Same-Day Surgery Manager

Year-end cleanup: 10 lessons we learned

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

It has been a wonderful year, right? Some will nod; others will not. It has been a mixed year for me. Relocating to Houston was good. We said goodbye to some clients and hello to others. Ebb and flow. We learned a lot, though. Take a look:

• Employee theft.

We discovered a new way to steal, sadly. While preparing for some clients' employee reviews, we found some staff members at several locations were in cahoots with the business office staff. The scam was that some employees' PTO (paid time off) had been tampered with and up to several weeks of PTO had been secretly added to their account. It is apparently pretty widespread. You might want to audit your PTO accounts.

• Unit pricing.

While many facilities are showing the unit price of each item in their supply rooms, they are not keeping up with price changes.

• Reimbursement mismatch.

More than you would think, facilities are not being reimbursed their contracted rates. You need to dig into the computer and check. Sadly, we are finding too many office managers are just not doing their job. Some facilities are underpaid, while other are overpaid. The bad news is that you need to discover on your own the underpaid. The overpaid eventually are discovered by the payer, who will come back at you for a refund. That' s not cool if it already has been spent.

• Unrealistic budgets.

Since when did you decide not to do a budget? We review so many unrealistic budgets that we are amazed at how blind the financial community has become. It is so much easier in the long run to prepare a budget that is at least in the ballpark rather than constantly trying to justify one that is not.

• Anesthesia -– 2013.

This year just might be the year you hire your own anesthesia staff and get away from the burdensome chains around your ankles. Surgery is usually uncomfortable without anesthesia, but some anesthesia groups have become so large and inflexible that you might be tempted to try. The stipends and restrictions that many hospitals and surgery centers pay or tolerate for coverage is becoming ridiculous. It might be time to consider alternatives.

• Regulatory compliance.

Do you know what Medicare changes have taken place for 2013? Do you know the new accreditation standards? Tick-tock-tick-tock...

• Accountable care.

You think you hate the paperwork now? Just wait. Much like an undertaker secretly enjoys a good plague, the insurance companies are gleefully rubbing their hands at the prospect of reducing payments to you because of poor outcomes. You better get caught up on this change!

• Surgeon retention.

While there are some you hope will leave, most of them you need to hang on to. While many surgery center managers are tracking surgeon' s utilization, most of our hospital clients are not! Well, they are, but no one reads the printouts. We can' t blame them too much as there is so much other paper that is screaming for attention. But still.

• Nasty staff.

Back stabbing, passive-aggressive, lazy, incompetent, moronic, and just plain rude employees seem to be gaining a foothold in many facilities. Why? I know it is a legal minefield getting rid of these individuals, but they seem to be growing at an alarming rate, and they are being tolerated. Do what you want, but wow!

• Parties.

December is a good time for staff parties, but you need to incorporate more during the year. Have as many get-togethers as you can afford in 2013. My experience is that a cohesive staff is a happier staff, and a happy staff typically has better outcomes. Enjoying your job more in 2013 would be a cool thing. Party on! Thank you, and HAPPY HOLIDAYS! [Editor' s note: Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates' address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: Web:]