The current healthcare environment appears to make this a good time to open a new ASC. The trend of employer-sponsored health plans and payers looking for lower-cost alternatives to hospital procedures is creating new opportunities for the industry’s growth.
“There are so many benefits to an outpatient surgery center for patients and providers. It is a welcome addition to the healthcare offerings in our community,” says Corrie Massey, MBA, the CEO of Wake Forest Baptist Health Outpatient Surgery in Clemmons, NC. The ASC was formed in a joint venture with Surgical Care Affiliates (SCA), which manages its operations.
The de novo ASC, which contains three operating rooms, serviced its first surgical case in February. Staff found that patients were eager to use the new facility. “We had patients who went into their doctor’s office, saying, ‘I want to go to the new surgery center,’” Massey says. “Some people waited until we opened to have their procedures.”
In board meetings, during the ASC’s planning stages, physicians were the most vocal about how the surgery center would not need an extensive marketing campaign. “A chief medical officer said, ‘If you build it, they will come,’” Massey recalls. “He said we’d have no trouble filling it. So far, he has been right.”
While the operating rooms are full, some managed care contracts have taken longer than expected. “Part of our situation here is that contract negotiations are coinciding with renewing contracts for the health system. It’s taken on a larger conversation than it normally would in a freestanding surgery center,” Massey says.
This delay has not affected the ASC’s ability to attract patients and find experienced staff and physicians. For instance, hiring surgeons to practice in the new ASC was not a challenge, says Kevin E. Coates, MD, MBA, MPT, assistant professor, orthopaedic surgery, sports medicine, Wake Forest School of Medicine in Winston-Salem, NC. Surgeons love the ASC setting, he says.
“It gets you out of the main facility and away from some of the burdens that come with being in the hospital,” Coates says. “For example, you don’t have people saying, ‘Hey, since you’re here ...’”
ASCs also are more efficient. “We have inpatient and outpatient operating rooms in the main facility, but they’re not designed to be as efficient as an ASC,” Coates says. “Spending less time waiting is something people like very much.”
For instance, a 15- to 20-minute wait between procedures is what surgeons expect at an ASC, he adds. One reason why an ASC is more efficient is that surgeons have more autonomy to drive the schedule in the ambulatory setting. In the hospital, factors out of the surgeon’s control affect his or her time, Coates notes.
Wake Forest anticipated the need for an ASC several years ago.
“They recognized they needed to increase operating room capacity,” Massey says. “As North Carolina is a Certificate of Need state, they started that process many years ago of getting approval for additional operating rooms under their umbrella.”
From the health system’s perspective, the ASC handles less complicated surgeries, freeing hospital operating room beds for more complex surgical cases, Massey adds.
Massey and Coates describe early steps to take when opening an efficient and successful new ASC:
• Plan according to procedures and surgeons. “The first step is to speak with the various surgeons who are planning to go to the facility and get a list of procedures they perform to get an understanding which procedures would move to the surgery center,” Coates says. “Know which procedures are going to be done before you buy the equipment.”
This process means projecting ahead of today’s needs as well. For example, the Wake Forest ASC has no immediate plans for 23-hour observation stays, but has reserved that option for the future. “We built a room that could be used for overnight cases,” Coates adds.
• Provide price transparency. “From an operational standpoint, patients are more aware, educated, and in control now, and I think that’s amazing,” Massey says. “It’s great to see that patients are becoming more aware of their options and aware of potential outcomes, and they are better able to take part in those choices; patient engagement has increased.”
Surgical costs and price transparency have long interested Coates.
“That is something I have an interest in and do talk with students, residents, and fellows about.”
While in private practice, before moving to Wake Forest, Coates knew what his services cost and would give patients a good idea of what their bill would look like. At the medical center, Coates does not handle billing, but he still helps patients learn more about costs.
“Anytime patients have a question prior to surgery, I get them connected with the folks in our financial counseling office and give them CPT codes, written down, for what I’m planning on doing,” he explains. “They can talk with our finance folks and find out what their bill will be from the medical center.”
Patients want to know how much they will pay the surgery center, surgeon, and anesthesiologist. If patients believe they have met their deductible, they do not want to be told they still owe someone money, Massey notes.
“I know how it feels to be on the other side when you suddenly get a bill and don’t understand where it comes from,” she says. “Patients need to know exactly how much they owe, within reason, unless something changes in their treatment.” The ASC provides a lot of education about the financial aspect of procedures so that the costs are transparent to patients, Massey adds.
• Go above and beyond in customer service. Patients complete an online satisfaction survey after their surgery. They can rate various experiences at the surgery center according to a 0-10 scale, with a score of 10 the best. Patients also can write some comments or complaints in a free text box in every section.
“Our goal is to have 100% satisfaction every single time,” Massey says. “Even if someone says it was really cold in the waiting room, we appreciate that feedback.”
Whenever there is a negative response, the ASC receives an alert. Massey uses that as an opportunity to reconnect with the patient. She has gone out of her way to resolve problems for patients, including helping patients discover payer errors and lowering their bills.