New Processes, New Software Help ASC Reach Elusive Goals

Center streamlines cost, revenue and patient satisfaction through use of technology

Like most ambulatory surgery centers (ASCs), the Surgery Center at Pelham in Greer, S.C., is constantly reminded of the need to accomplish challenging goals that are often thought to be contradictory: reducing operating costs, improving patient satisfaction, and increasing net revenue per case.

The road to meeting those goals is a steep one, especially in a surgical practice that, like most, comprises busy staff with their own responsibilities to fill — from the surgeons and nurses to procurement and administrative staff. The overall question facing the facility was how could everyone be aligned to pull in the same direction, toward the same set of goals, when, as the saying goes, the one hand rarely knew what the other was doing?

For the Surgery Center at Pelham, the solution consisted of two parts. First was the commitment from physicians and staff to thoroughly reengineer the processes we had become accustomed to. Second was the judicious application of software that addresses a full range of practice- management functions. And it goes without saying that the entire staff was to remain constantly mindful of the fact that high quality patient care and patient satisfaction are always our overriding goals.

Successful Process Transformation

The foundation of our successful process transformation has come from the use of Vision software from Birmingham, Ala.-based SourceMedical. Vision is a fully integrated solution that includes eight modules working in unison to promote cost savings and streamlined management functions. Included in the suite of applications are a schedule manager, clinical manager, an electronic health records, financial manager, supply chain manager, report manager, an integration manager, and patient satisfaction and benchmarking.

As one of the first centers to deploy Vision software, the Surgery Center at Pelham was aware that a common pitfall of any software rollout is the failure to use the system to its fullest potential. We were determined to utilize all of the system’s functionalities to achieve the goals we had identified. This was an important decision, because it enabled us to fully mesh our goals with the system’s capabilities.

Today, our practice-management software handles virtually all management functions, including real-time, live monitoring of charges during procedures in the operating room. When a case is over, an administrator can meet the surgeon at the door and immediately present the full cost of the case. Cost tracking is truly comprehensive, down to $0.04 thermometer covers.

Vision also features a tracking system that allows staff to monitor the exact amount of time a patient spends in the center, broken down by stage of the visit. We track a patient’s time in the facility very closely, because the longer a patient’s visit lasts, the less likely the patient will be satisfied. And, of course, the average length of patient visits tracks closely with costs. Our goal is to safely limit the overall length of patient stay to the least amount of time possible, which has translated into significant cost savings for the center.

The software was highly customized for our 19 nurses to better meet the center’s specific needs. Although it is not a full-blown electronic medical record, nursing staff can still perform certain clinical steps and documentation functions such as case management procedures. For instance, all discrepancies and variances are tracked, so when cancellations occur, the reasons are noted in the system. This information is used to complete the ASC Association quarterly report.

Since reshaping our processes and adopting the new software, the center has enjoyed very strong results. Patient satisfaction stands at 99.85 percent. In July 2007, case cost dropped to a record low of $159 — including medical supplies, implants and drugs. Average case cost now stands at a modest $214, and inventory has been kept below $205,000 for our 450 cases per month.

Another important element of the center’s improvements to practice management is the implementation of a quarterly incentive program. We use Vision to track the bonus criteria, and we have been very pleased at the level of detail the system allows us to monitor. For staff to collect the full bonus, the following five criteria must be met:

• Inventory must be below $205,000 
• Net revenue per case must be $1,500 or higher 
• Patient satisfaction must be 98 percent or higher 
• Physician satisfaction must be above 98 percent 
• Full-time equivalents (FTEs) must be 13 or fewer per case 

Other tactics, used in conjunction with the software, have enabled the center to achieve an overall reduction in operating costs. For example, we obtain supplies on consignment when possible, use single-source vendors, and use custom packs for various cases. These and other initiatives have contributed to streamlining the center’s operations and reducing costs.

Even the physicians are closely monitored when it comes to case costs. For example, each physician is assigned a confidential number that represents his or her costs per procedure. So when evaluating the cost of an ACL reconstruction, each physician can see where he or she falls in the cost arena. Highlighting those numbers prompts the physicians to share with each other the best strategies for performing the procedure with the least expense. In many cases, our physicians gravitate to using the same supply sources as a result of sharing this information, which leads to better prices through their group purchasing power.

And last, but certainly not least, Vision software allows staff to handle their administrative duties throughout the course of the day, rather than postponing significant amounts of paperwork for the end of a shift. As this example demonstrates, a major priority of our process upgrade was to be more mindful of the time constraints that everyone faces: our physicians, our staff, and of course, our patients.

The results to date have more than lived up to the expectations of physicians and staff, and although every staff member has had to alter his or her work habits to meet our efficiency goals, the results have made those efforts worthwhile. Indeed, physicians and administrators at other ASCs might well find our example to be useful as they look for ways to navigate a changing, often challenging, healthcare environment. 

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines