A Well-Oiled Machine

Keeping an ambulatory surgery center (ASC) running smoothly and efficiently is no small task. From reimbursement and Medicare, to IT and EMRs, to staff and doctors, and not to mention patients, each are an important part for an administrator to keep in mind in order to maintain a healthy balance of patient satisfaction, a happy staff and boosting the bottom line. SurgiStrategies spoke with Andrea M. Hyatt, CASC, of the Dulaney Eye Institute in Towson, Md., and president of the Maryland Ambulatory Surgical Association to discuss some of the challenges an administrator faces and her advice on how to handle them.

In what ways will the new ASC quality-reporting measures on “never events” impact efficiency, and do you think these measures will affect IT capabilities?

As far as impacting efficiency medically, these are precautions that should have been in place at all surgery centers. It’s mandatory to perform surgical timeouts and to make sure that proper verification takes place every step of the process. These need to be documented for all patients. There are always ways to tailor your paperwork, so that you can make the documentation aspect of this process as streamlined as possible.

When it comes to affecting IT capabilities, you’re either documenting this on paper or in an electronic medical record (EMR). Obviously on the EMR, it’s less writing, but if you have a check off system on your paperwork, you should be able to streamline the paperwork. The IT capabilities really come into play is evaluating quality indicators or complications. Any time you can log this information on to your system and it can produce reports for you, that is obviously the ideal situation. If you don’t have the software capability to do this, and you’re doing it by hand, obviously you’re less efficient.

As you know, hundreds of hours and thousands of dollars a year can be wasted on improper coding and billing techniques. Do you have any tips for what can be done to increase coding and billing efficiency?

A certified coder is ideal, especially for a multi-specialty center. But I think for the small, single-specialty centers, you can have somebody that’s very well-versed in coding and can do just fine. You have to provide them with good resource books. For the single-specialty, there’s a wonderful coding companion guide that is very comprehensive. It has illustrations and it definitely makes it easier to do coding. Our center has developed billing sheets for each sub-specialty. Those sheets are completed by the nurses and surgeons and sent out to the billing department for a final review before submitting claims.

How will the eventual implementation of ICD-10 codes affect efficiency initially?

There will be a period of time where you’re busy loading those new codes into your system. In my center, we will change the codes in the software, if applicable, as well as, on our coding sheets, that I mentioned earlier. You need to have somebody dedicated (a Type A individual) to go through and do all the legwork for you. The real inefficiency lies with the payors updating their system in a timely fashion and processing our claims correctly.

In your opinion, is it more difficult for an ASC staff to be efficient in medical tasks or office tasks? What leads you to this impression?

That’s a tough one. Both areas are always subject to new guidelines. Every time a new guideline, piece of equipment or procedure comes out, there’s a learning curve until you implement the change and examine how you can maintain efficiency despite the changes. But I’d have to say that overall, I think probably becoming more efficient overall for medical tasks are more difficult. Usually when you’re talking about the office tasks; it involves specific guidelines or requirements that have been implemented by payors or government agencies. You change your paperwork to adjust. You make changes in your software system, train your staff and it’s a done deal.

When you’re striving to be efficient on the clinical side, it often involves your biggest variable—human beings. The clinical side requires a lot more buy-in by individuals.

What have you learned about business efficiency that you wish you knew when your facility first opened?

I’d have to say that although we have not yet switched over to a EMR system in our facility, I believe that EMR software significantly streamlines any process involving documentation regardless of the size of the center.

Make sure that you utilize the capabilities of your software. There are excellent products out there right now for surgery centers, as far as software goes. Some of their adjunct programs have a cost associated with it. You must look at the cost and time associated with having a person perform those tasks efficiently.

What advice would you give other administrators on efficiency?

The best advice I can offer is the following:

• Always look at how you can streamline your paperwork to capture the vast amount of information that is required in our daily documentation. We are constantly subject to more and more regulation that requires us to add more steps to our procedures and document more information.
• Despite the size of your center, you can’t do it all, and you must have really good people on your team. You can have the best procedures in place and they can streamline things, but you always have to have the right people carrying them out. If you don’t have team players, it’s a problem.
• The last piece of advice is to remember that most problems stem from communication breakdown. No matter what issue arises, you have to give everybody the courtesy of sitting down and discussing it as a group. Staff members often think only about how their department is impacted by change. You need to have everybody come to the table and examine the impact of change.

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