Increase cases from 250 to 350 per month

Use new rules, welcome mat for surgeons

In addition to the problems of high staff costs, outstanding debts, and overpriced supplies, outpatient surgery programs that are not performing well often have underutilized procedure and operating rooms, according to experts interviewed by Same-Day Surgery.

Underutilization of a center can be addressed in several ways, says Luke M. Lambert, chief executive officer of Ambulatory Surgery Centers of America, a Norwell, MA-based company that owns or manages same-day surgery programs. By looking at block-time policies and times made available to nonowner surgeons, Brookside Ambulatory Surgery Center in Battle Creek, MI, saw an increase from 250 cases per month to 350 per month, he adds.

At Brookside, every physician partner had blocks of time, but not all of them used their time, he points out. This created a problem for same-day surgery scheduling staff and other physicians because there was no process for releasing block time to another physician, he says.

"There were other surgeons who wanted to use the center but couldn’t get OR time, so we have a new policy that basically says physicians must use their block time or lose it," Lambert says.

If a physician has not filled the block of time for a certain day two or three days prior to that day, then the time will be released to other physicians, he explains.

"We will also cut the amount of time blocked for a certain physician if he or she has a trend of not using the full time," Lambert says. "For example, if the surgeon typically only used two hours of a four-hour block on a certain day, we’ll cut that surgeon’s block to two hours."

A major shift in outlook for the physician owners was Lambert’s suggestion that the red carpet be rolled out for noninvesting physicians who wanted to use the center. "We ask a noninvesting surgeon what days and times would be convenient for his or her practice," says Lambert. "This means that some investors have to shift when they perform their surgery, but once they realized that this meant the center would become profitable, they were agreeable," he says.

In California, Santa Barbara Surgical Center’s management also had to focus on physician behavior as they tried to increase the caseload per month. "This center probably had too many physician investors, with about 22 surgeons, because the financial incentive to use the center wasn’t significant," admits Michael Sawyer, administrator of the Santa Barbara center.

"We had to talk with the physicians and explain that they needed to bring their patients to the center, not only to increase caseload, but also to present the image of a busy, successful facility," he explains. "People want to be associated with winners, so if a surgery center looks like it’s getting ready to close its doors, noninvesting physicians won’t bring their patients."

As more of the physician owners began using the center, other surgeons began to bring patients as well, Sawyer says. "The caseload at the center now averages 370 to 380 cases per month, but we are aiming for 400 cases per month," he adds.

Before you talk with your physicians, be sure that you know if all of their patients are good for your business, Lambert suggests. "On the first day we were in the center, we began case costing for all procedures," he says. "We discovered that we were losing an average of $450 per case for one plastic surgeon’s patients."

Because plastic surgeons quote a package price for their patients that includes the facility fee, the center set the fee for the doctor without really knowing how much the cases cost because they had not been collecting the information, Lambert says. "We met with the physician and explained that we needed to set a more accurate facility fee for his patients," he adds.

Now, the surgeon is choosier about the patients he brings to the center. "We do well with short cases, but longer cases are better handled in the hospital," he explains.

"We were able to go to the physician with specific information as a result of our case costing," Lambert points out. They used the same information to go to their managed care payers to renegotiate fees with them, he says.

For this reason, Lambert suggests, "find out what everything is costing your program before you start making changes, so you can be sure that the changes you make will fix the problem."