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ASCs Revolutionize the Medical Scene

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Yolawnda Stutzman

on 14 July 2016

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Transcript of ASCs Revolutionize the Medical Scene

Most Common ASC?
When I Have Grown a Foot or Two
Who Governs these things?
Hospitals are perhaps the most complicated business enterprise ever created by mankind- Peter Drucker
Types of ASCs
Regulations and Licensing
Trends
Every ASC must comply with laws and regulations from both federal and state levels. In addition, ASCs must meet specific requirements and obtain a state license in virtually every state. Each state sets forth its own licensure requirements, but typically they require initial and ongoing inspection and reporting. The states without licensure requirements are Idaho, West Virginia, Wisconsin and Wyoming.
Other Agencies related to ASCs
Where are ASCs going?
$1.25
Tuesday, May 17, 2016
Vol HS375, Module 1
Origins:
What is an ASC?
Challenges ASC Administrators face
Administrative Implications
maintaining the volume of needed procedures and care
increasing the volume of procedures performed
difficulty in recruiting qualified physicians
out of network disappearance
Physicians taking cases outside of ASC
Failing to plan for expansion (keep growth moving forward and not sliding back)
Accurately weighing costs against profits (choosing equipment that is cost effective, current, efficient, and necessary
maintaining good standing with regulatory agencies
Misunderstanding of physician motives/ disconnect between administrator and surgeons
ASCs Revolutionize the Medical Scene
Ambulatory surgery centers (ASCs) are health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting.
Procedures performed must not require patients to stay overnight
These procedures can include diagnostic, preventative care, and repair.
Treat only patients who have seen a health care provider who has chosen surgery as the appropriate treatment for their condition
Patient Benefits:
48% less expensive than surgeries performed in hospitals
less wait time after scheduling
more convenient
faster recovery
less risk of hospital acquired infection
surgical staff are more specialized- better quality care
shorter time away from home (home within 23 hours)
In 1968, Wallace Reed, MD, and John Ford, MD, both
Anethstesiologists
, were discussing the difficulties of current surgical procedures over dinner one evening. They wrote their ideas, solutions, and objectives on a napkin. They began collecting endorsements from the governmental bodies and members of the health care community to obtain financing for the project.
THE BIRTH OF ASCs
On Feb 12, 1970, Surgicenter, the first freestanding surgical center opened in
Phoenix, Arizona
Factors that led to the rise of ASCs:
The development of the computer chip camera that permitted the visualization of joints, organs, and body orifices without major incisions.
wait times for patient procedures grew from weeks into months (scheduling delays)
patients spent days in the hospital which increases likelihood of infection
patients then spent weeks out of work to recover
limited operating room availability
difficulty in obtaining new, more efficient equipment because of hospital budgets and policy restrictions
doctors wanted more autonomy, more control over their schedules
turnover of the hospital operating rooms was time consuming
costs!! Hospitals bill through line-billing rather than by procedure which increases costs
Physician Benefits:
Professional Autonomy
Control over quality of care
Decision making capabilities
able to schedule procedures more conveniently
ability to assemble high quality, specialized surgical staff
ability to ensure equipment and supplies that are best suited to their technique
ability to design facilities to their specifications
ability to keep costs down and keep a bigger piece of the profit pie
Financial Aspects
The ASC must have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the ASC’s total operation. The governing body has oversight and accountability for the quality assessment and performance improvement program, ensures that facility policies and programs are administered so as to provide quality health in a safe environment, and develops and maintains a disaster preparedness plan.
In 28 of the 46 states, accreditation by a third party is required as part of licensure. The three accreditation bodies recognized are Accreditation Association for Ambulatory Health Care (AAAHC), American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), and JCAHO.
CASC
-The Certified Administrator Surgery Center credential is a distinction earned by those in the ASC industry with a comprehensive understanding of the knowledge and skills that the role of an ASC administrator requires. (The only credential specifically for ASCs.
BASC
- The Board of Ambulatory Surgery Certification. Administers the CASC exam. Non-profit founded by the Federal Ambulatory Surgery Association (FASA)
OOPS
- Hospital Outpatient Prospective Payment System was a Balanced Budget act of 1997 that granted authority for CMS to have “ASC payment rates and lists the surgical procedures and services that qualify for separate payment under the revised ASC payment system.”
Medical procedures performed in an ASC in 2002 cost 88% of what it would cost in the HOPD. Today it is 55% of the cost. The average of all services performed in an ASC is about 47%
less
than HOPDs.
Avoiding Hospitalization means COST SAVINGS
On average, the Medicare program and its beneficiaries save $2.3 billion each year because they pay significantly less for procedures performed in ASCs compared to the rates paid to hospitals for the same procedures.
Why does it cost so much less than the HOPDs?
Lower overhead costs
no line item pricing
no markups on implants
increased efficiency
no overnight stays= less costs
reimbursed by previously contracted amounts (which creates incentives to keep costs down)
quicker turnover of operating rooms means more procedures performed in less time
“ASCs can significantly reduce cost for Federal health care programs, while simultaneously benefiting patients” (Health Care Financing Administration HCFA).
What is the single most expense item for ASCs?
Turnover time and surgeon tardiness are said to be the most costly expense followed by supply costs like anesthesia.
ASCA
- The ASC Association is a national, nonprofit membership organization (advocacy) that represents the interests of those who own, operate, provide health care in and seek the services of ASCs.
What if I want to
specialize an ASC administrator?
What is on the CASC Exam?
Regulatory and legal issues
Finance
Delivery of patient care
Quality management and
Human resources.

It is administered by the BASC (Board of Ambulatory Surgery Certification) .
Bachelor’s Degree or Master’s Degree in Healthcare Administration, Nursing, or Business Administration. Master’s degree not required but preferred. Most ASC facilities are looking for 5 years experience running a free standing Ambulatory Surgery Center, or surgery department. Other experiences that would be helpful: internships, residencies, fellowship programs, and CASC certification. Join Industry associations FASA.org, AAASC.org. Understand business management, finance, and accounting.
What about politics?
The politics of ASC ownership, operation, and performance work much like most businesses. The CEO provides the transition from the ownership (whether physician board owned, private owned, or hospital owned) to employees of the ASC.
The CEO/ Administrator is tasked with making sure the ASC is running properly and is profitable, but also that employees are happy and patients are being cared for in the proper manner and the facility is running according to all rules and regulations.
10 Key Financial Metric to Measure in ASCs
1. Number of days in accounts receivable

2. Review collections during the month

3. Estimated net revenue for the month

4. Net revenue per case

5. Number of days cash on hand (standard is 30 days cash on hand)
6. Number of days in accounts payable

7. Salaries and wages divided by net revenue (Salaries and wages should equal 20-25 percent of net revenue)

8. Total clinical hours per case

9. Supply costs per case

10. Maintenance and repair expenses
Works Cited
http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/10-key-financial-metrics-to-measure-in-a-surgery-center.html
http://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare
http://asdmanagement.com/10-key-factors/
http://www.ascassociation.org/educationevents/casc
http://aboutcasc.org/about-casc/what-is-casc/
http://www.nationalascbilling.com/Page/What+We+Do
https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/ASC.html
https://www.aapc.com/certification/specialty/cascc/
http://www.asge.org/uploadedFiles/Members_Only/Practice_Management/Ambulatory%20Surgery%20Centers%20–%20A%20Positive%20Trend%20in%20Health%20Care.pdf
http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/10-keys-to-being-a-great-asc-administrator.html
http://www.beckershospitalreview.com/or-efficiencies/6-cornerstones-of-operating-room-efficiency-best-practices-for-each.html
http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx
http://www.beckersasc.com/asc-transactions-and-valuation-issues/8-things-to-know-about-asc-ownership-and-development.html


The most frequently occurring type of surgery at an ASC is
Ophthalmology
(Eye Surgery)
What is a Transfer Agreement?
To receive a Medicare license, Each ASC is
required to have a transfer agreement
set

up with a local nearby full-service hospital or recovery center where a patient can go if he/she requires emergency services or an overnight stay for observation after their surgical procedure. (85% are Medicare licensed)
What is a Licensed Recovery Center?

A Licensed Recovery Center extends the patients stay beyond 24 hours.
Departments and functional components of an ASC
ASC pre-op (patient interview, collect medical history, counseled about their surgery)
ASC operating room (where surgery is performed)
ASC post-anesthesia car unit (patient monitored for adverse reaction to anesthesia)
Phase II recovery (pt waits to be discharged)
Discharge
As an administrator, It is vital to understand the motives of physicians. What is important to them? What do they value? How can we, as administrators effectively communicate with our staff and physicians if we are not empathetic to their cause?
According to Dr. Joseph Bujak, Physicians value:
Respect
Autonomy
Control
Efficiency
Quality Patient Care
TIME
Less invasive surgical procedures and the invention and use of Scope procedures have allowed for such growth in ASC's.

Because procedures can be done more rapidly and with a quicker recovery time. This allows for out patent procedure which allows ASC's to be possible.

Another very big technological advance was Lasik eye surgeries which has impacted the growth in number ACS's.
Technological advancements aiding ASC growth
Madison Memorial Hospital acquired North Fork Surgical Center In 2009

Some of the benefits included added support from local surgeons as they worked together to combine the two.

The ASC is now a not for profit business that is a community owned acute care facility.
There are different laws that make it difficult for an ASC to get started. The Certificate of Need program is used to see if a facility is actually necessary for the area. This can be used to prevent an ASC from being approved. It is often better to invest in an existing ASC rather than try to start up a new one.
Often times, when thinking of a partnership in an ASC, if one were to partner with a hospital, then they would take controlling interest. Partnering with a corporate entity is a good way to grow the business without losing control.
What about development issues?
What “key indicators” would be important for you to monitor as the administrator of an ASC? 
Financial well-being.
This is vital if the organization is to be successful. Many ASC’s are not profitable or simply break even. The mark of a truly successful and skilled ASC will be shown in its revenue.
Clinical Competency
. Make sure that there is a general culture of constancy in regards to proper medical procedure and obedience to state and government regulations.
Supply chain
. Many of the costs associated with ASC’s are avoidable. They are non-labor costs mainly because of waste and inefficiency. If we work with the staff on proper procedure and manage the supply chain, then the center will be successful.
Safety and Quality
. One of the defining factors with ASC’s is that they are safer and have a higher quality of service than what is found in the hospital. Ensuring that all personnel are committed to a high level of quality of care is vital.
Full transcript