Same-Day Surger Manager

Get your house in order for 2012

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

The holidays finally are over, and most of us have nothing really important to do this month. OK, maybe four of you have something really important to do at work this month, but for the rest of us…

I've written and spoken for years about the need for hospitals and surgery centers to get together and find a common goal to work toward. Hospitals know that they are losing money on many of their outpatient cases. If they think they aren't losing money, it is just because their antiquated accounting software doesn't capture all their expenses, which deceives them into thinking they are doing well.

Conversely, most surgery center out there are overbuilt and have capacity ('cept ours of course…) to do more cases. Furthermore, many surgery centers are doing procedures that should go back to the hospital since our backward-thinking method of reimbursement is driving them back into that model. Come on!

Chances are, if you are a GI-only surgery center, you probably are better off financing and doing these cases in your office, not in any facility-fee environment, and taking the high professional fee reimbursement rather than the minuscule facility reimbursement. Either do that, or push them back to the hospital and start recruiting new specialties and surgeons into your surgery center. Of course hospitals, even with their higher reimbursement, cannot make money on them either. So … what to do? What to do? With the exception of the above, you are sort of running out of options, huh? Don't get so smug eye centers; you have a bull's-eye on your back too!

So, this month each entity needs to establish dialog with each other. It is completely legal and aboveboard to do so. Many great minds in the insurance industry already are finding ways to ratchet down reimbursement further, so we (you!) need to start doing some planning as well.

Every single person reading this is experiencing accounting errors in their facility. This month, you need to reach out and grab an invoice and check the amount you are being charged by the vendors versus what you contracted. I have eased up on the vendor reps over the years because I am now convinced that overcharging or incorrect charging is not really their fault. They have to face us too often to pull that kind of stuff. I think it is just poor communications or keystroke errors on those at their home office doing the invoicing. Regardless, you still are overpaying! Do yourself, your facility, and your investors a favor and just audit 10 — no, 20 — invoices this month while you're just hanging around. (Oh, hate mail is on the way!)

Another reaching out effort this month is to check your reimbursement per your agreed-upon contracts. We are all in that same sinking boat. Again, audit! Just check 20 claims from your top payers, and see where you are. Again, those facilities that are "right on" are in the minority!

Reach out for your employee files. It is guaranteed that many competencies and licenses are in need of updating.

Even if you sub out your credentialing, you are going to find some expired insurance coverage. It's not all that big a deal now, but when someone else discovers them, or there is a problem and someone looks at them and finds out there is no coverage, it is going to be at the worst possible time. Again, do it now, and get it over with.

Just when you want to really fire someone, up jumps the regulations demanding more employee protections. That is all well and good, but you never signed on to be a babysitter or an employment agency. Put those issues behind you this month.

Lastly, book that trip to the islands! The weather is miserable, and the world probably will blow up this year anyway, so get your vacation in early. If you do believe the world is ending this year, put your vacation on your credit card! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: Web: Twitter: @SurgeryInc.]