YOUR NEIGHBORHOOD ASC · removal of three Ambulatory Surgical Center Quality Reporting (ASCQR)...

Improving productivity in pre-op

Real patients share ASC experiences

Navigating growth in an era of consumerism

2018: ISSUE 8

Ideas to improve clinical, financial & operational efficiencies

YOUR NEIGHBORHOOD ASCCreative administrators are making healthcare more accessible — and affordable — nationwide

SPECIAL PEOPLE ISSUESurgery center staff discuss their unique roles

minute VH2O2 results

Continuous innovation in vaporized hydrogen peroxide sterilization monitoring now provides biological indicator results in just 24 minutes. Finally, you can fully implement Every Load Monitoring across sterilization modalities to help ensure maximum patient safety. Feel confident that no patient’s well-being is left to chance with the fastest VH2O2 results available.*

Know. Then go.

For more information, visit go.3M.com/VH2O2.

Know sooner so you can act faster.

Get the Attest™ Brand Advantage for consistent sterilization monitoring across modalities.

* Compared to FDA-cleared, commercially available products August 2017.3M and Attest are trademarks of 3M. © 3M 2017. All rights reserved.

A survey taken a few years ago revealed that patients have a 92 percent satisfaction rate with the care they receive in ASCs. That’s really no surprise for those of us who work in this segment of healthcare. The benefits of choosing a surgery center versus a hospital are unquestionably clear: less cost (lower co-pays), transparent pricing, reduced wait and procedure times, and a more personal and convenient experience. In this issue of Outpatient Outcomes, we look at different ways ASCs are delivering superior patient experience and impacting their communities.

Healthcare is an essential service, but many people still struggle to get the care they need. As our cover story, “Your neighborhood ASC,” illustrates, ASC administrators are finding new ways to improve healthcare access and affordability — not just for those in their local communities, but nationwide.

To get the patient’s perspective, “It’s better in a surgery center” captures the experiences of several ASC patients in their own words. Convenience, efficiency and service were common themes in their stories.

Personal care provided by staff is a key reason patients give ASCs such high marks. “Is laughter the best medicine?” examines how some healthcare professionals are using humor to alleviate patient fears and build patient-clinician relationships. We also speak with Director of Nursing Katie Vieux about her success balancing patient care with management roles. In “Touching hands and hearts,” Vieux explains how she helps lighten the load for her staff so they can spend more time with patients.

Other clinicians and staff are also making a huge impact on patient outcomes and overall care delivered at their centers. In “Prevention detective,” Infection Preventionist Christine Cavallo works behind the scenes to improve patient safety by helping her facility maintain an infection rate of less than one percent. And, in “A knack for numbers,” Materials Manager Gigi Copeland keeps Melville Surgery Center running like clockwork by knowing the location of every surgical item — including the room and rack where it resides.

As always, we hope this issue provides you with valuable insights for your job and your center, and we invite you to contact us with your ideas, comments and suggestions at [email protected]. Your feedback is crucial to helping us deliver relevant, interesting information to help you move your business forward.

Sincerely,

Josh CarterSenior Vice President, Ambulatory Service Center DivisionMedline Industries, Inc.

welcomeASCs care for the community, one patient at a time

Josh Carter

minute VH2O2 results

Continuous innovation in vaporized hydrogen peroxide sterilization monitoring now provides biological indicator results in just 24 minutes. Finally, you can fully implement Every Load Monitoring across sterilization modalities to help ensure maximum patient safety. Feel confident that no patient’s well-being is left to chance with the fastest VH2O2 results available.*

Know. Then go.

For more information, visit go.3M.com/VH2O2.

Know sooner so you can act faster.

Get the Attest™ Brand Advantage for consistent sterilization monitoring across modalities.

* Compared to FDA-cleared, commercially available products August 2017.3M and Attest are trademarks of 3M. © 3M 2017. All rights reserved.

Issue 8 3

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26

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6

©2018 Medline Industries, Inc. All rights reserved.Medline is a registered trademark of Medline Industries, Inc.

Medline Industries, Inc. Three Lakes Drive

Northfield, IL 600931-800-MEDLINE (1-800-633-5463)

www.medline.com/[email protected]

Published by Convero

835 Sharon Drive, Suite 200 Westlake, OH 44145

(844) 428-8844 www.converoinc.com

Editor: Laura MarzecCopy Editor: Sue OstrowskiArt Director: Stacy Vickroy

Project Manager: Michelle Almenar

27

8

CONTENTSspotlightWelcome letter . . . . . . . . . . . . . . . . . . . . . . . . 3

Briefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Featured products . . . . . . . . . . . . . . . . . . . . 10

featuresTouching hands and hearts: Director of Nursing Katie Vieux . . . . . . . . 12

Improving productivity in pre-op: La Veta Surgical Center . . . . . . . . . . . . . . . 13

Cover story: Your neighborhood ASC . . . 16

Prevention detective: Infection Preventionist Christine Cavallo . . . . . . . . . 23

It’s better in a surgery center: Patient stories . . . . . . . . . . . . . . . . . . . . . . . . 24

Is laughter the best medicine? . . . . . . . . . . 26

Navigating growth in an era of consumerism . . . . . . . . . . . . . . . . . . . . . . . 28

A knack for numbers: Materials Manager Gigi Copeland . . . . . . 3025

1310

16

Issue 8 5

briefsSPOTLIGHT

CMS announces ‘Patients Over Paperwork,’ payment updatesPatients Over PaperworkOn Nov. 1, the Centers for Medicare & Medicaid Services (CMS) launched the Patients Over Paperwork Initiative, a process designed to reduce regulatory burdens on healthcare providers in an effort to improve patient care. As part of this effort, CMS is finalizing the removal of three Ambulatory Surgical Center Quality Reporting (ASCQR) Program quality measures for the 2019 payment determination. By removing these measures, CMS expects to reduce the administrative burden and maintenance costs to ASCs by $48,066 and 1,314 hours in 2019.

Final payment rule CMS has released its 2018 final payment rule for ASCs and hospital outpatient departments. Here are several key takeaways for ASCs:• Based on projected inflation (1.7

percent) and a new multi-factor productivity (MFP) adjustment (0.5 percent), ASC payment rates will increase 1.2 percent in 2018.

• Total ASC payments are projected to increase approximately 3 percent in 2018, after accounting for enrollment, case-mix and utilization changes.

• Due to concerns about the difference between Hospital Outpatient Prospective Payment System (HOPPS) payments and ASC payments, CMS is also soliciting comments on ways to improve payment accuracy for ASCs.

NOTE: In addition, CMS is finalizing its proposal to add three procedures to the ASC covered procedures list (CPL) for 2018.

EHR recommendations to improve patient safety Electronic health records play an important role in helping healthcare providers report and communicate patient information. However, improper or inaccurate accounting of laboratory results, alerts and patient care data can put patients at risk.

A recently released report by the Healthcare Information and Management Systems Society Electronic Health Record Association provides recommendations to help facilities improve patient safety when using EHRs. Those suggestions include making simple text formatting changes related to the use of punctuation, word spacing, numbers, upper and lowercase letters, and signal words to indicate an alert. Other proposed text modifications include using uppercase letters in certain medication names to differentiate them from similarly names medications, using consistent formatting for abnormal lab results, and using abbreviations sparingly and carefully.

To read the full report, visit www.himss.org/sites/himssorg/files/ ehra-design-patterns-for-safety.pdf.

TALK TO USHave a comment on something

you’ve read in Medline’s Outpatient Outcomes

magazine? Have an idea for a story in a future issue?

Please submit comments and suggestions to

[email protected].

6 OUTPATIENT OUTCOMES 2018

Trends in price shopping for healthcareThough most Americans say price shopping for healthcare is important to them, few take the time to seek out price information from healthcare providers, a new survey shows.

Published August 2017 in Health Affairs, the nationally representative survey examined how frequently patients are price shopping for healthcare and the challenges they face in the process. Respondents included 2,996 nonelderly U.S. adults who had received medical care in the previous 12 months.

Researchers found that:

• Only 13 percent of people who paid some out-of-pocket spending in their last healthcare encounter sought information about their expected spending before receiving care.

• Only 3 percent compared costs across providers before receiving care. • Respondents cited common barriers to price shopping, including difficulty

obtaining price information and a desire not to disrupt existing provider relationships.

To read the full study, visit www.healthaffairs.org/doi/10.1377/hlthaff.2016.1471.

*Based on an internal review of national data. © 2017 Medline Industries, Inc. All rights reserved. Medline is a registered trademark of Medline Industries, Inc. MKT1781520 / 31

Are You Confident in Your Gown Mix? Be Sure.

40% OF HIGH-FLUID PROCEDURES USE THE WRONG GOWN*

Benchmark your gowns today. Visit Medline.com/GownBenchmarking.

Find Out How You Compare.Validate your gown program with an objective assessment at no cost.

As the industry-leading provider of surgical gowns, we’ll analyze your gown mix and benchmark it against our nationwide data.

The result: A validated gown program to help ensure your best practice expectations are met.

SPOTLIGHT

eventsJanuary 2018

ASCA WINTER SEMINARSJan. 11-13Rio All-Suite Las Vegas Hotel & CasinoLas Vegas, NevadaThe ASCA offers three practical seminars to help your ASC navigate the complex hurdles it will face in the coming year: Coding Update & Reimbursement Strategies, Minimizing Your Regulatory & Legal Risk and Infection Control & Prevention Techniques for ASCs. Attend sessions from other seminars at no additional cost.For more information, visit www.ascassociation.org/ 2018regulatory/home.

March 2018

AORN GLOBAL SURGICAL CONFERENCE & EXPO March 24-28Ernest N. Morial Convention CenterNew Orleans, LouisianaMore than 10,000 perioperative nurses and exhibitors come together to discuss the latest industry research, best practices, technologies and trends, and to interact with more than 500 exhibits. The event is the largest gathering of perioperative nurses in the world. For more information, visit www.aorn.org/events.

June 2018

BECKER’S 16TH ANNUAL FUTURE OF SPINE + THE SPINE, ORTHOPEDIC AND PAIN MANAGEMENT-DRIVEN ASC CONFERENCEJune 14-16Swissotel ChicagoChicago, IllinoisLearn the latest best practices and trends in spine, orthopedic and pain manage-ment at this annual ASC-focused event. For more information, visit www.beckersasc.com/ conferences-and-events.html.

ARIZONA AMBULATORY SURGERY CENTER ASSOCIATION (AASCA) ANNUAL CONFERENCEJune 28-29JW Marriott Camelback Inn & SpaScottsdale, ArizonaThe AASCA Annual Conference features a variety of educational seminars dedicated to helping ASC professionals stay updated on the latest practices and standards of care.For more information, visit www.arizonaasc.org/conference/ 2017-conference-exhibit-information.

If you would like to have your event listed here, please send an email to [email protected].

April 2018

ASCA 2018 ANNUAL MEETINGApril 11-14Hynes Convention CenterBoston, MassachusettsThis annual meeting features more than 60 educational sessions designed to help today’s medical professionals further their skills and industry knowledge. Walk the exhibition hall between sessions to meet top medical equipment distributors and see what’s new.For more information, visit www.ascassociation.org/asca2018/home.

May 2018

AMERICAN ACADEMY OF AMBULATORY CARE NURSING (AAACN) 43RD ANNUAL CONFERENCEMay 9-12Walt Disney World Dolphin Hotel Lake Buena Vista, FloridaThe only conference tailored specifically to ambulatory care and telehealth nurses, this annual gathering features educational sessions and presentations designed to help attendees improve processes and enhance patient care.For more information, visitwww.aaacn.org/professional-develop-ment/annual-conference.

ASSOCIATION OF SURGICAL TECHNOLOGISTS (AST) SURGICAL TECHNOLOGY CONFERENCEMay 31-June 2Walt Disney World Swan and Dolphin ResortOrlando, FloridaThis conference is the number one surgical technology and surgical assisting trade show in the country. Attendees participate in education led by nationally distinguished surgeons.For more information, visit www.ast.org/AboutUs/Conference.


*Based on eight internal Medline case studies. © 2016 Medline Industries, Inc. All rights reserved. Medline is a registered trademark of Medline Industries, Inc.

Perioperative Supply Management Consulting Services Discovering ways to improve your supply processes is our mission. Since no two facilities are the same, our approach to understanding your process allows us to customize solutions that will effectively reengineer your routine supply management process. Giving clinicians more time to do what they do best which is care for the patient, not chase supplies.

For more information, contact your Medline ASC representative or call 1-800-MEDLINE (633-5463).

MEANINGFUL CHANGE.

PART ONE: Lean AssessmentWe examine each step of your perioperative process utilizing Lean philosophies and provide ideas and opportunities for improvement.

PART TWO: Clinical AnalysisExperienced Perioperative Nurse Consultants use a data driven approach for a fresh perspective in analyzing the appropriate clinical supply optimization while incorporating best practice for improved clinical outcomes.

PART THREE: Logistical AnalysisFocusing on both your supply flow process and storage needs, we introduce the concept of inventory rationalization: having neither too much nor too little of any product as the ultimate goal.

PART FOUR: Financial AnalysisOur consultants provide a complete financial analysis detailing the cost per procedure from an overall cost impact perspective. Typical results include a 46% reduction in case pick time, a 40% reduction in number of items picked and a 47% reduction in setup time.*

www.medline.com/asc

SPOTLIGHT

Expanded opportunities in reprocessing

Did you know that reprocessing single-use medical devices can save your surgery center between $10,000 to $25,000 per OR suite? The quality of reprocessed devices and the financial advantages of reprocessed versus new products can open up new opportunities for both cost savings and operational efficiency.

Starting in the ASC space and becoming the largest third-party reprocessing company in the United States, Medline ReNewal has a portfolio of nearly 5,000 products spanning across all device categories. Because each facility is unique, we can tailor a program optimized to your facility’s needs. Whether your specialties include ophthalmology, orthopedic, ENT, GYN, urology, GI or general surgery, we have a growing portfolio of options to help you reach your goals.


Manufacturer Catalog Number DescriptionArthroCare ASHA 4250-01 Ambient® Super TurboVac® 90° IFSArthroCare ASH 4250-01 Super TurboVac 90° IFSArthroCare ASHA 4830-01 Ambient® Super MultiVac® 50° IFSArthroCare ASH 4830-01 Super MultiVac® 50° IFSArthroCare ASHA 3730-01 Ambient® CoVac® 70° IFSArthroCare ASHA 2530-01 Ambient® CoVac® 50° IFSS&N Dyonics 72202140 Dyonics RF-S Cross 50° Suction ProbeMedtronic LF1212A LigaSure™ Small JawStryker 0702-020-000 Neptune 2 Four Port Manifold

In addition to our existing portfolio of reprocessed devices, Medline ReNewal recently received FDA 510(k) clearance to reprocess several new products, which include high-spend, high-volume items in the ablation probe, vessel sealing and fluid management product categories. Reprocessing these newly cleared, single-use devices can save your facility up to 50 percent of the new cost of these products. (See chart below.)

To learn more or to discuss a reprocessing program for your facility, contact your Medline ASC representative or email us at [email protected].

featured products

Issue 8 11

Medline CS Pro™ nitrile gloves

In the central sterile department, staff must clean and prepare many instruments with bioburden to handle the next sterile procedure. For the clinicians, technicians and staff who clean, decontaminate, sterilize and disinfect these instruments, Medline’s CS Pro™ nitrile gloves provide exceptional protection, fit and performance.

Key product features include:• Longer, 16” cuffs for extra protection — Provides extra

protection between the cuff and the sleeve.• Fully textured for better grip — Performs well in both wet and

dry situations.• Thick glove for superb protection — Tested to withstand harsh

chemicals.1

• Strong and durable material — Outperformed commonly used alternatives in puncture resistance tests.

• Chemo-tested — Meets the ASTM D6978-05 standard for providing protection against select chemotherapy drugs.1

Compared with other 12” gloves on the market, the test data1 shows CS Pro offers:• Over 30 percent more tensile strength than against gloves over 25 percent thicker.• Over 35 percent more puncture resistance than against gloves over percent thicker.

CS Pro also outperforms the competition in elongation and is a latex-free glove. The chemical compatibility shows that it withstands many key chemicals found in the CSD (Fig. 1):

To request your free CS Pro sample today, contact Denis at

[email protected] or call (847) 643-3211.

1. Data on file.

CS PRO Extended CuffChemical Test Used Concentration Breakthrough

(min.)Foam First – MDS8800FOAM (active ingredient 4- Enzyme)

ASTM F739 >480

Glutaraldehyde, 4.0% ASTM F739 4% >480Instrument Stain Remover – MDS88000T5

ASTM F739 >480

Instrument Lubricant Super Concentrate – MDS88IL25CM (active ingredient Surfactant & Propylene Glycol 57-55-6)

ASTM F739 >480

Low Foam Automatic Detergent Super Concentrate – MDS88LFD25CM (active ingredient Surfactant)

ASTM F739 >480

Sodium Hypochlorite 10-13% (Clorox Bleach)

ASTM F739 10-13% >480

FIG. 1

Is there an existing product that has worked great for your facility? We want to hear from you. Send us your story at [email protected].

Share your experience.

Since entering the nursing field in 1984, Katie Vieux has balanced compassionate patient care with her management roles. Today, she brings that same balance to her job as direc-tor of nursing at Audubon Ambulatory Surgery Center in Colorado Springs, Colorado.

Outpatient Outcomes recently spoke with Vieux about her role directing staffing and clinical surgical schedules, overseeing compliance and reporting, and helping ensure Audubon patients receive excellent care. Q: What do you like about your role as director of nursing? I like the quick pace, and there is enough variety of procedures to keep things interesting. Also, the people here are upbeat and physicians are very caring about our patients and staff. When I came here on Nov. 1, 2015, we completed 147 cases in our first week. It was a huge undertaking for everyone involved. I like when everyone can come together to do the best we can for our patients.

Q: What part of your role would others be surprised about? People often picture a director of nursing as working behind a desk. They would be surprised by how much time I spend on the floor, working with patients, helping turn over rooms or setting up carts — anything to lighten the load. After about an hour in my office, I go out

— from pre-op instructions until they are discharged — to ensure they have all the knowledge they need to return home safely.

Q: How do you personally contribute to making your ASC great? I think I am a strong employee and patient advocate. I look at what is best for everyone around me. We obviously have certain constraints, but I don’t ask anybody to do anything I wouldn’t do. We have hectic days and people don’t always get the kudos they deserve, so I like to recognize the staff for their hard work. We recently organized an employee picnic, which had never been done before.

into to the real world. I’m used to walking miles on my feet every day.

Q: Why do you enjoy working at an ASC? Our center is more of a partnership. We can resolve problems without huge hurdles. If we have an idea that would benefit our patients or staff, or a solution to improve the surgery center, then we discuss implementing it. Everything is not mandated down from someplace else, where no one may have practiced it or knows if it will work.

Q: What do you think ASCs do that makes them great? Because we are freestanding, we are very careful about screening our patients to ensure they are appropriate candidates for a non-hospital setting. We are focused on being proactive versus reactive. For example, we are educating patients all the way through their procedures

Touching hands and hearts


Director of Nursing Katie Vieux lightens the load for patients and staff

COLUMN

DIRECTOR OF NURSING

Responsibilities: Managing most clinical staff, overseeing the flow of the surgery center,

interacting with patients, staff and physicians, and

ensuring everything is running smoothly.

“We are educating patients all the way through

their procedures — from pre-op instructions until they

are discharged — to ensure they have all the knowledge they need to return home safely.”

– Katie Vieux, director of nursing, Audubon Ambulatory Surgery Center

Issue 8 13

FEATURE

As a multi-specialty facility, La Veta Surgical Center has been a fixture of Orange, California, since 1988, when a group of physicians set out to create a safe, cost-effective alternative to hospital surgical care.

In fall 2015, Medline representative Phil Mitchell scheduled his annual Perioperative Business Review (PBR) for La Veta. He invited along Regional Vice President Malia Goss from Medline’s Perioperative Consulting team. During the PBR, the team discovered various challenges with the facility’s available space. Goss suggested a Lean Assessment to review La Veta’s entire perioperative supply management process and look for efficiencies.

Giving time back to caregiversIn the Lean Assessment Findings report, Goss presented a touchpoint analysis. It revealed that between 21 and 30 routine items were being picked for every procedure at La Veta, meaning the facility had a lot of inventory that could be consolidated and delivered more efficiently.

“It takes significant time to pick each item and open it in the room,” Goss says. “And each time someone opens an item, it could contaminate the sterile field.”

Improving productivity IN PRE-OPHow La Veta Surgical Center streamlined its perioperative supply management process to provide more efficient, personalized patient care

FEATURE

The Medline team explained to La Veta staff that they could help reduce the center’s inventory levels, saving time for the facility’s scrub techs and nurses in pre-op. They suggested updating La Veta’s supply management protocols with Medline’s Complete Delivery System (CDS).

Each CDS module contains all disposable and procedure-specific items for a case in one box, eliminating the need to pick dozens of items. By creating a different customized module for each procedure La Veta commonly performs, Medline could eliminate nearly 800,000 touchpoints for the center over the course of a year (Fig. 1).

This hit home with Mary Gamez, administrator for La Veta. “We wanted the nurses to have more time to pre-op the patient,” she says.

At the time, the only custom packs the nurses had were for ophthalmology procedures. The patient population had grown, and La Veta nurses were extremely busy performing approximately 1,250 cases per month with just five operating rooms and one gastrointestinal suite.

“Caregivers should have enough time to communicate with patients, go over any concerns, and get them admitted without making them feel rushed,” Gamez says.

Financial results, and moreMotivated to help other sites optimize staff time and patient care, Gamez invited Andy Ard, finance manager, Surgical Care Affiliates (SCA), to the financial presentation to La Veta, which has been affiliated with SCA since 2005. “I felt that this was something special,” Gamez says. “Because Andy is also regional, he was the perfect person to come see the results and then spread


“Caregivers should have enough time to

communicate with patients, go over any

concerns, and get them admitted without making

them feel rushed.”– Mary Gamez, administrator,

La Veta Surgical Center

the news to the other facilities.”Ard, Gamez and other staff from

La Veta attended the financial presentation. The Executive Financial Summary estimated that the center could save $255,297 over five years (Fig. 2).

After the presentation, Ard said he believed Medline’s efficiency savings estimates were actually too conservative. He was confident the labor savings would more than offset the 5.35 percent increase in acquisition costs. Plus, with CDS there is no extra charge for Lowest Unit of Measure (LUM) delivery, providing additional savings.

La Veta agreed to transition from two custom surgical packs to 16 custom CDS modules (Fig. 3). Medline then immediately began the process of depleting the appropriate inventory, freeing up space to house the new modules. Implementation was completed in June 2016.

Embracing efficiencyToday, Gamez says, “Patients in pre-op are experiencing a more personalized care approach and a friendlier environment.”

Patients are also safer. With just one surgical pack to open, instead of many, it’s easier to maintain the sterile field in the OR.

La Veta staff benefit from the

Current Practice Proposed Practice6 steps in the supply chainx 21 average items picked per procedure= 126 touchpointsx 6,660 procedures per year= 839,160 touchpoints

6 steps in the supply chainx 1 item picked per procedure= 6 touchpointsx 6,660 procedures per year= 39,960 touchpoints

Eliminating 799,200 touchpoints annually.If each touchpoint takes five seconds, this saves 1,110 hours annually. If the average hourly wage (with benefits) is $18 per hour, the labor reallocation savings cost avoidance is $19,980.

FIG. 1

FEATURE

Issue 8 15

more efficient system, too. For the scrub techs, there’s less room for error when picking cases. “And they go a lot faster,” Gamez says. “The new system has made it easier — and helped to decrease stress.”

For RNs, there’s more time for patient care. “The nurse can easily pick up the pack and pre-op the patient, rather than going to six different areas to get what they need,” she

notes. Nurses are confident everything they need is there.

In addition to providing cost savings, the CDS modules have helped La Veta cut down on linen costs. “We used to use a sheet to transfer patients from the OR bed to the gurney,” Gamez says. “Now a disposable sheet comes in the pack.”

When asked if the program lived up to her expectations, Gamez replied, “Absolutely.”

FIG. 2

EXECUTIVE FINANCIAL SUMMARY / La Veta Surgical CenterPerioperative Supply Management Proposal / Presented January 25, 2016Re-engineered Program Year 1 Year 2 Year 3 Year 4 Year 55-year Annual Expenditure $517,063 $517,063 $517,063 $517,063 $517,063Savings CategoriesInventory Shelf Reduction 75% Reduction $277.478 $0 $0 $0 $0Inventory Holding Cost 2.25% $224 $224 $224 $224 $224Distrib. Fee Avoidance 3% $5,036 $5,036 $5,036 $5,036 $5,036GPO Rebates 3% $5,036 $5,036 $5,036 $5,036 $5,036Preferred Components 0.50% $0 $2,585 $2,585 $2,585 $2,585Touchpoint Savings 1,110 Hours Annually $19,980 $19,980 $19,980 $19,980 $19,980OR Productivity Savings $15/minute $48,060 $48,060 $48,060 $48,060 $48,060

Savings Total $76,625 $79,211 $79,211 $79,211 $79,211Net Program Cost $440,438 $437,853 $437,853 $437,853 $437,853Current Practice Cost $489,429 $489,429 $489,429 $489,429 $489,429Annual Savings $48,991 $51,576 $51,576 $51,576 $51,576

Savings over 5 years: $255,297

NEW CDS MODULES

Ear Pack CDSHysteroscopy Pack CDS

Lap Chole CDSLaparoscopy Pack CDS

Nasal Pack CDST&A Pack CDS

Basic CDSBreast Pack CDSCysto Pack CDS

Head & Neck CDSKnee Arthroscopy CDSLower Extremity CDS

Minor ENT CDSPediatric CDS

Shoulder Pack CDSUpper Extremity CDS

La Veta Surgical Center Sterile Core

FIG. 3


COVER STORY

Issue 8 17

Healthcare is an essential service, but many people still struggle to get the care they need. The services they require might be too expensive or too far away, and healthcare providers still struggle to reach patients who fall through the gaps in care.

Fortunately, hospitals and doctors’ offices are not the only option for healthcare consumers.

Creative administrators are making healthcare more accessible — and affordable — nationwide

YOUR NEIGHBORHOOD

ASC


Since the first U.S. facility opened in 1970, ambulatory surgery centers have played a critical role in making healthcare more accessible for Americans. As pressure continues to rise to reign in healthcare costs, ASC administrators are finding new ways to improve access and affordability — not just for those in their local communities, but nationwide.

Lowering the cost of care The cost of healthcare, particularly surgery, can be prohibitive. There are 28.2 million people under the age of 65 who are uninsured in the United States, according to the National Center for Health Statistics.1 In addition to the uninsured, 20.2 million Americans have a health savings account or high-deductible health plan.2

Those consumers are faced with substantial out-of-pocket costs. The price tag can be so high that some people will avoid seeking the care they need. Thirty-one percent

of Millennials report forgoing healthcare services because of price, while 25 percent of Gen Xers report doing the same, according to a survey from Bankrate, a personal finance website.3

Concern over healthcare pricing is driving more Americans to look for cost-effective alternatives. That is where ASCs enter the picture.

ASCs can provide many outpatient procedures that hospital outpatient departments (HOPDs) perform at a fraction of the cost. Medicare pays ASCs 55 percent of what it pays to HOPDs, which means ASCs save Medicare and its beneficiaries approximately $2.6 billion a year, according to the Ambulatory Surgery Center Association.4 ASCs also provide substantial savings for private payers and their beneficiaries.

“Deductibles and coinsurances are going up,” says Chris Markford, CASC, administrator of Orthopaedic Surgery Center of Clearwater in Florida. “I can

get the exact same care, equipment and doctor at an ASC, or I can go to the hospital and pay twice as much. It becomes a no-brainer choice for the patient.”

Many ASCs are taking cost saving a step further by making it easier for patients to prepare for their financial responsibility. Typically, a patient undergoing a surgical procedure will provide her health insurance information, but the final amount she owes remains a mystery — until she receives a bill well after her surgery.

“Most hospitals can’t map out what your out-of-pocket costs are before a surgery,” Markford says. “All those expenses are unique to each patient.”

By embracing price transparency, Markford and his team at the Orthopaedic Surgery Center of Clearwater hope to take the mystery out of billing. For uninsured and underinsured patients, every procedure performed at the center has a set price that includes fees for the physician, anesthesia, facility and implant. Patients have the option to accept that price instead of going through the lengthy — and murky — process of working with their insurance company. The ASC also works directly with the patient’s employer, who may wish to utilize the available pricing because they are often responsible for paying the bill.

A single, out-of-pocket cost can be a less expensive option, particularly for patients who have deductibles creeping toward $5,000 and even $10,000. When offered an affordable alternative, people who might otherwise delay treatment — or avoid it entirely — may be more likely to get the care they need.

“For people who see healthcare as a daunting system they don’t want

to enter, ASCs can be the friendly neighbor there

to help them. ASCs are a smaller, more efficient,

consumer-focused option.”– Joan Dentler, president and CEO,

Avanza Healthcare Strategies

COVER STORY

Issue 8 19

Transparent pricing also forces competition in the market, which can further drive down costs.

“We set the price and patients can take it or leave it,” Markford explains. “This introduces free market principles to healthcare. If my competitor can beat my

price, I need to get creative while watching my profit

margin.”Markford says people now

come from all over the state and

the country to receive healthcare services at Orthopaedic Surgery Center of Clearwater. Patients treated at the ASC instead of a HOPD can still expect significant savings when processing their claims through traditional insurance, he notes. However, the continued interest in the center’s bundled, transparent pricing option over insurance is a positive sign for those hoping to reign in the costs of care.

Filling critical gaps People who live in rural areas often have to drive for miles to find a

“We set the price and patients can take it or leave it.

This introduces free market principles

to healthcare.” – Chris Markford, CASC, administrator,

Orthopaedic SurgeryCenter of Clearwater


hospital. That one hospital — and its prices — may be their only option. However, more and more ASCs opening across the country means more options for people in small towns and rural areas.

Cities have more surgery centers due to their higher populations, but ASCs operate in rural settings, as well. Rural ASCs not only offer patients improved access to surgical care, they also attract physicians who can bring specialized services to underserved areas.

“Physicians want to invest in and operate at ASCs, and that can draw them to small, rural areas,” says Joan Dentler, president and CEO of Avanza Healthcare Strategies.

ASCs do more than help serve rural populations. Surgery centers often take cases that hospitals will not. For example, Florida’s Panama City Surgery Center has an entire program dedicated to teeth extraction for Medicaid patients, both children and adults. The center’s maxillofacial surgeon and the surgery center take on those cases despite the low pay. The hospital turns down those cases for that very reason. Patients come from all over the state because they cannot get that care anywhere else.

Some surgery centers go further than taking low-paying cases and waive their fees entirely. Physicians want to see their patients cared for, regardless of their financial situation. Those who have ownership in a surgery center can reach an agreement where both the physician and facility will waive their fees.

“We tripled county access for women’s health services in Gulf County,” Madewell says. “This really illustrates access to care when you have a reasonable rate.”

After Panama City Surgery Center started

working with Gulf County, the news spread to Jackson

County, which enlisted the ASC’s help in providing the procedures

for local women. In addition to government

bodies, Panama City Surgery Center partners with two local prisons to provide healthcare services to inmates.

“Inmates need surgical care,” Madewell says. “Our center can care for more patients than hospitals for the same amount of money. We are helping our local municipality.”

Perfecting patient experience Hospitals are enormous entities. They see thousands upon thousands of patients of every age across every specialty imaginable. It can be difficult and intimidating for patients to navigate this vast system.

“For people who see healthcare as a daunting system they don’t want to enter, ASCs can be the friendly neighbor there to help them,” Dentler explains. “ASCs are a smaller, more efficient, consumer-focused option.”

ASCs are small, specialized facilities with a set number of specialties and procedures. That narrow focus allows surgery centers to hone every aspect of patient interaction down to an art — all

“We do charity care every day,” says Mike Madewell, administrator of Panama City Surgery Center. “We have 42 physician partners. Over the 14 years I have been here, every single one has called me with a charitable case.”

Because ASCs are smaller, and therefore more flexible, adults and children who are uninsured or underinsured can receive much-needed procedures at an ASC much quicker than at a hospital.

Additionally, surgery centers will often work with other entities to serve patients in need. Panama City Surgery Center has arrangements with Gulf and Jackson counties to provide women with sterilization procedures.

Previously, Gulf County was working with a hospital partner, but the hospital was able to perform only one sterilization per year with the allocated $1,500 budget. Panama City Surgery Center took over and now performs three procedures with that same budget.

COVER STORY

“Physicians want to invest in and

operate at ASCs, and that can draw them

to small, rural areas.” – Joan Dentler, president

and CEO, Avanza Healthcare Strategies

Issue 8 21

the way from intake paperwork and the actual procedure to discharge and billing. ASC staff members can walk each and every patient through the entire process. Patients do not have to worry about struggling with red tape or unexpected surprises. “You can’t compete with ASCs when it comes to providing information to patients in a timely manner,” Markford says.

Where ASCs can perform the same outpatient procedures as hospitals, they do so for less cost without sacrificing quality. In fact, surgery centers can outperform hospitals on infection rates and patient satisfaction scores.

Many surgery centers maintain virtually non-existent post-surgical infection rates, which in turn saves money. Infections cost patients and the healthcare system a significant amount of time and money to treat. The more personalized, customer-focused atmosphere of ASCs also contributes to higher patient satisfaction scores.

A changing landscapeASCs are for-profit businesses. So it is in their best interest to treat patients as consumers. Surgery centers must compete with one another and with the hospitals in their community. Accessibility is a critical aspect of creating a consumer-friendly experience for patients.

Instead of making multiple phone calls to the physician’s office

ASCS AS SMALL BUSINESSES

Hospitals and national corporations are increasingly seeing the value of ASCs and actively pursuing ownership in them, but the majority of ASCs remain independent, physician-owned facilities. In fact, 65 percent of ASCs in the United States are owned by physicians, according to the Ambulatory Surgery Center Association.4 This means that most ASCs are small businesses.

ASCs provide vital healthcare services, but they also contribute to their communities as small businesses. They partner with other local businesses for important services, such as housekeeping and laundry. As for-profit businesses, ASCs pay taxes that support the local economy.

“All of that money stays local, and the community as a whole benefits,” explains Joan Dentler, president and CEO of Avanza Healthcare Strategies.

ASCs also hire locally. When a new surgery center opens, it brings with it job opportunities for nurses, surgical techs, office workers and more. In this sense, ASCs invest in their communities both financially and through the people who live there.


FEATURE

and different hospital departments, patients can speak to a single point of contact at the surgery center. Instead of worrying about which papers to fill out and bring on the day of surgery, ASCs streamline the entire process to make it as simple as possible for their patients. And when it comes time to pay for the surgery, ASCs can do everything in their power to make sure patients are aware of their financial responsibility and able to meet it.

With a large aging population and rising healthcare costs, having adequate access to healthcare is more critical than ever for Americans. Many will rely on the ASCs in their communities, which are rising to the occasion to help patients get the care they need at the right time and price.

REFERENCES

1. National Center for Health Statistics www.cdc.gov/nchs/fastats/health-insurance.htm.

2. America’s Health Insurance Plans www.ahip.org/wp-content/uploads/2017/02/2016_HSASurvey_Draft_2.14.17.pdf.

3. Bankrate www.bankrate.com/banking/savings/money-pulse-0617.

4. Ambulatory Surgery Center Association www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare.

COLUMN

Q: Why do you enjoy working at an ASC?ACSs do so many different things, from routine procedures like colonoscopies to orthopedic surgeries. There are many specialties. It gives me a broad perspective. Are some areas more prone to infection? How do the different specialties play a role in infection prevention?

Because ASC patients go home the same day, we don’t usually see patients again. In my role, I have a unique opportunity to learn what happens to patients after they’re discharged through their patient charts and notes from their physicians.

Q: What do you think ASCs do that makes them great?ASC patients get to go home after their procedures. This cuts down on infections.

Sick people go to hospitals. At an ASC, patients are generally healthy. Because it’s safer, there’s a much lower risk of infections. ASCs are the best place for many procedures.

Q: How do you personally contribute to making your ASC great?I stay up to date on infection prevention guidelines and regulations. I read journal articles and attend meetings, and then bring what I learn back to my colleagues.

Issue 8 23

Christine Cavallo’s work is essential to improving patient safety and outcomes, though much of it happens outside the patient’s view.

“When I started in this role, I never realized it would be so broad,” says Cavallo, RN and infection preventionist at Summit Medical Group in New Jersey. “Infection prevention covers every area of patient care — from direct patient contact to the myriad infection prevention details patients don’t see, such as how instruments are sterilized and if the sterilization machines are working properly.”

Outpatient Outcomes recently spoke with Cavallo about how she helps make infection prevention a priority at SMG, which maintains an infection rate of less than 1 percent.

Q: What do you like about being an infection preventionist?I like all the behind-the-scenes work that goes into keeping infections at bay — things most people wouldn’t even think of. I investigate infections and conduct root cause analyses to determine why they occurred. I try to figure out if there’s a pattern: the same bacteria, the same doctor, the same procedure. Then I develop programs to reduce the risk of infections.

I also make sure what we’re doing as an ASC minimizes infections. For example, I recently did a quality study on cleaners and learned that the one SMG uses is the best at preventing disease.

Prevention detective

“Infection prevention covers every area of patient

care — from direct patient contact to the myriad

infection prevention details patients don’t see.”

– Christine Cavallo, RN, infection preventionist, Summit Medical Group

INFECTION PREVENTIONIST

Responsibilities: Minimizing infections through compliance

with industry rules/regulations, program development

and best practices implementation.

Infection Preventionist Christine Cavallo works behind the scenes to improve care at Summit Medical Group

With the rise of consumerism in healthcare, patients have a choice of where they receive their outpatient surgical procedure — an ambulatory surgery center or a hospital outpatient facility. The benefits of ASCs are clear [Fig. 1]: less cost (lower co-pays), transparent pricing, reduced wait and procedure times, and a more personal and convenient experience due to their smaller size. It’s no surprise that patients have a 92 percent satisfaction rate with the care they receive in ASCs.1

What do patients think ASCs do to provide a superior experience? To find out, we spoke with several patients who recently chose surgery centers for their procedures. Here’s what they had to say about their experiences.

It’s better in a surgery centerFour patients share why care, cost and outcomes are superior at surgery centers

FEATURE


FIG. 1

STEVE – MUNDELEIN, ILLINOIS Issue/Procedure: Repair torn meniscus

Why did you choose this facility? My surgeon did his procedures at this facility.

Overall experience: It was a seamless experience from start to finish. There was very little paperwork when I checked in because I had completed most of it beforehand. Within 10 minutes, I was taken to the prep area. The staff answered all my questions and the surgeon clearly told me exactly what he was going to do and what I should expect. The entire staff was very nice and attentive and the facility was just a few minutes from my house.

What was unexpected: When I woke up from the procedure, the surgeon was right there to tell me how it went and what I should expect from the recovery. They even gave me a DVD of the surgery.

TAMMY – DALLAS, GEORGIAIssue/Procedure: Repair broken leg

Why did you choose this facility? The date and time they offered me were sooner than other facilities.

Overall experience: Everyone was very warm and caring, but they also did their work with military-like precision. They were right on schedule. I went in at 10 a.m. and was out by 4 p.m. The admission process was very quick and then I was taken straight back to the prep area. There were no complications and I felt no pain. The fact that I could get this procedure done in

Patient Cost Medicare CostASC

Co-payHOPD Co-pay

Total Procedure Cost ASC

Total Procedure

Cost HOPD

Cataract $193 $490 $964 $1,670Upper GI

Endoscopy$68 $139 $341 $591

Colonoscopy $76 $186 $378 $655

ASCA Analysis of CMS Rates Effective 1 Jan. 2012

COST COMPARISON:ASC v. Hospital Outpatient Department

one day and get to go home with the best care made the surgery center a great experience. I don’t think a hospital outpatient facility would have given me the same experience.

What was unexpected: The attention to detail was amazing. During the pre-surgery process, the facility made sure the person accompanying me (my husband) knew to bring a jacket because the waiting room can be chilly, and that they provided snacks if he got hungry.

MICHAEL – SAFETY HARBOR, FLORIDAIssue/Procedure: Repair detached retina

Why did you choose this facility? It was in the same building as my doctor’s office.

TRACY – LINDENHURST, ILLINOISIssue/Procedure: Two procedures within two months – cyst removed from thumb and bone spurs removed from both feet

Why did you choose this facility? It was where my doctor practiced, and it was near my house.

Overall experience: For both procedures, the staff was incredibly attentive. They called me about a week before the surgery to give me instructions, answer my questions, take my insurance and ask if I had a ride to and from the procedure. I felt like I had everything covered and was confident before I walked in the door of the facility. When I did check in, the staff was really nice and did everything to keep me comfortable and reduce my anxiety level. The surgeon even marked the thumb with the cyst to make sure he was operating on the right one. The facility was very updated and modern, but much smaller in size than a hospital so it felt more intimate and personable.

What was unexpected: The nurse was very helpful in advising me on the medications I received as part of my post-op care. They were strong prescriptions, and she wanted to make sure I understood what they were for and when I should use them.

Consumers are placing increasing demands on the healthcare system. They want care that is affordable, convenient and patient-centered, and that delivers quality outcomes. As these patients attest, surgery centers are more than delivering on all of these requirements.

REFERENCES1. ASCA Association website. www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare.

Overall experience: There was very little paperwork for me to do when I was admitted because I completed it the day before. They took me back almost immediately after I checked in, so everything moved along quickly. After the pre-op, when they explained exactly what was going to happen, the last thing I remember is being wheeled in the operating room suite. I woke up about an hour later feeling a little groggy but with little pain. After I recovered, I went right to my doctor’s office conveniently located in the same building so that he could examine my retina. My doctor gave me post-op care instructions and products in a nice branded package. In all, it was a really nice experience and the staff was very polite and attentive.

What was unexpected: The whole process was super quick. They gave me a general anesthetic and, before I knew it, the procedure was over — and successful.

“The fact that I could get this

procedure done in one day and get to go home

with the best care made the surgery center a

great experience.”– Tammy, ASC patient in Dallas, Georgia

Issue 8 25

FEATURE

“Did you hear the one about the surgeon in the OR?”

OK, telling slapstick jokes to a surgical patient before a procedure may not be appropriate. But humor — when used to make a connection with patients and to help relieve fear and anxiety — is actually a powerful and useful tool for physicians, nurses and other ASC staff who work directly with patients.

“When people are faced with emotionally charged information, it helps to blunt the edge with humor,” explains Marc Leavey, M.D., a prima-ry care specialist at Mercy Personal Physicians at Lutherville, a Mercy Medical Center Community Physician Site. “Making a subtle crack to diffuse tension is golden — it breaks down the wall between you and the patient and allows you to communicate bet-ter. It lets patients feel more connect-ed to you.”

Why humor helps“Humor gives people a sense of pro-portion,” says Patricia Raymond, M.D., a gastroenterologist in Virginia Beach, Virginia. “If you can reduce fear with humor and warmth, it makes the sit-uation much better for patients. They can be more accepting of things.”

She says physicians have noticed

the difference in levels of sedation patients need to be put to sleep, for example. Agitated patients need more sedation than those who are comfortable.

As a gastroenterologist, Raymond often meets patients for the first time right before their colonoscopy. “I have to bond quickly with the person

By alleviating fears and building relationships, humor helps bond patients and healthcare professionals

Is laughter the best medicine?


Issue 8 27

and let them know I’m friendly, I’m nice, I’m competent and I will take very good care of them,” she says. “All this has to happen in a two-to-three minute conversation.”

Humor helps.Raymond will often introduce

herself with a quip about how’s she’s responsible for what the patient did the night before. “I’ll say something like, ‘I hope it came out all right in the end.’ “It’s easy to have fun at the colo-noscopy prep’s expense,” she says.

Humor can also help physicians, nurses or other ASC staff alleviate a patient’s fears. “Fear of the unknown [in healthcare] is huge,” Leavey says. Patients are often concerned about anesthesia. “Nobody likes getting put to sleep,” Raymond shares. Also, patients fear pain and potential out-comes. “Every patient is nervous. You have to be able to address that.”

Tips for incorporating humorYour surgery center’s staff may have different “styles” of humor — and some employees will be more com-fortable telling a joke than others. Rather than ask people to conform to any one style, help them understand how they can use their own brand of humor appropriately and effectively by suggesting these tips.

Be yourself. “Weave humor into the conversation. Talk to patients as if they are a member of your family,” Leavey says. “Speak in a familiar, connected tone, and when you see an opportunity to weave some humor into it, do it.”

Leavey recalls how a patient recently expressed her stress about caring for an elderly patient. “I told her, ‘It’s just like having a baby,’ and she laughed. I addressed her anxiety with an analogy she could accept in a

way that showed her I understood. I got it.”

Raymond says people who are not “naturally” funny can focus on being authen-tically engaged.

“Humor is real-ly about connect-ing to another human being,” she explains. “It’s not about making someone laugh, but making them part of the team. They know they have a friend in the room, someone who is looking out for their best interests.”

Know your audience, and lis-ten. Patients will often guide you and tell you what they think is funny, Leavey explains. Or, they may joke about what they fear, giving you an opportunity to address their concern.

“I use a joke as an introduction into hard-to-address topics,” Leavey says, like the time he joked about birth control as an entry into a discussion about sexually transmitted diseases with a (newly in love) elderly patient. “Humor is universal. Keeping the mood light really does help, especially if you have to be extremely serious.”

Listen and consider the unique situation before you respond with humor, avoiding anything potentially offensive. “It’s easy to lapse into a joke or story that might be construed as offensive to the person who’s hear-ing it,” Leavey adds.

Plan your timing. Raymond gives her patients small gifts following a normal colonoscopy, including a joke book of colonoscopy humor (she’s

compiled three). She will tell patients, “I got you a gift for being really clean.” Patients are proud of it, she says. Of course, if she’s just found cancer or a patient’s cultural differences indicate he or she might not understand the humor, she will refrain.

“Humor pre-op is gentle, bonding,” Raymond says. Overt humor is more appropriate after a procedure, when everything is OK.

“Using humor [inappropriately] be-fore a procedure might reduce your standing in your patient’s eyes,” she says. “They might not perceive you as competent to take care of them. Afterward, humor promotes good health. People feel good about their procedure. They go back to the office and talk about the thing they don’t normally talk about.”

“If you can reduce fear with humor and

warmth, it makes the situation much

better for patients.”– Patricia Raymond, M.D.,

gastroenterologist


FEATURE

Without question, ambulatory surgery centers are well-positioned in the val-ue-based world of the future. One has only to glance at industry magazines, Medicare rulings or historical trends to see a bright future for ASCs.

Payers are actively steering patients to lower sites of care across many pro-cedural areas. Anthem has restricted MRI and CT scans provided in hospital outpatient departments (HOPDs) in several states and plans to roll out those restrictions to 13 states by March 2018. It has announced restrictions for emergency room care, as well.

UnitedHealthcare is joining in, as it requires site of service medical necessi-ty reviews for nearly 80 surgical proce-dures that could be furnished in an ASC to be covered in a HOPD. These span a wide range of service lines, such as orthopedics for carpal tunnel release, ear, nose and throat (ENT) procedures and hernia repairs.

Consumers are listening, particularly when it comes to elective procedures such as joint replacement. They are taking their procedures from the HOPD to an ASC setting. Sg2 saw the percent-age of outpatient joint replacement surgeries performed in an ASC setting shift from 22 percent in 2013 to 44 percent in 2016.

Consumer driversHow do consumers make these deci-sions about their surgical care? A recent article in JAMA, the Journal of the American Medical Association, revealed that the top reasons consumers select a surgeon are acceptance of insurance, followed by primary care physician referral and surgeon reputation.

Consumers are also getting increas-ingly savvy in using healthcare com-parison data to select their surgeons. Though 65 percent of patients report-ed that they did not research the qual-ity of their surgeon, the study found that higher patient incomes and pos-session of health insurance increased the patient’s likelihood of searching for a surgeon online. And interestingly, the top healthcare comparison website used by these sought-after patients wasn’t their insurer’s website, which only 7 percent of respondents used. It was — you guessed it — Yelp.

A forward-thinking strategyASCs will not only need to plan for the rate of change, but also the seasonal

NAVIGATING GROWTHIN AN ERA OF CONSUMERISM

FIG. 1: PERCENT OF NATIONAL OUTPATIENT SURGERY VOLUME BY QUARTER, 2014-2016

30.0%

25.0%

20.0%

15.0%

OP ORTHOPEDIC SURGERY – SEASONALITY BY YEAR

Q1 Q2 Q3 Q4

2014 2015 2016 2014-2016

Issue 8 29

trends that accompany them. For example, Sg2 research shows that a higher share of orthopedic surgical case volumes is performed in the last quarter of the year, when consumers have met their deductibles and are seeking to optimize their insurance benefits. The trend was consistent across the three years of analysis. ASCs should plan for a busy end of the year to accommodate this surge in patients and understand long-term ASC procedural growth projections specific to their market.

Ultimately, there is substantial variability in how industry trends will impact individual markets. To account for this variability, successful ASCs will leverage market insights to develop a forward-thinking strategic plan. Follow-ing Sg2’s “rules of the road” will help you develop a strategy that is future- and consumer-focused:

Use a “focused factory” mentality. Having a surgical team and facilities dedicated to specialized services improves efficiencies, enhances brand

awareness, and improves patient throughput and experience.

Understand current and potential partnerships. Not surprisingly, Sg2 has consistently found a more rapid shift of procedures from an inpatient to an am-bulatory setting for markets in which surgeons have ownership in ASCs.

Evaluate market readiness for risk. There is wide variability in how aggressively markets are shifting to a value-based model. Markets with a higher penetration of payers such as Anthem and UnitedHealthcare, which are actively implementing initiatives focused on site-of-care shifts to lower-cost settings, will be areas of potential growth for ASCs. However, many other factors are also good indicators of regions primed to take on risk. These include risk-sharing history, economic pressures and partnership availability.

Understand patient demographics. Markets serving patients with higher rates of co-morbidities will experience a slower and ultimate shift of surgical

cases to lower-acuity settings. Howev-er, ASC administrators and strategists can predict the patient population primed to shift to the outpatient setting by evaluating inpatient length of stay (LOS) distribution across key surgical service lines. Patients with an LOS of one day are primed to shift to the outpatient setting.

Looking to the futureWith the shift from volume to value, it is crucial that ASCs take a future-fo-cused approach to developing their strategies. Careful consideration of current market dynamics and consum-er drivers, as well as a good under-standing the current market landscape, will solidify a successful strategy that leads to high-volume growth for your surgery center.

REFERENCES 1. LeClair Group. UnitedHealthcare: site of service for outpatient surgical procedures expanding Oct. 1. July 21, 2016.2. Sg2 Ambulatory Market Strategist; Health Intelligence Company, LLC; OptumInsight; Healthcare Data Solutions; Sg2 Analysis, 2017.3. Consumer Preferences and Online Comparison Tools Used to Select a Surgeon. JAMA Surgery Research Letter, April 2017.

Markets with a higher penetration of payers

such as Anthem and UnitedHealthcare, which

are actively implementing initiatives focused on site-

of-care shifts to lower-cost settings, will be areas of

potential growth for ASCs.


COLUMN

Ask Gigi Copeland to locate any surgical item at Melville Surgery Center, and she can point you to the room and rack where it resides.

“I can tell you how many products come in a box, what they cost and where I can order more,” says Copeland, materials manager for the past five years at the ASC on New York’s Long Island. “Everything is in my head.”

Outpatient Outcomes recently spoke with Copeland to discuss her role managing medical supplies and pharmaceuticals, and why she thinks it’s a perfect fit for her skill set.

Q: What do you like about being a materials manager?I am grateful to have a varied background — I’ve done accounting, restaurant management, catering — and I can apply those business skills in this role. I find I have a knack for it. I am all about numbers, and I know how to get what we need, when we need it.

Q: What part of your role were you most surprised by? Before coming to Melville, I worked in materials management in a hospital setting. Prior to that, I was in the hospital’s clerical pool–so I learned healthcare from the inside out.

In the hospital setting, I had fewer responsibilities. We had a central supply that stocked basics

worthwhile is finding creative solutions that keep our center running. Recently, our operating schedule increased and we needed more customized surgical core packs. It came to me in the middle of the night that we might be able to reconfigure some warehoused packs we weren’t using. Sure enough, we only had to add three items and it was a solution we could implement immediately. We didn’t have to cancel surgeries and my doctors could continue using their preferred equipment.

A knack for numbersMaterials Manager Gigi Copeland keeps Melville Surgery Center running like clockwork

MATERIALS MANAGER

Responsibilities: Monitoring inventory, rotating

stock, checking expiration dates, handling purchase orders,

building and managing ASC database, and

working with vendors.

like dressings and surgical packs, as well as a pharmacy. At Melville, I am the purchasing department, the pharmacy and the repair shop. I wear many hats.

Q: Why do you enjoy working at an ASC?The hours are fabulous. There is a big appeal to working in a medical field without having to work weekends or holidays.

Our setting is also intimate and friendly. The staff is accessible and everyone comes together to ensure our patients are well cared for from the time they walk through our door. Our ASC is owner-operated, so our surgeons are very invested in the quality of our services and patient outcomes.

Q: How do you personally contribute to making your ASC great? For me, what makes this job

“I am the purchasing department, the

pharmacy and the repair shop.

I wear many hats.”– Gigi Copeland,

materials manager, Melville Surgery Center

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