The website, stopcoloncancernow.com/referring-physicians helps patients find ASCs performing colon screenings and also helps doctors refer patients for colon screening. Colon cancer can be prevented by removing polyps in the gastrointestinal tract. According to cancer.org, there’s a 90% chance of survival when colon cancer is detected early.
Ambulatory surgery centers can direct patients to this interactive portal, especially those turning 50 – the age when it is recommended that people screen for colon cancer. ASCs can become affiliate centers by registering on the site.
Since 2010, the ambulatory surgery center (ASCs) market has neither grown nor declined. ASCs start, shut-down and acquire other ASCs. There are over 5,400 surgery centers. Available physicians are limited and hospitals continue to pose a strong competition – sometimes partnering with ASCs. According to arecent Becker’s ASC article, ASCs will need to excel in a single specialty and run a very low cost center model to sustain in the future.
ASCs can further add plans that involve diet and exercise, virtual follow-ups for a monthly fee. This creates additional revenue streams based on deeper understanding of patients and their conditions. It also engages patients and their families better and brings them back to the center on a regular basis.
Outsourcing activities or tasks in a controlled and methodical manner is clearly a way to bring costs of administrative tasks down. Identify tasks that are lower on the complexity scale and delegate and outsource them. When they aren’t core to the business model (i.e., treating patients), tasks such as billing, coding, denial management, patient collections, accounting, credentialing, pre-authorizations and so on will tend to be distractions from the core focus of the surgery center. Outsourcing companies centralize operations for a large number of providers, giving them benefits of scale – these cost savings are typically passed on to the center that could then pass them on to patients.
According to the ASC Value Driver Survey, 24% of ASCs experience stable volume, 27% reported growing volume and 27 percent declining volume. In the same survey, respondents cited competition from other ASCs and hospitals as one of their biggest challenges. Clearly, it’s a time to focus and cut costs to stay competitive.
Aravind Eye Hospital is a popular case study among business schools. After being encouraged by a friend, I saw this video of Pavi Mehta who studied the hospital’s model and wrote a book (called Infinite Vision). It reminded me of the MBA case study and made me think about how ambulatory surgery centers could use the ideas presented. Aravind performs the largest number of cataract operations at the lowest costs but at the highest levels of quality. Each doctor in the hospital performs on 2,000 cataracts/ year v/s an average of 200 cataracts/ year in the US. Here’s a summary of the book:
When a crippling disease shattered his lifelong ambition, Dr. Venkataswamy (better known as Dr. V) chose an impossible new dream: to cure the world of blindness. The tiny clinic he founded in India defied conventional business logic and is now the largest provider of eye care on the planet. At Aravind, patients choose whether to pay or not. Millions are treated for free, yet the organization remains stunningly self-reliant. Serving everyone from penniless farmers to the president, it delivers world-class outcomes at a hundredth of what similar services cost providers in advanced nations. Its model is emulated by organizations everywhere from Rwanda to San Francisco.
In several ways, it largely performs the largest number of outpatient surgeries by using 3 creative constraints set forth by its founder:
1) We can’t turn anyone away
2) We can’t compromise quality
3) We must be self-reliant
In an environment of universal coverage, increasing malpractice liability, and reimbursement cuts, all these three creative constraints apply to ambulatory surgery centers (ASCs). How would a center run high volume operations, keep capacity utilization high, not build a business model that relies on getting paid by low or delayed or difficult insurance plans but yet standout in its quality? Unimaginable? Watch the video.
The Healthcare reform is pushing healthcare organizations to follow a more quality based reimbursement model vs. quantity based. It’s imperative that being in the business of serving patients, the quality of care carries supreme importance. While every center wants to provide quality services, there are aspects by which quality may sometimes be compromised – increasing patient volume, lack of resources, the time spent behind each patient visit. It’s the need of the hour for centers to do things differently and here are some thoughts.
Build a lean organization. Go back to the drawing board and lay down your entire operations. Map the number of resources associated with each process and outline their responsibilities. This exercise will give you clarity on everyday resource utilization. You will get answers to questions such as – do we actually need four full time resources at the front-desk? Can the process be managed with just two?
Identify the gaps. The operations outline exercise will also help you identify process gaps within your surgery center. Say a patient comes to the surgery center for a particular visit, simulate the entire visit from the time patient registers an appointment to the time the claim is billed and note down the gaps in the process. The gaps can be pre-visit related like prior eligibility and authorizations, or during a visit like wait times, transfer from one room to the other, or can also be post-visit like same day claims submission, patient resources and medications. Fix the gaps to build an optimized operational flow.
Use technology where possible. The main advantage of using technology is it frees up time and resources which could have been used to do more meaningful tasks. Consider your billing for instance, how many resources have you allocated? Are they coding, proofreading, submitting your claims daily? Is simply submitting claims challenging enough for their capabilities? Ambulatory surgery centers should evaluate the possibilities of automating aspects of their revenue cycle management. Whether, collaborating with companies that provide automated services or building a software system in-house, technology can be used to remove redundancy.
Track and measure from every aspect. While there is a significant need for surgery centers to change the way they function, it is equally important to measure and track each aspect of the business. How has the center performed this quarter compared to previous quarters? How have the reimbursements changed? What contributed to the fluctuations in the reimbursement model? How effective is the inventory management? Surgery centers and business owners need to have a centralized way to measure progress across different metrics. They can invest in software systems that can crunch essential numbers automatically and provide executable insights.
Once you’ve built a lean organization, optimized your operations, have leveraged technology and start tracking every aspect, you have more time for your patients. The quality of focus on patients is to a greater degree with the operational bottlenecks out of the way. The process cannot be changed overnight, but once that is done it becomes a self sustaining model. Cost reduces, patients are happy and the center operates more seamlessly.
When I review billing of an ambulatory surgery center, here’s what I mainly look for and it usually gives me enough clues to what I need to know.
1) Are there unbilled charges from more than a month ago?
2) How many denials show up in the EOBs received from Medicare and BlueCross for the previous week? I tend to review ALL the EOBs.
3) What’s the comparison of new patients to existing patients over the past year? What types of insurances do they represent?
4) How does the Accounts Receivable Master look? How many high-dollar claims (e.g. above $1,000) are untouched – over 90 days, 120 days and so on?
5) When were the contracts last updated?
There are several other things that I could look for and I do but at the outset am looking for a feel of how a center is doing. Answering these five questions usually provides me with a direction to probe more. I supplement these with interviews with staff. Another important activity that I do is to simply sit by the front desk and observe patient flow and work flow through the day – sometimes for several minutes at a stretch.
Taking the above steps, we turned around a gastroenterology center at one of the major hospitals in New York.