Maximize Efficiency in Your ASC

Part II of II: Reaching your full potential by making the most of your investment

PRAVIN U. DUGEL, MD

In part one, you learned how to use due diligence when considering joining an ambulatory surgery center. Once you’ve conducted the proper research and asked the right questions to choose the ASC that is best for you, you’ll need the practice to run as efficiently as possible for your investment to reach its full potential.

In part two, I’ll discuss the areas to analyze to ensure maximum efficiency.

EQUIPMENT

Spare No Expense

While some may try to reduce costs in an ASC by purchasing the least expensive equipment, a well-run ASC should not compromise on anything, especially equipment. I frequently analyze my expenses, and personnel make up the majority of the expenses, usually about 70% to 75%. Given the comparatively small percentage of all other expenses, it makes no sense to cut costs by compromising on patient care from a business standpoint, not to mention an ethical standpoint.

The general thought is that you have to compromise on profitability to achieve the best quality, which is not true. A well-run ASC can be efficient while the quality of equipment is as good or better than any hospital in the area.

When I consider an equipment purchase for my practice, the first thing I ask myself is, “Will this help my patients?” If it will help me to be a better surgeon, the answer is “yes,” which means I will see a return on my investment.

Measuring True Cost

Part of the problem with assessing which equipment you will buy is the lack of consideration to the overall impact it will have on your ASC.

Even if a device costs more than a comparable one, you must evaluate whether it will increase your practice’s efficiency. True cost analysis requires a level of sophistication that most ASC personnel don’t possess. If you’re going to spend the time, money, and energy to buy new equipment for your ASC, it may be a smart idea to seek an outside consultant’s opinion — getting negative information is better than getting no information at all.

For example, before we purchased the Constellation Vision System (Alcon, Fort Worth, TX), the company allowed us to conduct a study to determine its true cost. We contacted an outside independent consultant that calculated activity-based costs to ensure we were making the right decision. Despite fewer days of surgery scheduled, we perform more surgeries each day while overhead, including personnel costs, decreased. All aspects of the purchase have to be assessed in a careful, systematic way to determine an objective cost and profitability potential so as to not use more than capital outlay.

In addition, your business will endure an enormous cost if equipment needs repairs and is inoperable for a week or even a day. Therefore, you have to determine the level of support you’ll receive for the device. I recommend choosing companies with a history of great service, which includes being available with a backup if the machine goes down. If you don’t have a history with the company, or they are fairly new in retina surgical equipment, ask a colleague or do research about their track record of providing reliable service.

STAFFING

Along with misunderstanding the true cost of equipment, we often lose sight of how much time is spent operating the equipment, who is operating the equipment, and the value of their time. A physician manager or CEO should have a very good understanding of all tasks that are required in your ASC and the level of personnel in terms of skill and compensation that will fill that task requirement.

For example, before we purchased the Constellation, our nurse, a well-paid, well-qualified staff member, spent too much time standing next to a laser pushing buttons while I operated. This was a terrible waste of time and money as she was overqualified for this task. The Constellation has a foot pedal control that doesn’t require more than one person to operate, freeing up our nurse to do more appropriate work. Even though we found less expensive systems on the market, this feature heavily influenced our purchase.

We’re constantly asking whether our staff is doing the appropriate work. There’s no specific formula of matching salary with tasks to determine that certain tasks don’t require as much training as others, but you constantly have to ask yourself whether staff is doing the appropriate work. Be task-sensitive and task-appropriate in your approach and decide whether your most qualified staff’s duties can be accomplished by others.

Patient Flow

We strive to provide the best care for our patients as efficiently as possible, which includes staff members at every level. When I go to the surgery center, it is the most efficient part of my day by far. By the time I see patients, they have been prepped and blocked by an anesthesiologist who specializes in eyes surgery. As soon as I finish with one patient, I walk to our other surgery room and continue this process throughout the day.

To have efficient patient flow, you must have the highest degree of proper utilization of resources for the best possible outcome. We constantly look at each step of the process for the patient and ask whether we can make it better. Every ASC has a different requirements, structure, and philosophy, but everyone should look at the flow pattern and decide whether each touch point is appropriate and designed to be as efficient as possible. For example, about two decades ago we decided to add a group of six anesthesiologists who were decided to doing nothing but ophthalmology. While this might not be right for everyone, we determined this would increase our efficiency as a whole.

People often confuse efficiency with speed, but the two are not equal. Being efficient means getting the safest results with the minimum amount of wastage. My staff may finish tasks faster to make sure everything in our surgery center is efficient, but I never tell someone to work faster or rush to do something at a speed that makes them feel uncomfortable. Rather, we make sure they waste as little energy and time as possible to accomplish what they need to do.

When everything is running at optimal efficiency, I don’t have to rush while operating on the eye. I’m perfectly fine with taking the time required to finish a case. In fact, my time spent in the eye isn’t much different than other good surgeons. What sets our practice apart is everything else that occurs prior to guide patient flow.

Creating an Efficient Mindset

Efficiency becomes the culture of your practice when you demand it, paying attention to detail, and constantly refining and reinforcing the culture. To establish this philosophy at every level of your ASC, each staff member needs the proper marching orders to know its importance, which should come from the doctor-owners to the CEO, chief nurse, and all the way down.

To help reinforce this culture, offer efficiency-based rewards for staff, such as verbal compliments or promotions and monetary bonuses. For example, we reward our staff whenever we receive positive feedback from a patient about their treatment in our office. We’ll determine who worked with that patient and reward the staff accordingly.

When staff knows what is expected and know they will be rewarded for meeting expectations, you are more likely to get the desired results for your ASC.

CONCLUSION

Put Patients First

When running an ASC, you need to have a “patient first, profitability second” philosophy, and everything else will fall into place. In most instances, patients will be satisfied and you will be profitable if your ASC is run properly. Focusing on profitability above all else is a short-sighted, unsustainable model from both a patient care and business point of view. Your success will be short-lived while eventually garnering a poor reputation.

This flow toward specialization can be a rewarding, profitable business model for retinal physicians and ASCs if you take the necessary steps to ensure maximum efficiency. RP