1. Use software to improve compliance, benchmarking and quality reporting. With the increasing pressure for ASCs to capture, track and report key quality indicators and outcomes data, ASC planning must also involve evaluating technologies that will aid in meeting current and future reporting mandates, says Chris McMenemy, Vice President for Administration, Ortmann Healthcare Consultants, and Sean Benson, Co-Founder and Vice President of Consulting, ProVation Medical . Luckily, the same advanced technologies that maximize revenues and streamline processes can also drive structured and compliant data capture for quality initiatives, benchmarking and other reporting statutes.
Look for menu-driven documentation processes that enable fast, easy capture of compliant data at the point of care, without the need for manual manipulation or intervention. Software should be able to automatically capture discreet data elements for each procedure and upload them automatically to a central repository. It should also feature built-in reporting and analytics tools to simplify quality reporting, clinical research and audit preparation with pre-built reports or customized query-writing capabilities that enable every captured data element, including free text, to be queried, exported and submitted in appropriate formats.
ASC-specific EHRs should also deliver features and functionality that aids in tracking and utilization of QI and outcomes data to improve operational and clinical performance. For example, the EHR should be able to generate safety alerts, record safety measures taken and significantly streamline the gathering of data and documentation should a Joint Commission or AAAHC audit occur.
The application should have the capability to address state, facility and association requirements, such as documentation of items like pre-anesthesia assessments, ASA scores, “time-outs,” informed consent and estimated blood loss, by allowing them to be pre-built into the EHR workflow and automatically documented as part of an official record. It should also simplify and ensure pathology tracking, patient instructions and repeat procedures, recall and surveillance through a flag or reminder system.
Finally, the EHR should feature comprehensive data tracking capabilities that enable identification of areas for practice improvement, such as scope withdrawal time, adenoma detection rate and rate of cecal intubation.
2. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward says Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla.
“One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole,” Ms. Bollinger says. “There are specific guidelines based on what time you should give an IV antibiotic.”
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. “Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete.”
3. Provide technical training to physicians and staff members. Launching a QI program starts with investing time and energy in collecting internal data as well as national standards and benchmarks. John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, found laying the groundwork for a QI program required an investment in training physicians and staff on how to use newer technologies to gather and assemble information for its QI studies.
“It’s time-intensive and resource-intensive in terms of trying to gather data in order to create meaningful comparisons to external benchmarks, and a lot of our clinical staff are not trained on how to use spreadsheets or statistical methods of inquiry,” he says. “So we’ve had to create open sessions where we train our staff on how to use software, like opening and saving documents.”
4. Track outcomes post-surgery. Once patients have returned home, call them periodically to track the outcome of the surgery. “We don’t just discharge our patients,” says Jimmy St. Louis, Chief Corporate Operations Officer of Laser Spine Institute. “We have a patient services department that tracks outcomes based on the patient’s condition, surgery type and physician who treated them. This allows us to understand and assess optimal levels of patient care and also provides our in house research team with the correct and accurate information to continue to advance our medical practices.”
Laser Spine Institute has a full time in house research specialist to follow the data and create reports on the medical performance. “We want to make sure the patient is treated properly and that we are always improving from a medical perspective,” he says.
5. Hire new personnel to spend extra time with patients. After taking the time to perform surgeries and deal with the administrative aspects of a busy practice, if a surgeon feels like there isn’t enough time to spend with patients during initial visits, he or she should hire extra staff to spend time with patients, says Craig Levitz, MD, an orthopedic surgeon and partner at Orlin & Cohen. “Some people think it’s a waste of space and resources to hire extra personnel, but you want to invest in your resources,” says Dr. Levitz. “You are better off having an extra nurse to develop a relationship with the patient and hire extra staff to deal with the administrative aspect of the practice.” He also suggests hiring a physician’s assistant to make sure the patients are satisfied with their visits. The PAs can listen to patient stories and relay the important aspects to the surgeon before he or she visits the patient to save time. “You can bridge the quality gap with a good physician’s assistant,” says Dr. Levitz. The PA can also assist in the OR, and the practice can collect revenue for the assistance.
Alternatively, the physician can also give his or her e-mail address to patients in case the patients have non-emergency questions. The patient can communicate with the surgeon in real-time, which makes it seem as though the surgeon is spending more time with each patient. Dr. Levitz says he would normally pay five people to handle calls from patients with questions, but now he does most of the responding himself using e-mail on his cell phone. However, surgeons should still be mindful of communicating with patients who prefer not to use electronic communication. “A mix of electronic communication and phone calls is the way to go,” he says. “You still need to have the office and people there to answer your calls, but you can really extend your reach if you use technology wisely.”
