1. Where will pain management cases be profitable? Pain management physicians who aren’t employed at a hospital need to analyze their cases to see where they will be most beneficial. “Not all cases are great cases for ambulatory surgery centers,” says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. “Some cases are better for hospitals or clinics. The way to determine where your cases will be most profitable is to understand your case contracts and know what the yield is for each case.” Don’t schedule cases that aren’t yielding enough in the ASC if you are able to perform them elsewhere.
2. If we are just adding spine, how can we ensure codes are captured correctly? When dictating, physicians should describe the surgical procedure in detail, allowing the coder to clearly visualize the entirety of the surgical encounter, says Mona Kaul, chief coding and compliance officer of GENASCIS. This should include the type of approach used (endoscopic, percutaneous, open procedure, etc.), whether the procedure was anterior or posterior, the laterality and if the surgeon operated on more than one level.
Physicians should also describe any implants/graft used, and include details such as the type of implant and the number of units used (i.e., screws).
Finally, the physician’s report should also establish medical necessity for the procedure, which needs to be defined through diagnosis codes.
3. Which types of surfaces are appropriate for disinfectants? Look at the label of your disinfectant. It should tell you if a product is compatible or not compatible with particular surfaces, says Jack Wagner, President of Micro-Scientific.
As an example, there a chemical surface wipe that says in the small print on the bottom of the label, “Do not use this product on clear plastics.” This tells me that it is not appropriate for clear plastics, which include domes (the covering on anesthesia machine ventilators), plastic lenses over operating lights and blood pressure cuffs. There are a number of materials in an ambulatory surgery center that are made of clear plastics. If this product cannot be used on clear plastics, then obviously this product is not compatible with an ASC’s equipment and is not appropriate for use in a center.
4. Will a joint-venture with a hospital work? Most physicians invest in an ASC to gain control over their time and surgical environment. Physician investors can have direct input on the future of the center, and generous distributions are common. However, an ASC with a hospital partner reduces or eliminates physician control over the center. Jon Vick, president of ASCs Inc., says he has seen hospitals reduce ASC profitability and eventually convert their ASC to a hospital outpatient department, a move contrary to the goals of the original physician-investors. “It’s not any of the doctors’ original motivation or goal,” he says. “It just happened because that’s the way hospitals manage things.”
5. How will we approach new legal and regulatory issues? Physicians must be aware of Stark Law and referral issues to avoid accidentally breaking the law, says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. They must also be aware of the potential for malpractice suits and be prepared for any action that could come their way. Select a competent “health lawyer” who can guide you through any issues that might arise. They will be helpful in assessing partnership contracts, as well as regulation issues. “The physicians have to understand how the wording in a contract could increase their liability,” says Dr. Vergne-Marini.
Related Articles on Orthopedic ASCs:
9 Reimbursement and Business Concepts for Orthopedics in ASCs
8 Best Business Practices for Building an Orthopedics-Driven ASC
Dr. Michael Redler: 3 Trends for Orthopedics in ASCs
