OR Manager - April 2018 - 23

AMBULATORY
SURGERY CENTERS
Management pearls position ASCs for successful growth
he rapid growth in outpatient procedures
presents exciting opportunities
for leaders at ambulatory
surgery centers (ASCs), but also the
challenge of accommodating a higher
volume and more specialties without
sacrificing efficiency and patient safety.
That's why it's important not to lose
sight of the fundamentals in managing
an ASC, whether you're a new leader or
a long-time administrator.
T
Beverly Kirchner, BSN, RN, CNOR,
CASC, chief operating officer and chief
nursing officer for SurgeryDirect, was
first involved in building an ASC in 1985.
Since then, she has seen the number of
rules and regulations balloon from 36 to
more than 1,200. In this article, her expert
advice focuses on three key areas:
finance, governance, and credentialing.
Dollars and sense
Factors such as unpaid receivables,
denial of claims, insurance verification,
coding, and over-ordering of supplies
and medications influence the financial
picture.
" You need to submit claims within
24 hours and have someone who is on
top of any denials, " Kirchner says. The
ability to do so depends on surgeons
dictating their reports promptly, and that
means having buy-in from the ASC's
medical executive committee and board
to help ensure compliance.
Getting paid requires upfront legwork,
including verifying insurance coverage
before surgery and collecting
Physician peer
review helps
protect the ASC
from lawsuits,
fines, and other
financial loss.
copays and deductibles on the day of
service. Kirchner notes that an advisory
opinion from the Office of Inspector
General (OIG) indicates prompt pay
discounts are acceptable as long as
they are consistent: " Your policy should
state the percent discount on any coinsurance
or deductible amounts. "
Kirchner also recommends having a
certified coder and a billing software system
that provides timely reports. Other
recommendations are listed below.
" If you aren't currently using a group
purchasing organization [GPO], you
probably want to look into it, " Kirchner
says. " It costs you nothing to be a
member, and it will save you tremendous
amounts of money. "
She adds that centralizing purchasing
and ensuring strict adherence to
processes will pay off in savings.
Pay on time to avoid interest penalties,
audit regularly (quarterly for accounts
payable and monthly for accounts
receivable), and control costs.
" The number one cost in an ASC
is staff salary and benefits, " Kirchner
says. Supplies, medications, and implants
round out the top four.
The average cost to cut a purchase
order is $125, Kirchner says. She recommends
limiting the number of purchase
orders and doing a cost breakdown of
supplies and medications used by anesthesia
personnel.
Carefully manage fixed assets (assets
purchased with an expected useful life of
greater than 3 years for technology and
greater than 3 years for medical equipment)
by making sure all invoices sent
for payment are properly labeled as capital
equipment or capital purchase (eg,
a computer). The ASC's accountant will
know how to prepare the fixed asset list
and how to determine depreciation.
When equipment is damaged and
must be replaced before its established
life span, the purchaser and the leader
should notify the accountant of the
equipment to be removed from the list
and the new equipment to be placed on
the list.
An annual capital equipment budget
is essential to effectively manage fixed
assets. " Include a return on investment
document so the board knows why you
are requesting the equipment and how
long it will take to pay for it, " she says.
" That will help them prioritize capital
purchases. "
Keeping a repair and maintenance
binder helps identify which equipment is
at or near the end of its life. " If repairs
and maintenance costs are more than
Continued on page 24
AMBULATORY SURGERY ADVISORY BOARD
Michele Bossi, MSN, RN, Director of Clinical
Operations/ASC Administrator, OSS
Health, York, PA
Ellen Carpenter, RN, Nurse Manager,
Center for Advanced Medicine Ambulatory
Surgery Center, Long Island Jewish
Medical Center/Northwell Health
System, Lake Success, NY
www.ormanager.com
Tracy Hoeft-Hoffman, MSN, MBA, RN,
CASC, Administrator, Heartland Surgery
Center, Kearney, NE
Donna Quinn, MBA, BSN, RN, CAPA, CPAN,
Administrator, Orthopedic Surgery
Center, Concord, NH
Mary Jo Steiert, BSN, RN, Administrator,
Director of Nurses, Lowry Surgery
Center, Denver, CO
Mary Stewart, MSN, BSN, RN, Director,
Patient Experience, SIU Medicine,
Southern Illinois University School of
Medicine, Springfield, IL
OR Manager | April 2018
23
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OR Manager - April 2018

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