orm_november-2023 - 24

Finances
Benchmarking resource
The Ambulatory Surgery Center Association
(ASCA) offers the Clinical & Operational
Benchmarking Survey, which provides quarterly
reports that ASC leaders can use to
compare their own facilities to others. " It
represents about 600 ASCs, so it's a goodsized
database, " says Becky Ziegler-Otis,
MHA, CASC, RHIA, CPHQ, CHC, an ASCA
board member.
Baseline metrics include volume, quality,
operational measures, outcomes, complications,
staffing (broken down by licensed
clinical staff, nonlicensed clinical staff, and
nonclinical staff), and financial. Participating
ASCs can enter data for three specialties-total
joints, complex spine, and
ophthalmology.
ASC leaders can sort data in several
ways, including specialty, region (state),
urban vs. suburban setting, ownership, and
total patient encounters. Reports are available
in Word, Excel, and PowerPoint; the
recognition time clock
helps ensure accuracy
of staff hours.
Rena Courtay, MBA,
BCN, RN, CASC, CPPM,
CNOR(e), does not include
nonclinical staff
such as schedulers in
productivity measures.
" Those positions don't
change on a daily basis
the way clinical staff
do, " says Courtay, who is assistant vice
president for perioperative ambulatory
surgery at Duke Health and an ASCA
board member. Instead, nonclinical staff
are considered a fixed cost, so part of
the annual budget process is determining
the appropriate number for the anticipated
volume.
Rena
Courtay, MBA,
BCN, RN,
CASC, CPPM,
CNOR(e)
For OR staffing, Courtay uses the formula
of 2.5 fulltime equivalent employees
(RNs and surgical technologists) for
each OR. " That will cover you for nonproductive
hours such as meetings and for
24
OR Manager | Nov/Dec 2023
latter is helpful when leaders need to present
results to others.
" When looking at any benchmarking data,
you want to be sure you're comparing apples
to apples, " Ziegler-Otis cautions. For example,
an ASC leader who is outsourcing billing
needs to consider that when comparing the
center's number of nonclinical staff to aggregate
and benchmark data. " You might
look better than you really are because your
FTEs don't include billing staff when the
benchmark may include them, " she says.
Proper analysis can identify trends that need
investigation. Ziegler-Otis gives the example
of nonclinical staff time increasing faster
than case volume. The leader may discover
that a new specialty is requiring significant
nonclinical time to obtain prior authorization.
Ziegler-Otis says ASC leaders can use
the data to ask, " How do we compare to
the rest of the ASC world, how are we different,
and how can we get better? "
things like breaks and lunch, " she says.
For the most part, ASCs do not have
detailed productivity measurements for
the postanesthesia care unit (PACU) or
sterile processing department (SPD).
" That isn't information that's easy to
gather and benchmark nationally, "
Goehle says. Duke uses number of
trays processed for the SPD, but Courtay
acknowledges it should not be the
sole measure because it fails to account
for the complexity of processing
some trays. She adds that keeping up
with the increasing volume of trays as
surgical procedures become more complex
is challenging, and that last-minute
arrival of loaner trays also is a problem.
" We're needing a lot more people in
SPD than we ever did before to keep up
with the load, " she says.
Compared to hospitals, the role of
technology in obtaining productivity
measures is more limited in the ASC
because of cost and, in some cases,
not having an EHR. Courtay says Duke
was able to negotiate a special price
for iQueue for Operating Rooms (LeanTaas),
which uses predictive analytics
and machine learning to provide information
used to manage capacity. The
detailed information has helped facilitate
her discussions about block utilization
with surgeons.
Ziegler-Otis says that even ASCs
without an EHR usually have a practice
management system for scheduling that
leaders can leverage to obtain useful
productivity data. " Most scheduling software
has the ability to run analytics and
data reports, " she says. For example,
practice management software typically
can track surgeon-specific surgical procedure
time and calculate an average
case time that can be used to schedule
future cases, resulting in effective utilization
of a surgeon or group block time.
As with any system, data entry must be
precise to obtain useful data.
Data analysis
Benchmarking can be a challenge for
ASC leaders because few national resources
exist. One resource is Intellimarker
(VMG Health), which has data
for multispecialty ASCs, including revenue,
expenses, case volume and mix,
payor mix, reimbursement, and staffing.
Courtay adds that Becker's sometimes
publishes articles with benchmarking
data, and that the ASC management
company often sets benchmarks. Another
resource is ASCA's Clinical & Operational
Benchmarking Survey (sidebar,
Benchmarking resource).
In addition to external sources, ASC
leaders can benchmark productivity
measures, such as clinical hours per
case, against their own performance
over time to determine operational efficiency
levels. Goehle gives the example
of an ASC that has been running at 8
hours per case for the past four quarters
but slipped to 7 (a number the center
has never seen). In this case, more
staff are likely needed, unless staff is
complaining about their workload, which
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