reduce the risk of drug diversion and promote a safer environment for patients and staff.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Review Profitability Reports

Best Practices

After patient outcomes, profitability is the second highest priority for surgery centers.

Regularly reviewing profitability reports is essential for understanding the center’s financial performance and making informed decisions to enhance profitability. Doing so monthly allows timely detection of any issues and enables the center to implement changes quickly.

As a best practice, your financial and administrative staff should leverage advanced financial analytics tools and practice management software, such as HST, to aggregate and analyze data from various sources, identify trends, and generate actionable insights. In addition, they should also implement a standardized reporting structure that includes key financial indicators, such as revenue, expenses, and net income, as well as detailed breakdowns of these indicators.

Proper attention to each step of the process will ensure that the surgery center can identify and address any areas for improvement, maintain profitability, and provide financial stability.

Key Process Steps

Key Performance Indicators

01

Expected profitability per case vs actual profitability

02

Net revenue by surgeon or specialty

03

Net revenue by payer

04

Net revenue

05

Monthly case volume

Benchmarking Data

Regularly Recurring Operations: Monthly/Quarterly

Review Accreditation, Compliance, and Credentialing Statuses

Best Practices

Regularly reviewing accreditation, compliance, and credentialing statuses is essential for ensuring the highest standards of patient care and safety, maintaining operational integrity, and mitigating risk.

First and foremost – it is recommended that you maintain a centralized electronic database of all accreditation, compliance, and credentialing documents and statuses. Without software, such as HST, that utilizes automated tracking and alerts for upcoming deadlines, this process will be burdensome and a major headache with all the moving parts. You should involve key stakeholders, including clinical staff, administrative staff, and leadership, in the review process to ensure comprehensive evaluation and adherence to standards. Lastly, make sure to conduct regular internal audits to assess the center’s adherence to various accreditation, compliance, and credentialing requirements. This includes but is not limited to CMS, JCAHO, AAAHC, The No Surprises Act, state licensing, maintaining physician credentials and privileges, and more.

Key Process Steps

Key Performance Indicators

01

Accreditation renewal rate

02

Compliance audit pass rate

03

Incidents of non-compliance

04

Physician re-credentialing rate

Benchmarking Data

Please note this data below represents ASCs that participated in ASCA’s Benchmarking Program, and not the entirety of the outpatient industry.

 

Regularly Recurring Operations: Monthly/Quarterly

Perform Emergency Preparedness Drills

Best Practices

Emergency preparedness involves planning, organizing, and training for unexpected events that could disrupt the center’s normal operation or pose a risk to the safety of patients, staff, or visitors. Performing emergency preparedness drills monthly is essential to ensure that all staff are familiar with the emergency procedures, can respond quickly and effectively in an emergency, and can identify and address any areas for improvement in the emergency response plan.

Creating a comprehensive emergency response plan for different scenarios (like fires, power outages, medical emergencies, or active shooters) is key to effective preparedness. Involving all staff, planning for EHR downtime, simulating real-life scenarios, regularly updating the plan, and documenting drills and debriefings are essential steps in ensuring readiness.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Perform Marketing Review

Best Practices

Surgery centers are often reluctant to lean into marketing because patients are just continuously referred to them, so what does marketing matter? But marketing is about more than just attracting new patients. It’s about building and maintaining relationships with existing patients, the local community, and other potential partners. A good marketing plan includes strategies for keeping patients engaged and satisfied with the services provided, which can lead to repeat business and referrals.

There are plenty of affordable and talented marketing agencies or consultants who could help you develop a simple marketing plan to help build your brand, design your website, establish a solid online presence, create effective messaging, work with local media, drive revenue, and increase case volume.

A well-thought-out marketing plan with clear objectives will help give a competitive advantage, manage reputation, and succeed long-term.

Key Process Steps

Key Performance Indicators

01

Website traffic

02

Social followers

03

Website conversions

04

Patient reviews on Google, other sites

Benchmarking Data

Regularly Recurring Operations: Monthly/Quarterly

Manage Payroll

Best Practices

Payroll management is a critical function for any organization, including surgery centers. It involves calculating employee salaries, withholding taxes and deductions, paying employee salaries, and filing taxes with government agencies. Completing payroll accurately and on time is essential to maintain employee satisfaction, comply with legal requirements, and maintain the center’s financial stability.

For maximum success, use specialized payroll software to automate the payroll process, reduce manual errors, and guarantee compliance with tax laws and regulations. Use software to maintain accurate and up-to-date employee records, including hours worked, overtime, and vacation days. Lastly, stay up-to-date with the latest legal and tax requirements to ensure compliance and avoid penalties.

Key Process Steps

Key Performance Indicators

01

Error-free paychecks

02

Payroll processing time

03

Overtime percentage

04

Labor cost ratio (total expenses vs. overall expenses)

Benchmarking Data

Regularly Recurring Operations: Monthly/Quarterly

Perform Financial Review

Best Practices

Financial management, planning, and budgeting are essential functions for the successful operation of a surgery center. They involve forecasting revenue and expenses, creating a budget, monitoring financial performance, and making necessary adjustments to ensure the financial stability and sustainability of the center. Reviewing these functions monthly allows the center to promptly identify and address any financial issues and make informed decisions supporting its overall objectives.

Using specialized practice management software, such as HST, to streamline the planning, budgeting, and monitoring process will ensure the accuracy and completeness of the financial picture and remove as much manual input and analysis as possible. Involving key stakeholders from the beginning, such as your board of directors, management groups, and administrative staff, will also make sure everyone has alignment and buy-in for the plan/budget. The last thing anyone wants during a board meeting or monthly financial review is for surprises to pop up!

Key Process Steps

Key Performance Indicators

01

EBITDA

02

Revenue growth rate

03

Budget variance

04

Cash flow

05

Budget preparation timeline

Benchmarking Data

Regularly Recurring Operations: Monthly/Quarterly

Hold Quarterly Board Meetings

Best Practices

Board meetings are an essential aspect of the governance of surgery centers. They provide a forum for the board of directors to discuss strategic issues, review financial and operational performance, ensure compliance with legal and regulatory requirements, and make important decisions that will impact the center’s future. Holding board meetings on a quarterly basis allows the board to stay informed about the center’s activities, address any issues promptly, and provide the necessary guidance and support to the center’s management team. It is recommended that you schedule your meetings 2-3 weeks after the quarter ends, do your best to keep them under an hour, and offer the option to join in person or virtually.

While board meetings might not be the most exciting part of running a surgery center, you can make them most effective by preparing a detailed agenda, utilizing consent agenda and action(s) without meetings, and building in engagement. It is also critical that you record detailed minutes of the board meeting, including the discussions, decisions made, and any actions to be taken, as accreditation bodies will be reading these in detail.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Perform Infection Control Audits

Best Practices

Infection control is critical to patient safety and quality of care in surgery centers. Regular audits of infection control practices and procedures are necessary to obtain compliance with established standards and guidelines, identify potential areas of improvement, and prevent avoidable infections. These audits involve a systematic review of the policies, procedures, and practices related to infection prevention and control within the surgery center.

A comprehensive infection control audit typically assesses hand hygiene and personal protective equipment, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment. You will need to develop an audit plan, use standardized tools, such as HST, and checklists to guarantee consistency, involve trained auditors, and include a mix of observation, interview, and documentation review to make sure you see a holistic view. To help get started or review your current processes, CMS offers an ASC infection control audit tool on its website, available for download.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Review Patient Satisfaction Survey Results

Best Practices

Regularly reviewing patient satisfaction survey results is crucial for understanding the patient’s perspective, identifying areas for improvement, and implementing necessary changes to enhance the patient experience. Conducting these reviews monthly or quarterly allows the surgery center to respond promptly to any issues raised by the patients and to track progress over time.

To turn your satisfaction scores into actionable improvements, you must use software to collect and aggregate patient feedback on your behalf so you can quickly identify trends, areas of strength, and areas for improvement. Your patient satisfaction results can also inspire your next QAPI study, and your software will make it incredibly simple for you to collect and analyze results from one period versus another.

Reminder: The OAS CAHPS survey will be required and linked to reimbursement in CY 2025 for ASCs. If an ASC does not conduct and submit OAS CAHPS as part of the quality reporting requirement, they will receive a reduction of 2.0 percentage points in their annual fee schedule update.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Hold Planning and Business Reviews with Vendors

Best Practices

Effective quarterly planning and business reviews with vendors are key to smooth operations, cost efficiency, and no last-minute surprises. Start by maintaining consistent and open communication with all your vendors; this helps build strong relationships and keeps everyone on the same page. Setting clear, mutual goals and expectations for each quarter is also essential. When everyone knows what they’re working towards, collaboration is much smoother.

Another important step is regularly evaluating vendor performance against set benchmarks. Doing so helps ensure that your vendors meet your standards and allows you to address any issues early on. If your supply chain vendor expects disruptions or your anesthesia group expects shortages, being prepared for the unexpected is crucial. Lastly, keeping all contractual terms and obligations transparent and up to date helps avoid misunderstandings and will lead to a smooth working relationship.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Offer Staff Training and Education

Best Practices

Continuous staff training and education are essential for maintaining high standards of care, staff satisfaction, and staff retention. Start by regularly assessing your staff’s training needs based on performance reviews and industry changes to identify areas where additional training is needed. Consider the requirements for earning AEUs (Accreditation Education Units) or CEs (Continuing Education credits) and encourage your staff to pursue these through accessible options such as the ASCA conference, state association events, or relevant webinars. Implementing cross-training programs is also beneficial, as it not only enhances workforce flexibility and coverage but also helps prevent any single individual from being a critical point of failure by ensuring that multiple team members can competently handle various tasks.

Encouraging staff to obtain relevant certifications and advanced training shows your support for their professional growth. Use interactive and diverse training methods like workshops, simulations, and online modules to keep the learning process engaging and effective. Additionally, cross-training ensures that staff can step into different roles as needed, promoting a more resilient and adaptable team. Finally, establish a system for staff to provide feedback on training programs. Following these best practices can create a robust training and education program that benefits your staff and the surgery center.

Key Process Steps

Regularly Recurring Operations: Monthly/Quarterly

Perform Required QAPI Studies

Best Practices

Quality Assurance and Performance Improvement (QAPI) studies are essential for continuous improvement. To be effective, these studies should have a comprehensive scope covering all aspects of care and operations, including clinical outcomes, patient safety, and administrative efficiency. Using a data-driven approach is crucial.

Engaging a multidisciplinary team that includes clinical, administrative, and support staff will help offer diverse perspectives and more thorough analysis. Conduct regular monitoring through quarterly reviews to stay on top of compliance and identify areas for improvement. Finally, transparent communication is key. Share your findings and improvement plans with all staff to foster a culture of transparency and accountability.

Key Process Steps

Regularly Recurring Operations: Annual

Chargemaster Analysis

Best Practices

The chargemaster serves as a comprehensive listing of all billable services and items the surgery center provides. It plays a pivotal role in revenue cycle management, serving as the foundation for billing and coding processes. Annual updates ensure that billing remains compliant with current regulations, that all charges reflect the most recent costs and negotiated payer rates, and that the facility remains competitive and financially sustainable. Proper oversight and diligence in this process are paramount to ensuring the surgery center captures all revenue rightfully owed while avoiding potential compliance pitfalls.

When reviewing your chargemaster, most will build it based on a percentage of Medicare’s reimbursement. You can perform the analysis yourself using a tool that is as simple (and free!) as Microsoft Excel or Google Sheets. However, leveraging technology solutions, like automated chargemaster management systems, such as HST, can help save time and reduce errors.

Key Process Steps

Regularly Recurring Operations: Annual

Inventory Check

Best Practices

By conducting an annual inventory check, centers ensure they can maintain consistent patient care, optimize financial management, and streamline daily operations. A thorough inventory evaluation reduces the risk of overstocking or stockouts, enables accurate budgeting, and helps centers stay prepared for routine and unexpected scenarios. Furthermore, understanding inventory levels and usage trends can lead to better decision-making, reduced waste, and enhanced patient care.

Inventory management software, such as HST, can provide historical data to help you make informed decisions. The software can also track current inventory against your minimum and maximum stock levels to guide reorder points and prevent stockouts or over-purchases. While supply chain issues are certainly better than they were immediately following COVID-19 disruptions, fostering good relationships with suppliers and having various supplies to choose from will help with better purchase deals and timely delivery.

Key Process Steps

Regularly Recurring Operations: Annual

Payor Contract Review

Best Practices

Payor contracts are arguably at the center of the revenue cycle process. These contracts, which determine reimbursement rates and terms for services rendered, significantly influence a surgery center’s financial health and viability. An annual review and potential renegotiation of these contracts enable centers to ensure that they receive fair compensation for their services, adapt to changing market conditions, and continue to offer top-tier care to patients. Beyond financial implications, these contracts also impact operational protocols, patient access, and the center’s relationship with insurance providers.

To get the best possible rates, your financial team must analyze and track the performance of your current contracts in real-world scenarios to determine if they are meeting expectations. Gathering external intel, such as industry standards, reimbursement trends, and regional benchmarks, will help to understand where your contracts stand in the larger market. Lastly, there is still a benefit to cultivating a rapport with payor representatives, which can lead to more collaborative and transparent negotiations, so make sure to put a little extra time into building those relationships!

Key Process Steps

Regularly Recurring Operations: Annual

Performance Management Reviews

Best Practices

Performance Management Reviews (PMRs) help recognize and reward good performance, identify and address performance issues or areas of improvement, support professional growth and development, and enhance communication between managers and employees. When done correctly, PMRs can be a powerful tool to motivate employees, drive productivity, and foster a culture of continuous improvement. To be effective, all parties must perceive the process as fair, transparent, and constructive.

The most successful PMRs set clear objectives, maintain consistency, provide constructive feedback, and encourage open dialogue. Making the review process a two-way conversation where employees can share insights, concerns, and aspirations is key. PMRs can help with staff satisfaction, retention, and recruitment.

Key Process Steps

Regularly Recurring Operations: Annual

Prepare Annual Budget

Best Practices

A well-prepared budget is more than just numbers on a page – it’s a roadmap, guiding centers in their financial decisions and providing a tool to measure financial health. It forecasts potential challenges, optimizes resource allocation, and establishes a clear financial trajectory that aligns with the center’s goals. In essence, the annual budget ensures that surgery centers can continue providing premier care without compromising operational viability.

The annual budget is typically presented to the board in October for the following year. While preparing, administrators should engage key stakeholders from various departments, review past budgets and financial outcomes, identify essential expenses, and account for upcoming projects, expansions, or other initiatives that may impact the budget. Remember to allocate funds for unforeseen expenses or emergencies.

Key Process Steps

Regularly Recurring Operations: Annual

Vendor Contract Review

Best Practices

Vendor contracts form the backbone of many essential services and supplies that surgery centers rely on daily. Regularly revisiting your vendor agreements ensures that you receive the best value and competitive pricing, make sure you’re not spending unnecessary budget, maintain compliance with regulatory standards, and align vendor relationships with the center’s strategic goals.

Leading surgery centers use vendor management software, such as HST, typically built into your practice management software, to have a centralized repository for all vendor-related information, ensuring easy access and management of contracts, contact details, pricing, and historical data. The software will also help you mitigate risk, identify opportunities for bulk purchases, automate manual processes, and provide real-time analytics and reporting.

Key Process Steps

Regularly Recurring Operations: Annual

Renew Licenses and Certifications

Best Practices

It’s essential for surgery center administrators to be familiar with local, state, and national regulations and to maintain a calendar or tracking system for all required renewals to ensure continuous compliance. Regular renewals of these licenses and certifications affirm the center’s commitment to excellence, protect against legal repercussions, and provide uninterrupted service to patients.

Requirements will vary depending on your exact location. Still, a few examples of licenses and certifications to maintain would be your Certificate of Occupancy, State Department of Health license, accrediting body (JCAHO, AAAHC, AAAASF), CLIA Certificate of Waiver, or DEA license. It’s also important that your administration obtains enough Continuing Education and AEU credits to maintain CASC certifications, if applicable.

This annual process will be much smoother if you use specialized software, such as HST, to notify you of approaching renewal dates or changes in requirements.

Key Process Steps

Regularly Recurring Operations: Annual

Review Policies and Procedures

Best Practices

Policies and procedures for a surgery center serve as guiding documents to ensure patient safety, adherence to legal and ethical standards, and standards of operation. Specific policies and procedures can vary based on the type of surgeries performed, the location, and the regulatory environment. Each accrediting body also has its particular standards and requirements, but all strongly emphasize comprehensive, well-documented, and well-implemented policies and procedures.

Your policies and procedures must follow suit as your surgery center evolves and grows. Over the year, you might implement an EHR, adjust pain management protocols, improve your fire safety and evacuation plans, update employee vaccination requirements, or change your family visitation policy. Those are just a few examples of reasons you would need to update your policies and procedures.

Key Process Steps

Regularly Recurring Operations: Annual

Review Legal Compliance

Best Practices

Between CMS, OSHA, and all the other state and federal governing bodies, a surgery center must adhere to a growing number of regulations. One of the best practices for achieving legal compliance and staying on top of changes is conducting regular audits. These audits help ensure that the center complies with all relevant laws and regulations.

Another crucial step is regularly reviewing and updating policies to reflect current laws and best practices. It’s also wise to maintain a relationship with legal experts, your state ASC association, and ASCA to stay informed about changes in regulations. Finally, keeping thorough records of compliance activities, audits, and corrective actions guarantees that everything is documented and easily accessible for review.

Key Process Steps

Closing Message

Thank you for taking the time to read through our report. We hope you walk away with many insightful and actionable tips to continue providing excellent patient care in a way that is efficient and profitable.

Operating a successful ASC is not the same as it was a decade ago or even five years ago. The industry is undergoing transformative changes, shaped by factors such as regulatory changes, technological advancements, evolving patient expectations, and economic pressures.

Leading surgery centers, with their finger on the pulse of these changes, recognize the emerging challenges. They understand traditional methods will no longer cut it, and a proactive approach is essential. HST Pathways is committed to riding this wave alongside our clients and partners, and we will navigate whatever the future holds together.

About HST Pathways
HST Pathways is the leading provider of a suite of products that have been thoughtfully and clinically designed for the surgery center industry. Our many software offerings provide ASCs with intuitive solutions that cover the entire patient journey and help to unlock revenue, fuel growth, and deliver better care. Build, grow, and run your facility with solutions your entire team will love. See why more than 1,600 clients are choosing HST Pathways by visiting https://www.hstpathways.com/success-stories/.

Data Summary

Methodology

This report was developed using a comprehensive approach that included industry research, consultations with clinical experts, data from reputable industry publications, and insights from HST Pathways’ own products.

When benchmarking data was sourced from HST Pathways’ data warehouse, the conclusions for 2024 were based on data from Q1 and Q2 of the year. Year-over-year comparisons included data from Q1-Q4 of 2023 and Q1-Q2 of 2024.

You may notice variations between the 2023 data in the 2023 report and the same data shared in this 2024 report. These differences are due to an extended timeframe and the inclusion of additional client data.

In cases where data was incomplete, missing, or identified as an outlier, those cases and centers were excluded from the analysis. Additionally, to accurately assign a specialty to each case, primary CPT codes were mapped accordingly.