Features
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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