Same-Day Surgery Manager

A look at trends in outpatient surgery

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Well, this is a fine mess all us health care providers are all getting into isn't it? I mean, we have oil spills, the earthquakes, and volcanoes and various other sundries out there to make our lives more complicated and miserable. On top of those disasters, at press time it just had been announced that Medicare is cutting reimbursement to physicians by 21% starting in June. It is no wonder so many surgeons want to do their own surgery center — just to break even!

It is so frustrating for everyone dealing with this uncertainty. I normally focus on revenue and not expenses, and I still will, but with a slight turn of direction. I know that the paperwork under that new reform is not quoted as being "significant," but I have seen so many things change that were not going to change either that I am skeptical of just about all of it.

It is time to consolidate as much work effort as possible at our facilities, be they hospital or freestanding. Consider rolling everything into one package and letting one business handle it: custom packs, billing, revenue cycle enhancement, electronic medical records (EMR), staffing, you name it. Outsourcing of billing is probably cheaper now than doing it in-house. Even if it is breakeven, it is still a better deal to outsource it as the prices have come down. Having one company to handle transcription, insurance verification, and other stuff I don't even understand, "uncomplicates" the process.

Speaking of EMR, how many of you are making the transition? We have found that most facilities are holding off until they have a better idea of how health care reform is going to be handled. There's too much confusion right now for lots of people to deal with it.

Other thoughts on trends in health care:

I am really getting disgusted with the human billboards of people advertising some company's product or logo. I mean it would be different if they were paying you to wear their product on your T-shirt or hat, but you are paying them! This is really starting to irk me, and it is a practice that must stop.

In terms of dental procedures, how many of you are doing them? The facility fee from Medicare is about $675 for the smallest of procedures. Look into it.

Do you know the reimbursement for many of the urological cases? They have risen nicely over the past couple years. Call those urologists and talk with them.

In-vitro fertilization (IVF) is hot (Goggle it), and you should be doing these procedures at your facility. It offers nice private pay revenue.

If you are expanding your hospital suites or surgery center, put windows in your operating rooms. The natural light is a hit with the surgeons, and rooms that have full-length windows are the most sought after by the docs.

Make sure you insist on your business office manager taking vacations regularly. I am hearing more and more horror stories about embezzlement from centers where the manager insists upon not taking time off. Have someone oversee them frequently. Don't think it can't happen to you. It did to me more than once.

Want to shorten your patient recovery time? Turn off the recovery room TVs.

Increase your "time outs" to two per case. Don't rely on just one. In addition to the one timeout just before the case starts, add another one just before the patient is taken into the room. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management.]