The first question for any ASC director to ask is, “Are my costs really where they need to be as far as staffing is concerned?”

It doesn’t matter if it is an inpatient operating room or an outpatient OR, the most expensive component of care is staff, says Zeev N. Kain, MD, MBA, FAAP, chancellor’s professor at the University of California, Irvine Department of Anesthesiology & Perioperative Care, director of system redesign and value-based healthcare at the university’s Healthcare Policy Research Institute, and president of the American College of Perioperative Medicine.

Kain offers a few tips to surgery centers looking to contain costs:

  • Examine staffing patterns.

“You have to look at which staff you are talking about,” Kain says. “Are we talking about nurses or the anesthesiologist?” Ensure each employee’s time is optimized.

“Look at the time of day they work. Are nurses working 12-hour day shifts or eight-hour day shifts?” Kain asks. “If they’re working eight-hour day shifts, and you are paying overtime, is this the right model?”

If staffers work 12-hour shifts, is that the right model? Can a surgery center really keep nurses busy from 7 a.m. to 7 p.m.? The key is to look at all starts and finishes over time and match staff to these hourly needs. “How many hours a day does the operating room work?” Kain asks. “No one wants to operate after noon. People like to operate in the morning.”

But if all surgeries are scheduled in the morning, then what happens to staff in the afternoon? “The better model is to open only five rooms and staff those for a full day,” Kain offers.

  • Look at ratios in anesthesia staffing.

“How many nurse anesthesia technicians are you using?” Kain asks.

“What is the coverage ratio of nurse anesthesia to an anesthesiologist?” This ratio has to be reviewed carefully to ensure it is optimized, he adds.

  • Use process maps.

One popular technique is the swim lane, a process map that shows which employee is handling what work and at which time. “With a process map, you can find a bottleneck,” Kain notes.

If the holdup for an OR is because everyone is waiting for the room to be cleaned, then maybe the cutbacks on housekeeping were short-sighted. Surgery centers with inefficient staffing patterns will pay higher OR costs, which lowers investors’ income.

“You have to make sure the surgery center is staffed appropriately,” Kain stresses. “At net level, make sure you’re not overstaffed.”

  • Address variability.

When selecting surgical instruments, supplies, and implants, a low level of variability is preferable, Kain says. To lower this variability, find a way to align physicians’ incentives.

“You have to incentivize physicians to do the right thing,” Kain says. “Align the incentives, and they will agree and change their practices.” Kain says incentives do not have to be monetary. Incentives can be in clinical care if the change improves quality and is the right thing to do.

  • Aim for maximum capabilities.

ASCs do not always make the best use of their infrastructure. Rooms might be used too little. Some technology and equipment could be gathering dust. These are inefficient practices that could change. “For example, I visited a facility last week where they had a CT scan in the facility,” Kain recalls. “They just use the CT scan for their patients.”

This expensive piece of equipment was convenient, but not used as often as it could.

“One question I had for them was, ‘Why don’t you rent the CT scan to other practices?’” Kain says. “Make sure any ancillary services you have — a CT scan, MRI, pathology — are used the entire day.” If these services and equipment not used the entire day, then assess how to use that infrastructure when the ASC does not need it.