Same-day surgery questions and answers
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Here are my picks for the most interesting questions I’ve received during 2000 to date.
Question: We are considering outsourcing our billing for our technical facility fee. Is this a good idea or bad? What are the merits?
Answer: Outsourcing, in general, is a great concept, but only if it is cost-effective. I always hate to pay someone to do something that I could do myself. Billing and collection are very expensive if done in-house. In addition to the staffing required, the postage, the forms (always the forms!), the phone calls, the coverage for staff days off, and resubmissions — to say nothing of the compliance issues — are a major hassle.
If you decide to outsource your billing and collection, you probably will find that there is a setup fee for a company to come in and provide this service. In addition, there is a cost, usually per claim or per patient, to pay above that. There also will be issues related to your billing software. Your challenge is to weigh all factors to see if this is going to meet your needs in a cost-competitive manner — or is it more expensive? While you are trying to decide, take into account your reduced phone bill, personnel, cost of forms, and cost of postage. Add to that the reduced amount of time that management spends over the process. That reduction can be one of your greatest cost-control enhancement: the ability to save time. Don’t forget that you are still responsible for the activity of a billing company. The compliance is with the center, not the billing company.
How much lead time for accreditation?
Question: We are required to be accredited by either the Accreditation Association for Ambulatory Health Care or the Joint Commission on Accreditation of Healthcare Organizations. What is the lead time required to go through the process?
Answer: You need to decide which of the two agencies best suits your center and then contact them to get the particulars. We see the process taking anywhere from six to 12 months, depending upon your internal resources. It is time-consuming and requires incredible attention to detail. The end result, however, is something you can be proud of.
Question: We are a large outpatient surgical department that requires a lot of instrument sterilization. We made the decision not to have much in the way of instrument backup because of the price of duplication. Now we are paying for that decision in trying to keep up with the load during that day. We start out fine, but by 11 a.m., we are completely backlogged with dirty trays and a busy staff! No one has the time to process the trays and as a result, our afternoon cases are backed up and the surgeons are angry. Any suggestions?
Answer: I know that everyone reading this already knows the answer, but this is a classic example of being so buried in the process that it is difficult to see the solution. It’s the forest and the trees philosophy. The recommendation I gave was to hire a part-time instrument tech working from 9 a.m. to 2 p.m. each day. It worked, and the money to hire the individual came out of the reduced overtime paid.
Question: Several of our surgeons approached our hospital administrator saying that they want the hospital to pay for their private scrubs. The surgeons told him that the surgery center down the street is willing to do it, but that they would rather stay in the hospital. The hospital administrator asked me to give him an answer. I think it is a bad idea and a bad precedent to set for the rest of the staff. Any comments?
Answer: What you, the reader, do not know about this situation is that the orthopedic surgeons who approached the hospital administrator collectively did more than 1,900 outpatient cases in the hospital surgical department. Further, after discussing this issue with the surgeons, we discovered that the hospital rejected the offer from the orthopedic surgeons to help the hospital train the existing staff to assist them for orthopedic cases.
After collecting all the facts, our suggestion was to pay the three private scrubs for the actual hours they were in the operating room (not in the hospital) and that the private scrubs would have to abide by the policies and procedures the rest of the staff followed. The money would come from a very small staffing reduction during the next year. The total cost for the private scrubs was projected at $48,000 per year. The revenue from the collective orthopedic surgeons for the past 12 months was $7,220,000. It made sense.
As a footnote, the hospital rejected our suggestion and decided not to pay for the private scrubs. The orthopedics group took 75% of their volume to the surgery center down the street.
(Editor’s note: Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com.)
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