Why are other programs growing faster than yours?
Why are other programs growing faster than yours?
Cash flow, contracting, staff incentives are keys
How do you know if your same-day surgery program is successful? Number of procedures? Physician satisfaction? Growing number of managed care contracts? Net revenue? Staff or patient satisfaction? However you measure success, the bottom line is the same: You have to make money to keep your employees working and your program open.
"Cash is king," says Robert J. Zasa, principal at Woodrum/ASD, a Pasadena, CA-based firm that manages and develops ambulatory surgery centers. Once a same-day surgery manager understands this concept and knows how to make sure the program generates enough cash flow to handle the needs of the program, success will be attained, he adds.
A real problem for most same-day surgery managers is a lack of training that focuses on the business side of surgery programs, says Zasa. "We have health care executives who are excellent at providing quality care, overseeing good clinical practices, and handling personnel matters, but we haven’t done a good job to make sure our managers and executives have a business orientation," he explains.
Because most glitches in a same-day surgery program’s profitability are not usually clinical problems, the manager must be able to focus on the business side of ambulatory surgery, Zasa says. One of the most obvious mistakes made in an SDS program is that managers will set budgets, but they don’t look at monthly cash flow, he says. "A manager needs to look at collections and creation of new revenue to make sure cash is coming into the business," he explains. "You can only cut so many expenses, so the only way to increase your profits is to find new revenue." Ways to create new revenue include:
- Keep your current surgeons happy so they continue bringing their patients to your program.
- Recruit new physicians.
- Develop new programs that may tie in with recruitment of new physicians.
- Manage your contracts effectively.
- Monitor collections on a regular basis.
Know which managed care companies are paying in a timely manner as you renegotiate contracts, Zasa explains. Specify a payment timeframe in your original contract, and determine if the managed care company is meeting that timeframe, he suggests.
Contracting is an important part of any manager’s job, says Zasa. "It is not always beneficial to participate in a managed care program, but a manager has to evaluate information and know [his or her] market in order to determine which contracts are good and which are not," he says. (See "Tips you can follow for successful contracting," in this issue.)
Monitor physician satisfaction, advises Tracey E. Carrigan, RN, BSN, CNOR, administrator of the Texas Midwest Surgical Center in Abilene, TX. Carrigan’s center opened in early 2000, and the surgeons working in the center are very happy, she says. Even though the physicians are investors, however, it does not automatically mean they are performing all of their same-day surgeries at Texas Midwest, she point out.
"If I notice a physician who is not posting many cases, I’ll talk with him or her to find out the reason," says Carrigan. Sometimes the physician is allowing his or her office staff to post cases. Those staff members simply schedule at the hospital as they’ve done before, and the physician doesn’t realize the surgery center isn’t being considered, she says. Other reasons include patient preference or insurance restrictions. "As we increase the number of managed care contracts in which we participate, we tell the surgeons in meetings and through memos. This helps eliminate insurance restrictions as a reason not to use our program," she says.
For a same-day surgery program to succeed, surgeons have to think of it as an extension of their practices, says Zasa. "The surgery program must be convenient and comfortable with staff who are dedicated to helping the physician," he says. "Successful same-day surgery programs have top-quality staff who are committed to excellent patient care, but also realize that their real customer is the surgeon. Without the physicians, there will be no patients who need care and no same-day surgery program in which to work."
Ownership, actual or philosophical, is another key to success, Carrigan says "I and my clinical director were hired when the surgery center was a concrete slab, so we think of the center as our child, and we want it to succeed," she explains. All staff members have a vested interest in the success of the center because everyone, not just managers, receive bonuses tied to achievement of goals, says Carrigan.
Incentive programs make employees more willing to take responsibility for the success of a surgery program, points out Charles Logan, RN, executive director of St. Mary’s Ambulatory Surgery Center in Knoxville, TN. (See "Incentives increase staff commitment to success," in this issue.)
Another priority should be to manage collections, says Zasa. "Don’t blithely wait for 90-day accounts receivable reports," he says. "Managers should receive weekly collection reports that allow them to identify potential problems," Zasa advises. (For information on improving collections, look for a future story in Same-Day Surgery.)
Sources
For more information about success tips, contact:
• Robert Zasa, FACMPE, Principal, Woodrum/ ASD, 315 Bellefontaine St., Pasadena, CA 91105. Telephone: (626) 403-9555. Fax: (626) 403-0966. E-mail: [email protected].
• Tracey E. Carrigan, RN, BSN, CNOR, Administrator, Texas Midwest Surgical Center, 751 N. 18th St., Abilene, TX 79601. Telephone: (915) 677-6555. Fax: (915) 677-6976. E-mail: [email protected].
• Charles Logan, RN, Executive Director, St. Mary’s Ambulatory Surgery Center, 1515 St. Mary’s St., Knoxville, TN 37917. Telephone: (865) 545-3703. Fax: (865) 545-3700. E-mail: [email protected].
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