OR Manager - September 2020 - 24

AmbulAtory
Surgery CenterS
Continued from page 23
tions, 15% had space for 1 RN and 19%
were seeking 1 ST. About one-fifth (22%)
of ASC leaders report that the number
of open ST positions increased over the
past 12 months, whereas 59% said it
remained the same.
The percentage of those reporting increased
RN turnover has remained fairly
consistent over the past 5 years, ranging
from 22% to 30%. Similarly, the percentage
reporting an increase in RN open
positions ranges from 26% to 34%.
Congruent with the jump in the number
of staff layoffs, the percentage of
ASC leaders who hired more direct care
staff over the past 12 months dropped
from 46% last year to 22% this year.
The percentage of those who increased
use of agency or travel staff fell from
14% in 2019 to 4% this year.
Leaders aren't immune to the staffing
challenges; 11% reported management
layoffs in the past year. That
might seem like a small percentage
until one considers that in the past it
has consistently been below 5%, and in
2019, it was just 3%.
Patient care and volume
The average surgical volume was 4,510
procedures annually (compared to
5,115 in 2019), but there was a wide
range of responses (250 to 30,000).
The uptake of care models-Accountable
Care Organizations, joint ventures,
Enhanced Recovery After Surgery (ERAS),
Perioperative Surgical Homes, and duallicense
facilities-was once again low.
In all, 57% (vs 63% in 2019 and 59% in
2018) either do not have or do not plan
to implement them in the next 6 months.
Of those who had at least one of the care
models or planned to implement, ERAS
topped the list at 19%, followed by a joint
venture with physicians and a management
company or with physicians and
hospitals (13% each).
In an open-ended question, we
asked how the migration of traditionally
inpatient procedures (for example,
total joints, spine, and cardiac procedures)
from the hospital to ambulatory
care settings was affecting ASC leaders
and their organizations. Of the 51 who
responded, 21 reported no or minimal
effects. A few are planning to implement
these procedures, and others are
already adding them to their services.
Sample comments include:
* " This is a great migration. The biggest
struggle is changing the mindset
of employees who aren't familiar
with such a model and are,
understandably, nervous about the
change. We have already created a
total joint program from the ground
up, which staff found very exciting.
We are currently working on pricing
out vascular services for our center. "
* " Provides opportunities for growth,
but is difficult to grasp as a small,
freestanding ASC with the nearest
How many FTE positions does
your ASC currently have open
for RN and ST positions?
67%
0%
10%
20%
30%
40%
50%
60%
54%
N=54
RNs
STs
Trends in RN turnover
and open positions
Year
2020
2019
2018
2017
2016
2015
2010
% reporting
increased RN
turnover
24%
26%
22%
23%
30%
24%
11%
% reporting
increased RN
open positions
30%
32%
26%
29%
34%
26%
4%
Impact of COVID-19
In all, 51 respondents answered the
question about how COVID-19 has
affected their facilities and staffs, with
all of them mentioning lost volume
and/or staff effects such as furloughs,
reduced overtime, and layoffs. Several
reported closures that have ended;
one ASC closed for 2 months, and
four others were still closed at the
time of the survey. Some ASC leaders
reported that the facilities are reopening,
but at lower volumes.
Sample comments include:
➤ " Furloughed staff for 7 weeks,
had to change/add policies,
lowered number of patients
in facility, slowed process of
patient flow.
➤ " We have drastically decreased
our volume. Currently, the facility
is only open half of the day 4
days per week and closed 1 day
per week due to no cases. "
➤ " Only performing urgent/nonelective
procedures. Running at
about 20% volume. 50% of staff
furloughed. Will likely change our
plans for adding services and implementing
an EMR [electronic
medical record] ($$$). "
15%
19%
13%
10%
4%
None
24
1
OR Manager | September 2020
2
3
4
6%
5 or more
9%
4%
Perhaps this comment best reflects
the reported issues: " We have lost
a staggering amount of income and
volume resulting in the furloughing of
over 80% of staff. "
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