Here are eight strategies for expanding orthopedic surgery centers.
He says some physicians are good at identifying available colleagues but not that good at recruiting. Physician partners should follow up with new physicians on a regular basis to remind them of the opportunity for investment at the ASC and invite them to talk with current center physicians. The leading corporate partners are also skilled at recruiting new physician partners.
2. Weigh the increased upfront costs before adding a subspecialty. Bringing on a spine surgeon to perform outpatient spine procedures may bring in a higher case volume, but there are also increased costs associated with those procedures. Even if the surgery center already has the equipment for orthopedic surgery, additional technology and devices are necessary for spine. "The imaging equipment, microscopes and instrument trays for spine surgery are unique and expensive," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. The surgery center should weigh the costs of purchasing spine-specific imaging equipment and surgical devices with the potential market for that service in the community before bringing on a new surgeon.
3. Keep the infection prevention program updated. Infection control and prevention is especially difficult for orthopedic surgeons because they are often implanting artificial devices into the patient. "If patients develop an infection, it could mean losing the implant and going back to surgery," says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology's board and lead author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections. "Whenever you have an implantable device, one really worries about infection in that population."
Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
4. Employ professionals and provide continuous education opportunities. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
5. Review employee compensation annually. Every year, your ASC should look at the external factors that impact compensation and shift the entire compensation scale slightly, John Merski Jr., executive director of human resources for MedHQ. The scale will often shift up because cost-of-living has increased, meaning every employee will make slightly more than they did the year before. For individual employees, go through the 10 components of their job every year and determine whether any of the components has changed.
For example, if an employee used to supervise one person and now supervises three, he or she probably deserves a pay raise. If an employee has gained certification necessary for his or her position, that might deserve a pay raise as well. Just make sure that your pay raises are based on tangible changes in these 10 components, rather than a feeling on the part of the administration that an employee is performing well. Mr. Merski adds that every ASC position should undergo a complete review every 5-6 years to determine whether the key responsibilities of the role have changed.
Rosalind Richmond, CCS, interim coding compliance officer for Genascis, says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
7. Know your procedure margins and prepare to negotiate a carve-out for appropriate procedures. Knowing the margins on each procedure allows you to negotiate reimbursement for a group or procedure that is negatively impacting the ASC's profitability. When the group or procedure has a negative impact on revenues, suggest a carve-out to achieve adequate reimbursement. This is especially important as new, more expensive technology emerges because the old reimbursement levels may no longer be sufficient. "When some technologies first start coming out, reimbursement doesn't even cover supply cost," says Tom Faith of The C/N Group. "If asking for an appropriate increase doesn't work, focus on negotiating a carve-out with the payors for recognized reimbursement."
Understanding the average cost per case at your ASC is also important if you are looking to add a new specialty or procedure type because it promotes a good dialogue as far as setting reimbursement at a level that makes since for your ASC.
8. Be prepared for denied claims. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. "If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. "Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process."
An ongoing dialogue between coders and pain management physicians is essential for an effective billing process. "The physician shouldn't be surprised when they get questions from the coders," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process."
Related Articles on Orthopedic Surgery Centers:
100 Orthopedic- and Spine-Driven ASCs to Know
4 Questions for Orthopedic Surgery Center Administrators
4 Challenges and Solutions of Orthopedic Surgery Center Management
Practice management
1. Create a list of new target physicians. Even if your physicians are not nearing retirement, you should still have a list of potential new surgeons for recruitment, says Jon Vick, president of ASCs Inc.. "Part of an ASC's strategic plan should be to have a continually updated target list of new procedures, high-paying procedures and physicians that are coming into the community," he says. "There should be a continual recruitment process that brings in new procedures and new physicians."He says some physicians are good at identifying available colleagues but not that good at recruiting. Physician partners should follow up with new physicians on a regular basis to remind them of the opportunity for investment at the ASC and invite them to talk with current center physicians. The leading corporate partners are also skilled at recruiting new physician partners.
2. Weigh the increased upfront costs before adding a subspecialty. Bringing on a spine surgeon to perform outpatient spine procedures may bring in a higher case volume, but there are also increased costs associated with those procedures. Even if the surgery center already has the equipment for orthopedic surgery, additional technology and devices are necessary for spine. "The imaging equipment, microscopes and instrument trays for spine surgery are unique and expensive," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. The surgery center should weigh the costs of purchasing spine-specific imaging equipment and surgical devices with the potential market for that service in the community before bringing on a new surgeon.
3. Keep the infection prevention program updated. Infection control and prevention is especially difficult for orthopedic surgeons because they are often implanting artificial devices into the patient. "If patients develop an infection, it could mean losing the implant and going back to surgery," says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology's board and lead author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections. "Whenever you have an implantable device, one really worries about infection in that population."
Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
4. Employ professionals and provide continuous education opportunities. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
5. Review employee compensation annually. Every year, your ASC should look at the external factors that impact compensation and shift the entire compensation scale slightly, John Merski Jr., executive director of human resources for MedHQ. The scale will often shift up because cost-of-living has increased, meaning every employee will make slightly more than they did the year before. For individual employees, go through the 10 components of their job every year and determine whether any of the components has changed.
For example, if an employee used to supervise one person and now supervises three, he or she probably deserves a pay raise. If an employee has gained certification necessary for his or her position, that might deserve a pay raise as well. Just make sure that your pay raises are based on tangible changes in these 10 components, rather than a feeling on the part of the administration that an employee is performing well. Mr. Merski adds that every ASC position should undergo a complete review every 5-6 years to determine whether the key responsibilities of the role have changed.
Revenue cycle
6. Start looking at ICD-10 equivalency mapping. While the 2013 implementation date for ICD-10 is still a couple of years away, Raemerie Jimenez, director of education for AAPC, says coders should start looking at the expectations involved in ICD-10 coding and documentation. "It would be good for coders to see the ICD-9 codes that they're typically coding now and see what the ICD-10 equivalents are going to be," she says.Rosalind Richmond, CCS, interim coding compliance officer for Genascis, says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
7. Know your procedure margins and prepare to negotiate a carve-out for appropriate procedures. Knowing the margins on each procedure allows you to negotiate reimbursement for a group or procedure that is negatively impacting the ASC's profitability. When the group or procedure has a negative impact on revenues, suggest a carve-out to achieve adequate reimbursement. This is especially important as new, more expensive technology emerges because the old reimbursement levels may no longer be sufficient. "When some technologies first start coming out, reimbursement doesn't even cover supply cost," says Tom Faith of The C/N Group. "If asking for an appropriate increase doesn't work, focus on negotiating a carve-out with the payors for recognized reimbursement."
Understanding the average cost per case at your ASC is also important if you are looking to add a new specialty or procedure type because it promotes a good dialogue as far as setting reimbursement at a level that makes since for your ASC.
8. Be prepared for denied claims. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. "If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. "Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process."
An ongoing dialogue between coders and pain management physicians is essential for an effective billing process. "The physician shouldn't be surprised when they get questions from the coders," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process."
Related Articles on Orthopedic Surgery Centers:
100 Orthopedic- and Spine-Driven ASCs to Know
4 Questions for Orthopedic Surgery Center Administrators
4 Challenges and Solutions of Orthopedic Surgery Center Management