Features
Johns Hopkins Surgery Center Series’ innovative model includes integrated operations and student training
BY ROBERT KURTZ | JANUARY 2022
Lisa Ishii, MD, hopes the ASC program she oversees can serve as a model for academic health systems nationwide. Ishii, an otolaryngologist, is the president of the Johns Hopkins Surgery Center Series (JHSCS), which comprises six ASCs in Maryland jointly owned by the Johns Hopkins Health System and Johns Hopkins University.
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Purchase and manage inventory wisely
BY ROBERT KURTZ | JANUARY 2022
The second highest cost element on the profit and loss statement of SurgCenter of Western Maryland in Cumberland, Maryland, is supplies, says Raghu Reddy, the ASC's chief administrative officer. That makes it imperative for the center to execute an effective strategy for keeping supply costs down as much as possible, he says.
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Do your due diligence before signing on the dotted line
BY ROBERT KURTZ | JANUARY 2022
Lora Reed, RN, figures her ASC’s vendor service contract manual is at least five inches thick. To best ensure the manual serves her ASC in the most effective manner, Reed, the administrative director of Live Oak Surgery Center in Plano, Texas, devotes significant time and energy to evaluating and negotiating her ASC’s service contracts.
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ASCs embrace new less-invasive surgical options
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2021
In mid-July, Howard Nam, MD, an otolaryngologist at Sutter North Surgery and Endoscopy Center in Yuba City, California, implanted an upper airway stimulator in a patient’s chest. This was the first time Nam had completed the procedure in the ASC.
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As out-of-pocket costs rise, being up front about finances becomes a central piece for patient satisfaction
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2021
Surgery on its own is a stressful experience for patients. Present them with an unexpectedly high bill on the day of their procedure and that stress level could rise significantly and might even cause postponement of the surgery.
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Q&A with Janie Kinsey
INTERVIEWED BY ROBERT KURTZ | NOVEMBER-DECEMBER 2021
Janie Kinsey, RN, CASC, is the vice president of ASCA’s Board of Directors and the administrator of Surgicenter of Kansas City in Kansas City, Missouri.
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Seven steps to consider
BY ROBERT KURTZ | OCTOBER 2021
In the late 1990s, the US Department of Health & Human Services Office of Inspector General (OIG) began placing a heavy emphasis on corporate compliance plans, says Lani Dornfeld, a member at Brach Eichler who works out of the firm’s Roseland, New Jersey, and West Palm Beach, Florida, offices.
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Stay current, empower staff and be willing to experiment
BY ROBERT KURTZ | OCTOBER 2021
In 2010, after more than a year of research, Pasadena Plastic Surgery Center in Pasadena, California, invested in a new information technology (IT) system to better manage scheduling, inventory, billing and other key functions.
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Keep your system updated and educate employees
BY ROBERT KURTZ | OCTOBER 2021
ASCs must take the threat of ransomware seriously because cybercriminals are hoping they do not, says Robert Banniza, associate vice president of information security for Amsurg in Nashville, Tennessee.
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Hire experts and involve staff
BY ROBERT KURTZ | SEPTEMBER 2021
Over the past several years, Helena Surgicenter in Helena, Montana, has purchased a lot of technology, including a new C-arm and imaging solutions. One of the most important investments in technology the ASC made, however, had little to do with clinical care.
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Conversations with two achievers in the ASC community
BY ROBERT KURTZ | SEPTEMBER 2021
The ASC industry has many impressive leaders who work tirelessly day in and day out to serve their community and their industry. They take care of their patients and their staff and advocate for the ASC industry on Capitol Hill. ASC Focus talked to two of these leaders—Leslie Scott and Katherine Horowitz—to find out what makes a good leader.
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Use these ideas and high-quality resources to educate prospective leaders
BY ROBERT KURTZ | SEPTEMBER 2021
For ASC administrators planning to retire in the near future or those just wanting to take a more relaxing vacation, succession planning is essential, says Mary Ryan, RN, CASC, a senior consultant for Amblitel in Louisville, Colorado. “If you are in a leadership position, see who you have ‘sitting on the bench’ that you can mentor and help provide the education they need.
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Over years, ASCA and its members have reduced burdens on ASCs
BY KARA NEWBURY | AUGUST 2021
The ASC community celebrated its 50th anniversary last year and has much to be proud of over the course of its history. The past decade alone has been full of advocacy achievements.
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‘The next 10 years might be the best 10 years to own a surgery center’
BY ROBERT KURTZ | AUGUST 2021
If you operate an ASC, do not be surprised if you hear from any number of organizations asking if you will engage in a conversation about the future of your center. The reason, says Michael McCaslin, principal at Somerset CPAs and Advisors in Indianapolis, Indiana: ASCs are a hot commodity.
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Learning your surgery center’s value can help with short- and long-term planning
BY ROBERT KURTZ | AUGUST 2021
After ASC owners engage ASCs Inc. in Valley Center, California, to help facilitate a sale, the process they follow involves collecting significant due diligence material and developing a confidential information memorandum (CIM), says Jonathan Vick, the company’s founder and managing partner.
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Q&A with Suzi Walton of Ohio Surgery Center
INTERVIEWED BY ROBERT KURTZ | AUGUST 2021
In the wake of the COVID-19 pandemic, Ohio Surgery Center in Columbus, Ohio, hosted its first virtual facility tour. Suzi Walton, CASC, the ASC’s facility administrator, worked with ASCA to arrange a 30-minute virtual facility tour for Congressman Troy Balderson (R-OH) and several of his staff members.
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Consider safety, accountability and performance improvement
BY ROBERT KURTZ | JUNE-JULY 2021
While it might appear as just a few lines in a document, the agenda for the quality assurance and performance improvement (QAPI) portion of Raleigh Orthopaedic Surgery Center’s (ROSC) medical executive committee (MEC) meetings serves several important purposes, says Andria Barnes, RN, quality manager for the Raleigh, North Carolina, ASC.
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Give equal importance to both short- and long-term goals
BY ROBERT KURTZ | JUNE-JULY 2021
In early 2004, a group of surgeons operating at The Reading Hospital in Reading, Pennsylvania, approached hospital leadership with a proposal: partner on an ASC. Before year’s end, an outpatient department located a few miles from the hospital had been converted into a surgery center with ownership split between the physicians and the hospital.
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While location is critical, so are access, visibility and zoning
BY ROBERT KURTZ | JUNE-JULY 2021
If you are planning to build a new ASC, do not rush to get a shovel into the ground. “The pre-construction phase is a definitive component in the development of a new center,” says Ronald Blair, founder of Surgery Center Services of America in Mesa, Arizona.
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Develop protocols to guide decisions
BY ROBERT KURTZ | MAY 2021
The Ambulatory Surgical Center of Stevens Point in Stevens Point, Wisconsin, started performing total joint replacements in 2010. Since the program's launch, only a few patients have required postoperative transfer to a hospital.
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Analyze trends over time, make adjustments
BY ROBERT KURTZ | MAY 2021
Achieving ASC revenue cycle success is largely about timing, says Jenny Mishler, director of revenue cycle and payer relations for the Orthopaedic & Spine Center of the Rockies in Fort Collins, Colorado. From getting claims out the door to submitting denials before deadlines, timing, she says, is often the difference between receiving payment and leaving money on the table.
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Implications to consider before making the decision
BY ROBERT KURTZ | MAY 2021
Wondering whether you are allowed to mandate that your staff receive the COVID-19 vaccination? The short answer is yes, you can, says Marianne Monroy, partner-director and co-chair of Garfunkel Wild's employment law practice group who practices out of the firm's Great Neck, New York, office and serves the tristate area of New York, New Jersey and Connecticut. A lot needs to be considered before proceeding, however.
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What ASCs need to know to help patients avoid unexpected costs
BY ROBERT KURTZ | APRIL 2021
Over several years, congressional hearings and the continued rise in the cost of healthcare and patient copays contributed to a heightened awareness of the ill effects of surprise medical bills.
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Understand the requirements, keep current and use software to simplify processes
BY ROBERT KURTZ | APRIL 2021
In its 2020 AAAHC Quality Roadmap, the Accreditation Association for Ambulatory Health Care identifies credentialing, privileging and peer review as high-deficiency standards for ASCs.
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Lessen volume unpredictability, cross-train and drive decisions with data
BY ROBERT KURTZ | APRIL 2021
With staff wages one of the top expenses for Mohawk Valley Endoscopy Center in Utica, New York, Thomas P. Fiorentino, the ASC's chief financial officer, keeps a watchful eye on them.
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Educate yourself, keep your ear to the ground and stay prepared for change
BY ROBERT KURTZ | MARCH 2021
Add the ASC supply chain to the list of the pieces of the US healthcare system that will be dealing with the effects of the COVID-19 pandemic for years to come.
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Know the rules and keep an eye on staffing and payers
BY ROBERT KURTZ | MARCH 2021
While optimistic about the future of cardiology in ASCs, Janet Dees cautions about rushing to bring in too many cases within a specialty that is in its infancy in the ASC setting.
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Administrators weigh in
BY ROBERT KURTZ | MARCH 2021
Innovative technology drew Traci Kubaiko to the cardiology specialty more than 20 years ago when she started working in a hospital heart catheterization lab.
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Review Medicare’s interpretive guidelines, state licensure rules and your accreditation organization's standards
BY ROBERT KURTZ | FEBRUARY 2021
Reinforcing that your ASC is on par with like facilities. Identifying trends in need of improvement. Validating your commitment to the provision of high-quality care.
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Add this must-not-miss spring event to your calendar
BY ROBERT KURTZ | FEBRUARY 2021
For the second consecutive year, ASCA's annual conference will be a virtual event. While the COVID- 19 pandemic will keep everyone physically apart again, ASCA is taking what it learned from hosting the ASCA 2020 Virtual Conference & Expo online to deliver an improved experience for attendees.
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Physicians in the US who sign up would work with local physicians in Honduras and the Dominican Republic
BY SAHELY MUKERJI | FEBRUARY 2021
Like the rest of the world, the COVID-19 pandemic has impacted Honduras and the Dominican Republic (DR), the two countries where One World Surgery (OWS) sends its medical mission teams.
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Focus on key metrics, take action based on your results
BY ROBERT KURTZ | FEBRUARY 2021
Overlooking critical benchmarks can cause service quality to falter, physicians to become disgruntled and patients to be unhappy, says Nan Finch, CASC, president of Diverse Health Consulting in Austin, Texas.
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Industry experts share tips and strategies to make the best of what we have
JANUARY 2021
The COVID-19 pandemic wreaked havoc around the world in 2020 and threw all forecasts and projections out the window. As the country continues to respond, ASCs can keep rolling with the changes, delivering high-quality, lower-cost services to their community, and sharing their story with their patients.
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Crises like the COVID-19 pandemic test an organization’s habits and help reshape and improve it
BY ROBERT KURTZ | JANUARY 2021
In 2018, staff at Wichita Falls Endoscopy Center in Wichita Falls, Texas, completed the Agency for Healthcare Research and Quality’s (AHRQ) Ambulatory Surgery Center Survey on Patient Safety Culture. This served as the foundation for the ASC's development of a culture of safety, says Jeremy Watkins, RN, clinical manager.
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Show appreciation, support work-life balance and work as a team
BY ROBERT KURTZ | JANUARY 2021
There is no hesitation in Cynthia Armistead's voice when speaking about the challenges of confronting the COVID-19 pandemic. “I have worked in healthcare for about 40 years," she says. “I have never navigated something as unusual and stressful.”
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Q&A with ASCA Board member Stuart Simon, MD
JANUARY 2021
Stuart Simon, MD, is the medical director for United Surgical Partners International (USPI) in Dallas, Texas, which owns and operates more than 400 ambulatory facilities. He is a practicing anesthesiologist and chairman of the department of anesthesiology at North Central Surgical Center in Dallas, Texas, and serves on ASCA's Board of Directors.
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Play up your strengths, share your new safety precautions with patients
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2020
For an ASC to be successful, its marketing must be successful, says Melissa Hermanson, RN, CASC, administrator of Ambulatory Care Center in Vineland, New Jersey.
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Responsibilities can be divvied up among team members
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2020
The COVID-19 pandemic further put into focus that preventing infections depends upon everyone working in an ASC, says Debra Yoder, RN, director of clinical operations and corporate compliance officer for Surgical Management Professionals in Sioux Falls, South Dakota.
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Assemble a multidisciplinary team, follow evidence-based guidelines and use the right tools
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2020
Rockford Ambulatory Surgery Center in Rockford, Illinois, assumes every patient who walks in the door to be potentially infectious. That mentality, says Gina Hartman, RN, CASC, the ASC’s director of perioperative services, helps keep staff focused on effectively cleaning any surface that might come into contact with patients.
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Hire an experienced consulting firm, develop a pro forma and be creative in your design decisions
BY ROBERT KURTZ | OCTOBER 2020
Most of John Blanck’s work as senior vice president of operations for Surgery Partners in Kansas City, Missouri, focuses on ophthalmology, which he says is primed for steady growth.
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Use the right technology, correctly
BY ROBERT KURTZ | OCTOBER 2020
Limiting close face-to-face contact with individuals not in your household is considered by the Centers for Disease Control and Prevention to be the most effective way of reducing the spread of COVID-19.
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Ophthalmic ASCs go above and beyond their clinical duties to alleviate anxiety
BY ROBERT KURTZ | OCTOBER 2020
Surgical Eye Center in Greensboro, North Carolina, resumed surgery in early May following several weeks of suspended operations due to the COVID-19 pandemic. In the weeks that followed, Clinical Director Carrie Nitz, RN, was not surprised to see patient cancellations increase.
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Communication, clinical alignment and resource allocation
BY ROBERT KURTZ | SEPTEMBER 2020
A pandemic was not something Raghu Reddy ever expected to confront as executive administrator of SurgCenter of Western Maryland in Cumberland, Maryland. Navigating COVID-19, however, has been easier thanks to support from UPMC Western Maryland, the hospital that jointly owns the ASC with local physicians, he says.
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Follow CDC practices and recommendations from gastroenterology societies
BY ROBERT KURTZ | SEPTEMBER 2020
COVID-19 has not changed the importance of proper disinfection, handling and storage of endoscopes to ensure patient and staff safety. What the virus has done, says Shelley Allison, RN, director of nursing at EndoCenter in Covington, Louisiana, is further underscore it.
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Communicate, be aware of EUAs and create a policy
BY SAHELY MUKERJI | SEPTEMBER 2020
Complications surrounding drug shortages stemming from the COVID-19 pandemic continue to emerge.
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Q&A with Nader Samii
INTERVIEWED BY ROBERT KURTZ | SEPTEMBER 2020
Nader Samii, the chief executive officer of National Medical Billing Services in St. Louis, Missouri, has guided the company into its position as one of the largest and most reputable revenue cycle management companies in the ASC market.
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COVID-19 protocols could affect patient flow, timing
BY ROBERT KURTZ | AUGUST 2020
Many factors contribute to the Buffalo Ambulatory Surgery Center’s success, but few might be more important than ensuring operational efficiency, says Christina Norman, RN, administrator of the center in Cheektowaga, New York.
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Updated guidelines involve more focus on infection control
BY SAHELY MUKERJI | AUGUST 2020
As the country comes out of the COVID-19 lockdown, elective surgeries have resumed in most states.
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Educate up-front and be transparent about the bills they will receive
BY ROBERT KURTZ | AUGUST 2020
The data is in and it shows Americans struggling to understand their health coverage.
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Create a balance between in-person and electronic interactions
BY ROBERT KURTZ | AUGUST 2020
Thanks to technological advances, ASCs can now choose from multiple ways to communicate with patients.
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What ASCs need to know
BY ROBERT KURTZ | JUNE-JULY 2020
When Clay Landry, director of central sterile for Saratoga Surgery Center in Saratoga Springs, New York, began working in sterile processing in the late 1970s, standards for reprocessing equipment were few and far between. “What we did back then was basically the best we could without guidance or technology.”
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Protocols ASCs need to put in place to use these medications safely and avoid citations
BY SAHELY MUKERJI | JUNE-JULY 2020
In light of the COVID-19 pandemic and the consequent demand for certain medications, the US Food & Drug Administration (FDA) updated its list of extended-use drugs on April 3. The updated list now includes 569 drugs that may be used beyond the manufacturer’s labeled expiration date.
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ASCs nationwide come together to help their communities
BY SAHELY MUKERJI | JUNE-JULY 2020
As COVID-19 continues to ravage the US, healthcare workers across the country face shortages of personal protective equipment (PPE) and medical gear needed to treat patients. At press time, many surgery centers have shut down temporarily in compliance with their governors’ stay-at-home orders.
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Recycle, use eco-friendly products and identify a sustainability champion in your center
BY ROBERT KURTZ | JUNE-JULY 2020
An operating room (OR) produces a lot of waste. But waste can create opportunity.
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Add new procedures, technology to your ASC
BY ROBERT KURTZ | JUNE-JULY 2020
By embracing clinical innovation, ASCs can continue to be the preferred site for outpatient surgery among patients and physicians. “We should not sit back and only perform those procedures already coming our way,” says Alfonso del Granado, CASC, administrator of Covenant High Plains Surgery Center in Lubbock, Texas.
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Factors to consider before opening an ASC
BY ROBERT KURTZ | MAY 2020
Gwen Donithan, RN, Laurri Wallace and Teresa Burwell, RN, have one thing in common: Each helped open a new surgery center.
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Rely on strong surgeon leaders and carefully trained staff
BY ROBERT KURTZ | MAY 2020
Unity Surgical Center in Lafayette, Indiana, opened in 2001, with its spine surgery program already in place. That program continues to thrive, says spine surgeon Mario Brkaric, MD, who joined the ASC in 2006. The key to its success, he adds, is its team.
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Ways to hold payers accountable
BY ROBERT KURTZ | MAY 2020
Submitting clean claims to payers in a timely manner does not ensure getting paid appropriately. The complicated nature of insurance leaves a lot of potential for errors.
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Do you have a strong infrastructure and potential leads in the bag to eat the loss?
BY ROBERT KURTZ | APRIL 2020
In 2018, two high-volume orthopedic surgeons left CenterOne Surgery Center in Jacksonville, Florida, to pursue a new endeavor. While the loss was not crippling, says Executive Director Robert Haen, their unexpected departure left a challenging void.
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Hire candidates who fit, offer fair compensation and professional development opportunities
BY ROBERT KURTZ | APRIL 2020
When considering the importance of building and maintaining a strong staff, a quote attributed to Douglas Conant comes to mind, says Meg Wiebel, RN, CASC, administrative director of Crow Valley Surgery Center in Bettendorf, Iowa. “He said, ‘To win in the marketplace, we must win in the workplace,’” Wiebel says.
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Employee satisfaction is key
BY ROBERT KURTZ | APRIL 2020
When ASC staff are productive, the positive effects can be wide-reaching: more efficient care that results in patients spending less time in the ASC; more satisfied physicians who appreciate efforts to help them provide high-quality care at a low cost; and more engaged staff as a result of seeing how their work directly affects the ASC’s performance.
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Come to Orlando this May for the ASC event of the year
BY ROBERT KURTZ | MARCH 2020
Experience the magic of being surrounded by thousands of your colleagues, just miles from Disney World at the largest ASC conference of the year. Register now for the ASCA 2020 Conference & Expo, May 13–16, at the Orlando World Center Marriott in Orlando, Florida. This year’s conference will run concurrently with SAMBA 2020, the annual meeting of the Society for Ambulatory Anesthesia.
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Help surgeons understand why your ASC is a great choice
BY ROBERT KURTZ | MARCH 2020
In an optimal situation, any opening in an ASC’s surgical schedule would be filled by an investor physician. Often, that scenario is just wishful thinking, says John Piccione, CASC, a regional director for Surgery Partners based in Lake Worth, Florida.
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Eliminate blame; provide support
BY ROBERT KURTZ | MARCH 2020
To be a good provider, says Cori Prisco, RN, you must be able to confidently act on your instinct and experience. This can be difficult for staff members following an adverse event.
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Leverage your findings and re-evaluate
BY ROBERT KURTZ | FEBRUARY 2020
Completing a quality assessment and performance improvement (QAPI) project can take considerable time and effort. As long as your ASC is making that kind of investment, some who have managed QAPI studies in the past advise, make sure that your project goes beyond just meeting the requirements and provides real benefits to your facility.
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Educate, perform audits and ask questions
BY ROBERT KURTZ | FEBRUARY 2020
Irina Morrow knows that a lot is riding on her ability to consistently code her ASC’s procedures correctly.
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Share patient satisfaction ratings, hospital transfer data and other quantifiable measures
BY ROBERT KURTZ | FEBRUARY 2020
For payers on the fence about whether to provide your ASC with a new or improved managed care contract, sharing quality data could be what you need to swing the tide in your favor.
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Opportunities and challenges facing the ASC industry
JANUARY 2020
Industry professionals weigh in on the key trends.
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The time is ripe for surgery centers to do more heart procedures
BY ROBERT KURTZ | JANUARY 2020
Still a relatively new specialty for ASCs, cardiology is quickly cementing itself as one of the most promising.
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Help is available on the MHAUS website
BY ROBERT KURTZ | JANUARY 2020
Fiona Stephan, RN, considers her ASC—Vanguard Surgical Center in Maywood, New Jersey—fortunate. It has never experienced a malignant hyperthermia (MH) event.
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Plan for all facets of the encounter, including family members’ experiences
BY ROBERT KURTZ | JANUARY 2020
While your ASC will likely never be mistaken for Disney World, strive to provide the same level of attention and service that helps attract millions of people to the resort every year, advises Susan Burkett, RN, senior director of clinical services with Amsurg in Nashville, Tennessee.
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Involve your team, learn about the requirements, and make it a living tool
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2019
If your ASC’s primary motivation for developing an emergency preparedness plan is compliance with regulatory requirements, that is acceptable, says Mary Ann Gellenbeck, senior vice president of implementation services for Physicians Endoscopy in Jamison, Pennsylvania.
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One-on-one with an ASC urologist
INTERVIEWED BY ROBERT KURTZ | NOVEMBER-DECEMBER 2019
Brad Lerner, MD, CASC, is the medical director of Summit ASC, the surgery center division of Chesapeake Urology Associates in Baltimore, Maryland. Summit ASC comprises 16 single-specialty urology ASCs located throughout Maryland.
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CMS requires it
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2019
You cannot control when your ASC might encounter a natural or man-made hazard. You can, however, control your readiness to tackle those hazards.
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Adequate preparation and response required
BY ROBERT KURTZ | OCTOBER 2019
Stephanie Rodriguez, RN, has been punched, kicked and bitten. All these incidents occurred while she was working in the medical intensive care unit and emergency department at a hospital.
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Marketing to patients outside your community
BY SAHELY MUKERJI | OCTOBER 2019
Patient interest in medical tourism, a small but growing trend in the ASC setting, shows an uptick. “Patients [are] willing to travel short distances to receive care from a provider that has a contract for a bundled transparent rate for surgery,” says Christopher D. Stine, bundled payments & corporate compliance officer at Regent Surgical Health in Westchester, Illinois.
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Stay within a new safe harbor and avoid federal anti-kickback violations
BY ROBERT KURTZ | OCTOBER 2019
Tri-State Centers for Sight Surgery Center in Cincinnati, Ohio, relies on a transportation service to bring many of its patients to and from the ASC. About 20 percent use the service, says Deborah Bray, RN, the ASC’s director.
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Market collaboration on the rise
BY ROBERT KURTZ | OCTOBER 2019
The ASC industry is a hotbed of transaction activity. That activity is helping to drive up the value of facilities and likely spurring the development of new centers.
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Be sure to capture all the details of your patients’ use
BY ROBERT KURTZ | OCTOBER 2019
In 2012, Colorado and Washington became the first states to legalize marijuana for recreational purposes. Since then, the number of states where the drug has been legalized for medical and/or recreational purposes has increased.
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Choose an ASC architect and work closely with your state health department and full team
BY SAHELY MUKERJI | SEPTEMBER 2019
When Key Whitman Surgery Center in Dallas, Texas, had the option of either renovating or building new, it decided to opt for the latter and insisted on an experienced healthcare architect who specialized in ophthalmology.
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Implement a system that monitors and logs temperature, humidity and pressure of your unit
BY ROBERT KURTZ | SEPTEMBER 2019
While most components of an ASC’s heating, ventilation and air-conditioning (HVAC) system are typically out of sight, they should never be out of mind. A properly functioning HVAC system is vital to keeping patients safe, says Donald Smith, vice president of Agnew Associates in Austin, Texas.
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Follow the rules, educate staff and create checklists
BY ROBERT KURTZ | SEPTEMBER 2019
Months. That is how long the likes of Clostridium difficile, Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus and many other harmful pathogens can survive on surfaces within an ASC. How can an ASC keep its patients safe?
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Establish internal controls, use an external accountant and conduct regular audits
BY ROBERT KURTZ | SEPTEMBER 2019
Scrubs. Gloves. Scalpels. Drapes. A rowboat. Which of these is not like the others?
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Consider these practical, cost-cutting ideas
INTERVIEWED BY ROBERT KURTZ | SEPTEMBER 2019
Michael Gordon is founder and president of Gordon & Associates in Mount Dora, Florida.
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‘Dropless’ approach, bi-lateral, same-day sequential cataract surgery and Zepto system are improving the quality of eye surgery
BY ROBERT KURTZ | AUGUST 2019
Ophthalmology procedures continue to migrate out of hospitals and into ASCs, thanks to new clinical developments.
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Good relationship with adjusters is key
BY ROBERT KURTZ | AUGUST 2019
The good news: Workers’ compensation collections can be easy. The bad news: There are several obstacles that can make a simple experience difficult.
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The market appears primed to experience rapid growth
BY ROBERT KURTZ | JUNE-JULY 2019
In early January, Sovereign Healthcare’s North Valley Surgery Center received its robot. Less than a week later, the Scottsdale, Arizona, ASC performed its first cases using the orthopedic surgical system. Andrea Lessner, RN, North Valley’s outpatient total joint coordinator, expects the technology to help the ASC achieve its objective of doubling the number of joint replacement procedures performed this year compared to 2018.
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Research, plan and get physician buy-in before you act
BY ROBERT KURTZ | JUNE-JULY 2019
Thinking about starting a robotics program in your ASC? The time is now, says Jess Lonner, MD, orthopedic surgeon and member of Rothman Orthopaedic Institute in Philadelphia, Pennsylvania. Lonner has used robotics technology to perform surgery in multiple outpatient settings, including an ASC.
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Copper Ridge Surgery Center shares its patient care initiative story
BY ROBERT KURTZ | JUNE-JULY 2019
Walk around Copper Ridge Surgery Center in Traverse City, Michigan, and you will soon spot the “infinity loop.” Looking like an angled 8 with multi-colored dots on and around it, the infinity loop identifies every manner—direct or indirect—in which the ASC and its team members interact with patients.
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Focus on fundamentals and communicate
BY ROBERT KURTZ | MAY 2019
Total hip. Total knee. Partial knee. Total shoulder. Lumbar fusion. Lumbar laminectomy. Cervical disc replacement. Anterior cervical discectomy and fusion. Extreme lateral interbody fusion.
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Patient engagement and education are critical
BY ROBERT KURTZ | MAY 2019
Total joint replacement in an ASC was once a far-fetched idea, but now surgeons are performing these procedures safely in surgery centers every day.
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How to recruit and retain top-notch staff
BY ROBERT KURTZ | MAY 2019
In an industry that undergoes frequent changes, Dianne (Wallace) Appleby, RN, found comfort in a constant: her ASC’s coder.
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Participate in ASCA’s 2019 National Advocacy Day
BY DANIELLE KASTER | APRIL 2019
The ASC community had one of its most successful legislative and regulatory years in 2018.
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Collect upfront and make technology your friend
BY ROBERT KURTZ | APRIL 2019
Sara Ebert knows that nothing good can come from inefficiencies creeping into her ASC’s billing workflows.
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These members of Congress could make a difference to your ASC
BY JEFF EVANS | APRIL 2019
As the final year of this decade, 2019 brings with it a new Congress and plenty of fresh, and many familiar, faces on Capitol Hill. As a result of last November’s election, the US House of Representatives is now under a Democratic majority and the US Senate is operating with a larger Republican majority than in 2018.
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Evaluate expenses, ask for better rates and verify billings
BY ROBERT KURTZ | APRIL 2019
Improving your ASC’s bottom line does not necessarily require adding new procedures, physicians or specialties. Taking a closer look at some of the services and products your ASC is already paying for might be all you need to do.
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ASC community members share their thoughts
BY ROBERT KURTZ | APRIL 2019
ASCA would like to recognize and thank all the individuals who have participated in ASCA’s advocacy opportunities, including attending National Advocacy Day, hosting a facility tour and writing a letter to Congress.
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Join ASCA in Music City for education, networking and Honky Tonkin’
BY ROBERT KURTZ | MARCH 2019
Polish your rhinestones, put on your Stetson and join thousands of your colleagues in Nashville, Tennessee, for the largest ASC meeting of the year, the ASCA 2019 Conference & Expo, May 15–18.
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Consider new procedures, ancillary services and payment models
BY ROBERT KURTZ | MARCH 2019
Given the market trajectory, it might be time for GI ASCs to explore additional revenue sources.
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Improved ADR, quality reporting and reimbursement likely to follow
BY ROBERT KURTZ | MARCH 2019
A few years ago, colonoscopes with three camera lenses entered the market. Until then, gastroenterologists who performed colonoscopies had relied for decades on a single-lens platform that provided a 180-degree field of view.
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Clinical innovations and business trends in ASC pain management
BY ROBERT KURTZ | FEBRUARY 2019
Pain management is ripe for significant growth in ASCs, says Ronnie Pennell, executive vice president and chief operating officer for PhyBus in Brentwood, Tennessee. To support this belief, he points to the history of gastroenterology (GI).
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Counter negativity with a proactive approach
BY ROBERT KURTZ | FEBRUARY 2019
ASCs that adopt new technology can expect some resistance to change, says Steve Campbell, chief operating officer of Oppor Infrastructure in Overland Park, Kansas.
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Monitor traffic, track documents and improve operations
BY ROBERT KURTZ | FEBRUARY 2019
In 2013, Christus Good Shepherd Surgery Center in Longview, Texas, was the site of a fatal stabbing that claimed the life of a nurse and visitor. In response, the ASC implemented numerous security measures, several of which relied upon a new technology: radiofrequency identification (RFID).
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Key trends, challenges and opportunities
JANUARY 2019
Experts within the ASC community share their opinion on what is coming down the pipeline this year.
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Consider these tips
BY ROBERT KURTZ | JANUARY 2019
For an ASC to thrive, its staff must possess essential “hard” skills or the knowledge and technical expertise necessary to fulfill specific job responsibilities. For staff to get their jobs done and done well, however, says Lori Post, director of human resources for Medical Consulting Group, in Springfield, Missouri, “soft” skills are equally important.
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Review, revise and recirculate it every year
BY ROBERT KURTZ | JANUARY 2019
When Sabrina Westbrook, administrator for Premier Surgical Center in Madison, Mississippi, was helping her ASC prepare to open in June 2018, she had a lot of work on her plate. Still, she made sure developing the surgery center’s employee handbook received the attention it needed. The importance of an employee handbook should not be underestimated,” she says.
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Join ASCA in January for the 2019 Winter Seminar
BY SAHELY MUKERJI | NOVEMBER-DECEMBER 2018
ASCA’s 2019 Winter Seminar will take place January 17–19 in Austin, Texas. This is a smaller, more focused and intimate seminar than ASCA’s annual conference and offers Administrator Education Units (AEU), Certified Ambulatory Infection Preventionist (CAIP) and Certified Administrator Surgery Center (CASC) credits.
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Pre-planning goes a long way
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2018
In August 2017, Mississippi Valley Surgery Center in Davenport, Iowa, began work on a multi-million-dollar addition and renovation. One year later, the project is going “relatively smoothly,” says Michael Patterson, RN, ASCA Board member and the ASC’s president and chief executive officer.
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Focus on communication and collaboration and catch potential problems early
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2018
A significant focus on ASC expense management is directed toward labor costs, and rightfully so, considering they are a large piece of a surgery center’s overall spend, says Stephanie Martin, CASC, vice president of operations, clinical, for Westchester, Illinois-based ASC management and development company Regent Surgical Health.
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Points to consider before making a decision
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2018
Thinking about renovating your ASC? Do not be too quick to break down a wall; you may be wiser to break ground.
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Make it a continuous quality improvement process
BY ROBERT KURTZ | OCTOBER 2018
In her nine years as an ASC administrator, Angie Jimenez has come to appreciate the importance of complying with the Life Safety Code (LSC).
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One-on-one with an ASC director
BY SAHELY MUKERJI | OCTOBER 2018
Brenda Page, RN, director of Carolina Center for Specialty Surgery in Charlotte, North Carolina, discusses regulatory compliance and how her ASC consistently stays ahead of the curve. Carolina Center for Specialty Surgery performs minimally invasive spine procedures.
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Back up your data and develop a business continuity plan
BY ROBERT KURTZ | OCTOBER 2018
Even the most well-designed machines eventually fail. That includes the computers, servers and any other information technology (IT) in your ASC. Do you have a plan in place to respond when this day comes?
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Find one fitted to your ASC’s culture
BY ROBERT KURTZ | OCTOBER 2018
For ASCs struggling to manage their information technology (IT) while maintaining cyber security and compliance, partnering with a managed services provider (MSP) might provide needed relief.
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Join state associations and participate in benchmarking and National Advocacy Days
BY ROBERT KURTZ | SEPTEMBER 2018
A 2013 study of Medicare data by research scientists at the University of California-Berkeley found that in just four years, between 2008 and 2011, ASCs saved the Medicare program and its beneficiaries $7.5 billion. In 2011 alone, they report, the savings to Medicare and its beneficiaries totaled $2.3 billion.
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Deliver strong management, diversified revenue and a balanced payer mix
BY ROBERT KURTZ | SEPTEMBER 2018
It is a good time to be a seller of an ASC, says Glenn Prives, an attorney at the law firm of McElroy, Deutsch, Mulvaney and Carpenter in Morristown, New Jersey. “Numerous parties are interested in acquiring well-run ASCs these days. Hospitals are shopping, private equity firms are hungry for deals and management companies are looking to expand their portfolios.”
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A company shares its successful pain management program
BY ROBERT KURTZ | SEPTEMBER 2018
When HealthCrest Surgical Partners, an Edmond, Oklahoma-based ASC management company, set out in 2017 to build comprehensive total joint replacement programs at its two Maryland ASCs the team decided it also wanted to develop a supporting opiate-sparing pain management program that delivered excellent pain relief. HealthCrest manages Frederick Surgical Center in Frederick, Maryland, and Cumberland Valley Surgery Center in Hagerstown, Maryland.
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Learn their communication styles and speak their language
AUGUST 2018
While the generation an individual is born into cannot paint the entire picture of a person’s attributes and attitudes, it can provide insight for ASC leaders, says Margaret Chappell, RN, CASC, senior vice president of operations for ASC management and development company Ambulatory Surgical Centers of America, based in Hanover, Massachusetts.
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Stay on top of your paperwork, perform drills and collaborate with your local authorities
AUGUST 2018
Do not think of complying with emergency preparedness requirements as a regulatory burden, says Kris Kilgore, RN, administrative director at Surgical Care Center of Michigan in Grand Rapids, Michigan. Rather, think of it as an opportunity.
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Effective communication is key
AUGUST 2018
If you want your ASC to provide a better experience for its patients and physicians, focus on ways to get the most out of your staff, says Anne Hargrave-Thomas, chief executive officer of OakLeaf Surgical Hospital in Altoona, Wisconsin, and vice president of operations for Surgery Partners, a nationwide operator of surgical facilities based in Nashville, Tennessee.
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One World Surgery provides continuum of care to patients globally
JUNE-JULY 2018
One World Surgery in Chicago, Illinois, a nonprofit, partners with communities, health care providers and leaders in health care to deliver surgical services globally. ASCA has joined hands with the organization to help fulfill its mission. Below is an excerpt from an interview with Claire Cunningham, executive director of the organization.
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Keep ADA requirements in mind
JUNE-JULY 2018
Paralyzed patients rarely come into Reading Hospital SurgiCenter at Spring Ridge in Reading, Pennsylvania, says Brandi Reisch, RN, a perioperative nurse at the ASC. That, however, does not mean the ASC is any less prepared to meet their needs.
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Post your ASC’s surgery prices online
JUNE-JULY 2018
Northwest ENT Surgery Center in Woodstock, Georgia, started observing a trend around 2011–2012, says Shatul Parikh, MD, otolaryngologist and medical director of the ASC.
“There was a change in the tide of the insurance market,” he says. “The Affordable Care Act marketplace and employers started offering higher deductible plans. When patients had a $250 or $500 deductible, surgery was affordable, regardless of the type of procedure. Then deductibles started to rise sharply.”
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The credential is a seal of quality that demonstrates commitment to the ASC community, employers say
JUNE-JULY 2018
Different people take the Certified Administrator Surgery Center (CASC) examination for different reasons. ASC employers, however, say that to them the credential stands for one thing: validation that the credential- holder has mastered the skills that an ASC administrator needs.
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Consistency is key
JUNE-JULY 2018
Go looking for Occupational Safety and Health Administration (OSHA) regulations concerning eyewash stations and you might be surprised by what you find—or more likely what you will not find, says Cathy Montgomery, RN, CASC, president and managing partner of ASC and physician practice consulting firm Excellentia Advisory Group in St. Peters, Missouri.
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Boost collections with transparency and up-front payments
MAY 2018
Depending on specialty, geography, payer mix and technology, the critical components of an ASC revenue cycle can change, says Lindsay Miller, executive vice president of operations at National Medical Billing Services in St. Louis, Missouri. “The ASC revenue cycle is nuanced because of its complexity in all of these areas. Each ASC faces its own set of challenges,” she says.
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Expand, invest in new technology and market your brand
MAY 2018
The future of ophthalmology in ASCs looks bright, says George Violin, MD, board-certified ophthalmologist and one of the founding principals of ASC management and development company Ambulatory Surgical Centers of America, based in Hanover, Massachusetts.
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Educate yourself, develop relationships and act quickly on denials
MAY 2018
Whether your ASC is in- or out-of-network with a payer, payment denials, payment delays and underpayments are inevitable, says Brian Hufford, health care attorney with the law firm of Zuckerman Spaeder in New York, New York.
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The Certified Ambulatory Infection Preventionist credential is now available
MAY 2018
Infection preventionists in ASCs have their own certification program with the official launch of the Certified Ambulatory Infection Preventionist (CAIP) credential in January. This credential represents the culmination of extensive planning over several years, says Gina Throneberry, RN, CASC, executive director of the Board of Ambulatory Surgery Certification (BASC), which administers the CAIP exam.
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Expand your ASC network, knowledge and skills at ASCA 2018
APRIL 2018
Where can you find thousands of your peers, ASC industry leaders, cutting-edge technology, the Green Monster, chowder and duck tours all in one place? Boston, Massachusetts, of course, between April 11 and 14, when ASCA 2018 convenes at the Hynes Convention Center. Need some more reasons why you need to be at this meeting? Read on.
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How to protect your patients from paying out-of-network prices
APRIL 2018
Over the last several years, patients have been bearing the brunt of the first dollars coming off the top for their care, says Stanford Plavin, MD, ASCA Board member, an anesthesiologist and owner of consulting firm Technical Anesthesia Strategies and Solutions in Atlanta, Georgia. “As insurance plans have transitioned from low co-pays and low deductibles with good out-of-network benefits to higher co-pays and higher deductibles with little to no out-of-network benefits, patients are receiving what they perceive as inordinate bills. They might not have been previously privy to these bills, but they have essentially been around all along. That is where the ‘surprise’ comes in.”
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Know the current standards and follow established best practices
APRIL 2018
In 2014, the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Florida, conducted its first annual safety culture survey. It asked the employees to rank the ASC’s performance in areas including safety priority within the facility, safety as part of the ASC’s ongoing agenda, accountability, issues corrected, teamwork and training.
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Proceed with caution for best results
APRIL 2018
An electronic medical record (EMR) system can be a valuable tool in helping ASCs improve their billing performance, says Nanette Reintges, founder and principal consultant at Finance and Information Technology Performance Strategies, a consulting firm in Odenton, Maryland. It is vital, however, that use of the EMR does not streamline documentation to the point where potential problems can occur, she cautions.
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Groundwork laid for future success
MARCH 2018
Last year was an important year for the ASC community, as ASCA and its members achieved several beneficial policy changes through steadfast federal and state advocacy efforts. ASCA is optimistic about 2018 and, with its members, continues to work with Congress, regulatory agencies and state legislatures across the country to ensure ASCs are represented as policy decisions are made.
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ASCA’s Advocacy Fund helps make sure ASCs get fair legislation
MARCH 2018
ASCA created its Advocacy Fund as a way to solicit support from the ASC community and help communicate its legislative and regulatory agenda to federal and state policymakers. In particular, the fund was created to garner support from the many companies that sell products and services to ASCs and, therefore, benefit from a thriving ASC model.
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Convalescent centers, skilled nursing facilities or home care?
MARCH 2018
As more complex procedures move to the outpatient setting, ASCs should be looking at where patients can receive the best post-acute recovery care, recommends Rebecca Craig, RN, CASC, ASCA Board president and chief executive officer of Harmony Surgery Center and Peak Surgical Management in Fort Collins, Colorado.
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Meet your members of Congress and advocate for your ASC in Washington, DC
MARCH 2018
More than 5,600 Medicare-certified ASCs provide care to patients across the US. Despite the expanded access to top-quality care that ASCs offer and the billions of dollars ASCs save patients, Medicare and private insurers each year, many elected officials do not fully understand the role ASCs play in health care.
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Strategies for success lie in pre- and postop care
FEBRUARY 2018
Arthritis and spine- and backrelated conditions in adults aged 18 and older will grow from 54 million in 2014 to 63 million by 2020 and 78 million by 2040, according to the Centers for Disease Control and Prevention (CDC).
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Use external and internal parameters
FEBRUARY 2018
To say some ASCs do not enjoy the benchmarking process may be an understatement, says Carol Hiatt, RN, CASC, owner of Surgery Center Consulting Services in Ocala, Florida.
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Join the ‘transparency revolution’
FEBRUARY 2018
Health care consumers are at a disadvantage when it comes to researching their surgical options, says Thomas Wilson, chief executive officer of Monterey Peninsula Surgery Center in Monterey, California.
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Share basic information and encourage questions
FEBRUARY 2018
ASC staff typically have limited time to spend with patients. This makes it imperative for staff to take advantage of every moment available to provide critical education to patients, says Missy Soliz, RN, quality and risk manager for Mississippi Valley Surgery Center and Mississippi Valley Endoscopy Center in Davenport, Iowa. “We must also do so without overwhelming them or talking over their heads,” she says.
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More foot cases are migrating into the ASC setting
FEBRUARY 2018
Developments over the past few years have made this a particularly exciting time for outpatient foot surgery, says Scott VanValkenburg, MD, foot and ankle surgeon at Upstate Orthopedics Ambulatory Surgery Center in East Syracuse, New York.
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Where ASCs stand in the business of health care
JANUARY 2018
Three experts share their view on the future of the ASC industry and what surgery centers can ep[axpect to see this year. While ASCs are poised to grow and evolve, especially, with more higher acuity cases moving into the ASC setting, cyber security remains a threat.
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Reduce risk with understanding
JANUARY 2018
Although rare, surgical fires continue to occur in health care facilities. Their prevention must be an ongoing area of focus for ASCs, says Mark Bruley, vice president of accident and forensic investigation for ECRI Institute, a Plymouth Meeting, Pennsylvania-based organization that researches approaches to improving patient care.
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