To survive payment cuts, reduce overhead
Regardless of the specifics of an individual contract, outpatient surgery providers are facing decreased reimbursement overall, says Anne Dean Schilling, RN, BSN, consultant with The ADA Group in DeLand, FL. This reduction means you need to reduce overhead, she says.
"What are we doing to do to survive with our clients, our patients?" Dean Schilling asks.
Electronic medical records [EMRs] are one area to consider, she says. "EMRs save dollars on the mountains of paper that surgery centers use in charts, folders, clipboards, etc."
Consider these other suggestions:
• Inventory control.
Inventory control is possible but takes a lot of diligence on the part of the OR supervisor and staff, Dean Schilling says.
"Reducing inventory by standardizing preps, gloves, masks, hair covers, drapes, suture, and solutions is essential," she says. "Establishing par and reorder levels, performing case cost analysis studies on a regular basis, and doing supply cost analysis is essential."
An electronic materials management program saves the organization its cost in inventory control if the time is taken to load the inventory and physician procedure cards and then to use the program, Dean Schilling says. "I further believe that establishing a strong working relationship with your primary vendor/GPA [group purchasing association] is crucial," she says. "Many places don't tap into this resource, but these persons are specialized in this arena and can prove to be a great resource."
Watch your invoices to ensure that supply costs aren't slowly creeping up above the agreed-upon contract price, Dean Schilling says.
Look at each of your practices to determine whether it is an industry standard or whether you are insisting on something because it was "carved in stone" years ago, such as wearing shoe covers and using full coverage drapes for facial surgery, she says.
• Housekeeping costs.
Determine whether housekeeping services are provided in a cost-effective way, Dean Schilling says.
"Can you use [antibacterial] wipes bought at a discount store to wipe off equipment or stretchers, or do you need something far more costly?" she says. Perform an analysis, she advises.
• Utility costs.
Look at the cost effectiveness of electronic "eyes" for water faucets and paper towels, Dean Schilling suggests. "In the long run, these will save you tremendously," she says.
Look at sensors to turn off lights in unoccupied places such as bathrooms and storerooms, she advises. "I am appalled at the number of lights that are on in the centers all day," she says. Also, consider how many lights you need to have on for security during nonbusiness hours, Dean Schilling says. Consider whether all computers need to stay on, she says.
• Recycling.
Analyze the cost savings of starting a recycling program, Dean Schilling advises. "Some centers have found that the recycling reduces the cost of their refuse pickup," she says.
Examine the wasted paper from copying and faxing, Dean Schilling says. "Consider loading paper from the fax and copier that is printed on one side for internal use," she says. "We have done this in our office for years. The local print store will take these papers and cut them into notepads for a small amount of money."
• Materials management.
Examine the cost effectiveness of having electronic "eyes" that turn on/off water faucets and paper towels, Dean Schilling suggests.
Have staff buy and care for their own scrubs, Dean Schilling suggests. "If you don't want to initiate this policy in the OR, consider it for the prep and recovery," she says.
Encourage staff to use one set of linens for the patient throughout the patient's stay, unless it becomes soiled, Dean Schilling advises. The stretcher can go to the OR, and the patient can get back on the same stretcher to go to recovery, she says. "The top sheet goes onto the chair as a cover once the patient is ready to leave the stretcher for the chair," she says. The bottom sheet is the patient's cover. Patients use the same blankets and pillows throughout.
Calculate how much you are spending per patient on linen, Dean Schilling advises. "I had one center give the patient two sheets and a pillow in pre-op, and another set in discharge recovery," she says. "This is not free!"
• Staff theft.
Have conversations with the staff about being careful not to "accidentally" take home Post-it note pads, pencils, pens, or other supplies stuck in their pockets during the day, Dean Schilling advises.
"I read that this kind of unintentional pilfering can run up to something like $1,500 a year per employee in some organizations," she says. "In the surgery center environment, staff may stick tape or [adhesive bandages] in their pockets to be more efficient in taking care of patients, only to find it inadvertently carried home."
• Cost-savings contest.
Conduct a "cost-savings ideas" contest, Dean Schilling suggests, and enroll the physicians, nurse anesthetists, and other staff to participate. "Everyone can submit as many ideas as possible," she says.
Have a committee select the best top three ideas and give prizes, Dean Schilling advises. Subsequently, implement the ideas. "This is a great QI activity," Dean Schilling says.
Treat the surgery center's budget as if it were your own at home, Dean Schilling says. "The ASC does not have a bottomless pocket either!" she says. [Editor's note: Do you have a cost-saving idea to share? Contact Joy Daughtery Dickinson, Editor, at [email protected] or (229) 551-9195.]
Regardless of the specifics of an individual contract, outpatient surgery providers are facing decreased reimbursement overall, says Anne Dean Schilling, RN, BSN, consultant with The ADA Group in DeLand, FL. This reduction means you need to reduce overhead, she says.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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