1. Keep surgical supply inventory lean. Don’t keep access inventory in stock, says Lester Morales, executive director of the Laser Spine Institute in Scottsdale, Ariz. Proper utilization of the supplies is key. Bring in the supplies you need for each case every week but not much more. The physicians should make sure they don’t open supply packages until they need its contents so nothing is wasted. Cutting our inventory only to the weekly necessity can be a change in mentality for the staff. We slowly progressed into a keeping only a proper amount of inventory for the week.
2. Hire spine-specific staff members. “You need to find staff who can hit the ground running,” Lynn S. Feldman, RN, MBA, administrative manager of Eastwind Surgical, a two-OR ASC for spine surgery and pain management in Westerville, Ohio. Since spine surgery only recently became an outpatient procedure, staff will have to come from hospitals. One silver lining in the current recession is that talented spine-surgery staff members are easier to find. When the ASC recently added another nurse of the recovery area and two more per diems, it had a wide range of applicants. They must also be able to tolerate bumpy schedules. A hospital is a very structured work environment, but spine surgery in an ASC in particular has variable hours. Spine surgeons may come in and do five cases in one day and then not come back for many days. “You work when they want to work,” Ms. Feldman says.
3. Inform physicians of center data. Involving and educating physicians about reimbursement rates and profit goals helps them make informed decisions. “We educate physicians about reimbursement and keep them informed about new changes so they understand what procedures are costing and what reimbursement is not covering,” says Kathie Stewart, administrator at Cascade Spine Center in Tualatin, Ore. “There are some things that they know we can be reimbursed for, like implants and neurostimulators. Every month we go over how much each case costs on average, and average nursing expenses and other financial figures.”
4. Renegotiate payor contracts to take advantage of a new economic landscape. Due to rapidly changing economic circumstances, now is an excellent time for your practice to renegotiate contracts with payors. As spine surgeons exit Arizona health plans to escape falling reimbursements, the plans have had second thoughts and some are now agreeing to higher rates to fill gaps in their networks, Donna Lahey, the administrator of Spine Institute of Arizona in Scottsdale reports. So far, she says, two out of the practice’s 15 payors have agreed to rate hikes, at 10 percent and 15 percent. The practice has also signed on a new payor at a 20 percent higher rate than Medicare. Shannon Doyle, an MGMA consultant based outside of Denver adds that bringing a physician into negotiations will raise the practice’s credibility and improve chances for a reimbursement hike.
5. Reduce staff work hours. Our next change to aide efficiency was to reduce work hours, says Penny Forbes, practice administrator at Sierra Regional Spine Institute in Reno. We observed that during the time between 3:00 p.m. and 5:00 pm on Friday afternoons, our employees were extremely non-productive. Many employees would ask to leave early on Friday as well. So we decided to send everyone home early on Fridays, which forced the employees to be more efficient the balance of the week. The same work is being done, with two hours less a week than before. Thus, we cut our payroll expense (by approximately $30,000 per year) while maintaining work flow.
