Ambulatory Surgery Center Management: A Comprehensive Technology Guide for ASC Administrators

Chapter One

3 Top Management Goals for ASC Administrators

Besides overseeing the operations of a facility, providing exceptional surgical care, and delivering optimal outcomes, ambulatory surgery center administrators must meet the needs of the physicians while managing a diverse staff to fulfill a wide range of responsibilities.

Here are three of the top management priorities today's ASC administrators are focusing on.

1. Physician Engagement

An effective ASC manager can accomplish a great deal without much assistance, but it helps to have additional leadership support — particularly with issues that require the involvement of physicians and/or the governing board.

Essential to improving physician engagement is increasing collaboration and bridging gaps between your ASC and its physicians' offices. This can be significantly strengthened with the integration of technology and better data sharing between facilities. The right software can give offices the ability to submit electronic case requests to the ASC, better support communication between facilities around case preparation, and give surgeons and office staff visibility into the surgical schedule. This functionality can make it easier for offices to schedule cases and fill block times, reduce ASC staff workload, decrease the likelihood of mistakes and oversights that can lead to case cancellations, and ultimately make the ASC a more appealing site for scheduling surgery.

Another way to better engage with physicians is to identify a physician champion who can help overcome communication issues and act as a bridge between other physicians and board members. You can call upon this champion to support initiatives that are in the best interest of the ASC but face resistance from others. You can also rely on them to provide insight and guidance when needed.

A strong physician champion should be respected by peers and staff. They should be an effective communicator and have a strong grasp of ASC operations, both clinically and financially. It is also beneficial for the champion to serve on the board so they will be present at board meetings.

2. Staff Engagement

Recruiting the right staff members and managing them appropriately is key to running a successful ASC. To find candidates who are the right fit for your facility, ask your existing staff for recommendations. They may know of other professionals (e.g., from previous positions, facilities, industry meetings) who are looking for work or a new place to perform procedures.

Meanwhile, ensuring employee satisfaction can help you retain the most valuable team members. Provide staff with the technology they need to do their jobs effectively and efficiently. Staff will thrive when they can use ASC-specific software that was designed with their roles and responsibilities in mind (e.g., scheduling, revenue cycle, clinical documentation, patient communications). Providing staff with software that is not designed for ASCs and requires workarounds, navigating unnecessary screens, and other cumbersome tasks is likely to create frustration and reduce performance.

Empower your staff so they take pride and ownership in their work and performance. When you assign employees a task, explain your expectations and timeframe. Confirm that they understand the direction and encourage them to come back to you for clarification or additional support — then get out of their way and let them do their jobs.

Educate your staff about what is required for an ASC to be successful and how they can contribute to reaching goals. Once expectations are communicated clearly, hold your staff accountable. Part of this accountability requires you to fulfill your responsibilities as a manager by helping staff meet expectations and achieve their professional potential by providing the right tools, training, guidance, and ongoing support.

3. Technology Enablement

Investing in the right technologies has become more important for achieving across-the-board improvements in ASC management. The right ASC software and technology can provide managers, staff, and physicians with powerful tools that support timely and evidence-based decision-making while streamlining essential tasks to improve operational cost-efficiency.

Such technology can transform scheduling and documentation, accelerate revenue cycle, and streamline administrative tasks while facilitating team coordination and communication. For example, an ASC analytics solution can help you drill down into your facility's performance to identify areas for improvement. You can also gain a stronger understanding of the trends and developments that drive operational efficiency.

The right ASC technology helps ensure that staff members are consistently performing and producing at their highest level. When employees are successful in their work, you get a positive trickle-down effect: physicians tend to be happier and patients will receive better care, which is the ultimate measurement of an ASC manager's success.

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Chapter Two

Key Drivers Behind the Adoption of New Technology by ASCs

Now let's examine further additional factors motivating ASCs to pursue and invest in new software and technology. Ambulatory surgery centers are finding themselves under increasing pressure in areas including tightened reimbursement, greater scrutiny by regulatory bodies, increased reporting requirements, and growing competition for physicians, patients, and staff. To help meet these challenges head on, a growing number of ASCs are adopting new technologies to deliver a high quality of care while reducing errors, boosting efficiency, cutting costs, and ensuring compliance. The resulting improvements ultimately translate to higher physician, patient, and staff satisfaction.

Here are some other key considerations that drive the use of technology in ASCs.

1. Improve Data Collection Procedures

Collecting and analyzing data about your ASC's operation can help support accurate, data-driven decision-making. Such data assessment provides the insights needed to help improve the cost-efficiency, patient outcomes, and profitability of your facility.

Electronic health records (EHRs) can help you tap into the extensive clinical data, which is difficult to obtain with paper charts, to reveal trends and outcomes that can help you make targeted improvements. You can leverage data analytics to identify historical patterns, establish benchmarks, optimize scheduling, and maximize resource allocation.

Better data collection also helps you adhere to Ambulatory Surgical Center Quality Reporting (ASCQR) requirements. Without successful reporting of such data to the Medicare program, you risk having your Medicare payments reduced.

2. Minimize Revenue Cycle Issues

ASC software and technology can enhance an ambulatory surgical center's billing and collections efforts to maintain healthy cash flow and strengthen revenue cycle performance. The right solution can improve claims completion and submission speed, boost staff productivity, decrease payment time, and reduce expenses. ASCs that understand how to leverage the latest technologies effectively can reap the most benefits.

Start with an IT roadmap and be methodical about adding new applications or features. Keep in mind that the best technology is only as good as how well it is then used. Prioritize adoption and provide adequate training to ensure that employees are comfortable with new platforms.

For example, a digital payment system can facilitate the collection process and encourage patients to pay their bills. To achieve this goal, make sure your patient portal is easy to use and communicate to patients how the new platform can improve their experience.

3. Outsource Your Revenue Cycle

While new technologies can help shorten your revenue cycle, it is not a magic wand. You need the right experience and expertise to fully leverage the latest ASC technology.

A professional revenue cycle team can provide your facility with the expertise, dependable coverage, industry benchmarks, customized reporting, staffing, and the human touch you need for effective revenue cycle management. The right billing partner can also provide you with consistent updates and information so you can keep your fingers on the pulse while focusing your energy on delivering the best patient care.

When outsourcing your revenue cycle management, understand your ASC's specific needs. Do your due diligence to research the provider, set clear goals, monitor metrics, and benchmark performance. Have your vendor partner walk your team through performance numbers every month, check your key performance indicators (KPIs), and update your goals regularly to avoid complacency.

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Chapter Three

Improving Staff Performance and the Patient Experience

To attract more patients to your facility, you need to consistently deliver an outstanding patient experience. By freeing up your staff from repetitive and tedious administrative tasks, they can focus on providing the best patient care.

A patient tracking system can improve communications and provide the most up-to-date patient information to staff and families to ensure that nothing falls through the cracks. Here is how such a solution can help improve ASC management and patient outcomes in various stages of a procedure.

1. Pre-Op and PACU Areas Patient tracking technology gives your clinical staff access to all patient data from a single location to support the delivery of a safe and high-quality surgical event. The information includes patient demographics, which bay the patient is in, what the procedure is, who is performing the surgery, what type of anesthesia will be used, and what allergies a patient has. The patient information is updated in near real-time based on the latest clinical documentation. This helps eliminate time-consuming manual tasks, such as removing patients from the display upon their discharge, reordering patients as they progress through the surgical process, and grouping patients by category (e.g., specialty, surgeon). In addition, a digital display overcomes the many shortcomings of dry-erase boards. You do not need to worry about errors and delays caused by poor handwriting or the transfer of information from a dry-erase board to paper records or EHR. It can accommodate a high volume of patients without compromising the legibility of the information on the board.
2. Operating Room A digital OR board provides staff with a convenient, easy-to-read way to check the status of your ASC's ORs throughout the day so they can do their jobs more efficiently. With the latest information displayed where everyone can see it, you can be sure that the right personnel are at the right place and at the right time to prevent confusion and costly delays. Moreover, OR tracking boards can highlight when a case is running late. For example, you can use color codes to provide at-a-glance visual cues on which OR needs immediate attention. This helps push staff to take corrective actions and keep the ASC on its surgical schedule to avoid unnecessary costs or negative impacts on the patient experience and outcomes.
3. Waiting Room Patient tracking boards in waiting rooms help keep family and friends apprised of the patient's status throughout the surgical event. A HIPAA-compliant display shows a unique identifier for the patients alongside a progress bar that indicates their progress through the surgical event. The information reduces the sense of uncertainty and gives visitors peace of mind during what is likely a stressful event. When patients know that their family and friends are kept informed about their progress, they tend to be more relaxed and satisfied with their experience. Since visitors do not need to ask front desk staff for status updates, employees can spend less time speaking with visitors and making disruptive calls or visits to the nursing station for updates. As a result, staff interruptions are reduced while satisfaction is increased across the board.

Using Patient Tracking Technology to Enhance Outcomes and Satisfaction

Patient tracking technology can dramatically improve processes that seem to be working well enough on the surface but, when analyzed further, are inefficient in ways that can decrease facility and staff performance and increase risks.

When evaluating electronic patient tracking solutions, look for a system designed for ASCs rather than hospitals or clinics to ensure that the features are applicable to your setting. If you are using or considering an EHR, check to see if information documented in the system can be synched up for digital display in various patient tracker formats.

By investing in the right patient tracking system, you can improve the patient experience of your facility while maximizing staff productivity.

Other ASC Software and Technologies That Deliver Results

Adding a patient tracking system is just one of the ways ASCs are strengthening their staff performance and patient experience. There are a number of other ASC solutions available that ambulatory surgery centers should consider adding. They include the following:

• electronic pre-operative patient communications, including questionnaires, surgical instructions, and reminders that help reduce same-day cancellations and prepare patients for their payment responsibility;
• clinical documentation that covers all surgical phases and features clinical workflow tools that drive additional productivity for ASCs and value from their EHRs; and
• platforms that connect ASCs and their affiliated surgeons' offices to make communications more streamlined and efficient; provide the surgeon office scheduler with a personalized view into the ASC schedule to search for available times; make workflow easier between the office and ASC, increasing both staff and patient satisfaction; and more.

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Chapter Four

ASC Revenue Cycle Challenges and Opportunities for Improvement 

"Cash flow is king" for businesses, and it's no different when it comes to maintaining a successful ASC operation. Implementing a streamlined workflow and leveraging the latest technologies can help you shorten the revenue cycle to get paid faster and collect a higher percentage of outstanding payments from patients.

Consider the following key strategies to help you overcome revenue cycle challenges and uncover opportunities for improvement:

Examine Your Revenue Cycle

Here are three areas of focus that can help you shorten your billing cycle to improve cash flow and the financial health of your ASC.

1. Enhance billing performance

Effective and efficient ASC billing is contingent upon numerous factors. Billing staff must be skilled in their craft and receive ongoing education to keep current with changing rules. Physicians must provide the right information so billers and coders can perform their duties. IT systems must be configured to support an ASC's specific needs and requirements.

2. Improve the patient payment collection process

With patients increasingly responsible for a greater portion of their healthcare costs, ASCs must effectively collect these higher amounts while considering the potential stress and distress patients may experience under the financial pressure.

3. Leverage technology to improve the revenue cycle

Technology can enhance an ASC's billing and collection efforts. It can improve claims completion and submission speed, boost staff productivity, decrease payment time, and reduce expenses. ASCs that understand how to maximize their investment in a software solution will reap the most benefits.

Improve ASC Coding Accuracy

The consequences of poor coding in an ASC can be severe. Inaccurate coding can lead to lost revenue, unnecessary expenses, insurance audits, angry patients, and even trigger fraud investigations. Limiting the number of coding errors and quickly addressing those that occur are critical to a high-performing, compliant revenue cycle.

Support coders by keeping them informed about all the changes in your ASC that can impact their work. This includes developments concerning payers, procedures, physicians, specialties, and surgical technology. Show physicians how they can help improve the coding process by completing detailed operative reports, staying current on documentation changes, and demonstrating a willingness to speak with coders to resolve questions promptly.

Hire coders with ASC-specific coding experience and provide them with ongoing education and training. This helps ensure that they stay current with the latest coding rule changes and best practices to minimize errors and delays.

Whenever your ASC experiences a denial, review it carefully to determine the cause. If the rejection is associated with a coding error, educate coding staff on how to avoid the mistake from occurring again. Also, conduct routine audits to detect errors missed by payers. If an audit identifies mistakes, provide relevant education to coders.

Set quality- and quantity-based performance goals for your coding staff and motivate them with rewards to improve performance. Additionally, develop a plan to handle coder absences and manage workload with better coder scheduling during busier or growth periods.

Undergo annual, third-party assessments to stay current with the latest best practices and identify areas for improvement. Lastly, consider outsourcing your coding and billing functions to a reputable provider to help increase clean claims percentage, better ensure timely and accurate collections, and reduce denials and payment delays.

Understand Reimbursement Trends

Changes concerning reimbursement can have a significant impact on how an ASC performs collections and negotiates its managed care contracts. Here are six significant ASC reimbursement trends and developments from the past few years that you should be aware of.

1. Alignment of payment update factors

CMS's 2019 final payment rule aligned ASC and hospital outpatient department (HOPD) payment update factors from 2019 through 2023. This means ASC payment rates would be updated using the hospital market basket inflation factor instead of the Consumer Price Index for All Urban Consumers (CPI-U). 

ASCs should see an increase in their CMS reimbursement through 2023 compared to what they would have received had CMS not aligned the payment update factors. Since commercial payers often base their reimbursement rates on a percentage of Medicare, ASC may see an increase in commercial reimbursement. 

2. Coverage of more complex ASC procedures

CMS has been gradually adding spine, cardiovascular, total joint, and other complex procedures to the ASC-payable list. It has also been removing many codes from the inpatient-only list so they can now be performed in the hospital outpatient setting. This is often the first step in such procedures eventually being added to the ASC list. In the 2021 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system final rule, CMS finalized its proposal to eliminate the inpatient-only list over a three-year transitional period, beginning with the removal of approximately 300 primarily musculoskeletal-related services, with the list completely phased out by CY 2024. 

While many private payers have covered more complex procedures in ASCs for years, the decision by CMS to add them to the payable list allows ASCs to perform the surgeries on Medicare beneficiaries and receive reimbursement for the services. Private payers on the fence about whether to provide their own coverage may be swayed by CMS's decision to do so. 

3. Shift toward value-based payments

While fee-for-service remains the dominant payment model for ASCs, there is a gradual shift toward value-based payment models, mostly in the form of bundled payments. Bundled payment arrangements are designed to pay multiple providers for coordinating the total amount of services required for a single, predefined episode of care. Providers can share in the savings if they keep costs below the target price while maintaining quality standards. 

Total joint replacement is a good example that can benefit from this format. Such a bundled payment could cover the surgical fee, ASC fee, implants, anesthesia, physical therapy, and medications.  

4. Increased patient financial responsibility

When patient responsibility for their surgical care was low, ASCs could typically remain profitable if they focused on collecting reimbursement from payers. This has changed in recent years, with patients now responsible for a much larger portion of their healthcare costs. As such, ASCs need to give attention to both payer and patient payments by implementing an effective collection process that ensures on-time payment while considering the emotional or financial challenges that patients may face. 

5. Bypassing ASC reimbursement

Some ASCs are offering patients a self-pay option for their surgical care in which patients are responsible for covering all the costs associated with their procedure(s). In this model, ASCs do not bill or collect reimbursement from payers. Such an approach is particularly beneficial if ASCs are interested in attracting medical tourism (i.e., performing procedures on patients outside of their market/coverage area). 

While some ASCs rely exclusively on the self-pay model, others are embracing a blend of self-pay and covered procedures to grow volume and cater to patients who may want to avoid using their insurance for coverage of their surgical care. 

Recognize the Importance of Clean Claims

A clean claim rarely gets rejected or denied. Assuming a payer abides by its contract, a clean claim does not need to be filed more than once because of errors. It goes out your door, requires no additional work, and is paid. Almost all ASC key performance indicators (KPIs) are impacted by how fast the center can get claims out the door and how frequently claims are denied or rejected. 

Clean claims also help ASCs increase staff productivity because you may be able to reassign staff to other tasks or even reduce staff when your denial and rejection late is low. You will save on the expenses associated with re-working claims and submitting. Having a high clean claim rate can help you hit all your ASC's financial objectives and be in a better position to stay on budget. 

Here is how you can improve your ASC's ability to submit clean claims: 

First, everyone involved with getting a clean claim out the door in a timely manner — from physicians to coders and billers — must understand the pivotal roles they play and how shortcomings can have significant short- and long-term effects on an ASC's financial viability. Then, set goals to target a 100% clean claim rate to encourage everyone to scrutinize denials, rejections, and delays, then implement fixes to reduce the likelihood of them occurring again. 

Detail all the steps that employees must take to better ensure the complete, accurate completion of claims. Help your staff follow these processes by providing cheat sheets and other resources. New staff members should be able to understand the steps and their responsibilities quickly and easily. Furthermore, address what employees should do if they have a question or concern about a claim. They should feel confident that every claim going out the door is as complete and clean as possible. 

Be prepared to review and update your workflows to increase staff efficiency. Hold staff accountable for following your processes and achieving objectives. Also, help your employees succeed by providing ongoing support. For example, send team members to state or national meetings; allocate funding for certifications, online courses, and webinars; and purchase books, manuals, and cheat sheets. 

Use the right technologies and maximize your investment in them by learning the ins and outs of your solutions. Take the time to discover new features or older functions you have not been using that can make claims processing more effective and efficient. Ask your ASC software and technology vendors for guidance. You may be surprised to learn what handy tools are at — or will soon be at — your fingertips. 

Regularly assess your performance and processes to discover areas for improvement. If your clean claim rate starts to decline, do not wait to respond. Dive into your data right away and identify the cause(s) so you can implement fixes as soon as possible. 

Finally, getting out clean claims is all about teamwork. ASCs with the highest clean claim rate tend to have staff who work well together and communicate effectively. When employees not only work hard but also support one another, an ASC's performance improves. But when communication is poor and departments operate as silos, with staff members only concerned about their own work, this will drag down revenue cycle performance and KPIs. 

Achieve Managed Care Contracting Success

Strong managed care contracting improves the financial health of an ASC. Proper preparation is key to achieving success in this area. Gather internal and external data to help you understand your ASC's direct and indirect costs, your competitive advantage among other ASCs, your market's payers and their plan types, state fees, Medicare rates, CMS fee schedules, and other information applicable to managed care contracting. Review all the information and research the payers you are looking to target. 

Then, organize your research to support negotiations with payers. If you understand their market, reimbursement methodology, and types of contracts and understand what you need to remain financially viable and profitable before you begin the negotiations, you have a better chance at getting the terms you want. 

Establish your timelines and set reasonable goals to help you stay on track and meet contracting deadlines. When you enter a negotiation with a payer, be confident. During the research and organization step, you should have calculated bottom-line numbers that you are willing to agree to in the managed care contract. Always be reasonable — payers will be more likely to work with you if you negotiate in good faith and do not make outrageous requests. 

Work to a build relationship with someone in the payer's team and foster a mutually beneficial relationship. Keep the payer's business model front and center during the negotiation so they are more likely to treat you as a partner, not a competitor. Also, be willing to "give some to take some" during negotiations to build an ongoing relationship that will benefit your ASC in the long term. 

Once you have the contract signed, the work is not over. Set expectations from the start to check in frequently with the payer to measure progress and discuss misinterpretations either party may have run into post-agreement. Include payer contracting as part of your routine and revisit those contracts periodically to ensure that they reflect the latest changes in your facility and regulations. 

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Chapter Five

ASC Accreditation and Compliance Issues

Earning ASC accreditation can serve multiple purposes. By working to meet accreditation standards, ASCs are more likely to keep patients and staff safe. Accreditation demonstrates that an ASC is committed to delivering high-quality care and sends a powerful, positive message to prospective patients, physicians, and staff.  

Maintaining Compliance

Although there is no federal requirement for ASC accreditation, you'd need it in certain states. Some private insurers also require an ASC to receive accreditation before entering into managed care contracts. It takes tremendous work for an ASC to earn and maintain accreditation, and missteps can easily jeopardize your status. Follow these steps to better ensure that your ASC is successful during its next survey to maintain accreditation.

1. Keep accreditation in the spotlight Keep accreditation top of mind among employees by making sure processes and staff efforts are always focused on meeting, if not exceeding, standards. Discuss accreditation requirements frequently — formally at staff meetings and informally during other conversations. Send out periodic emails to highlight specific standards and how your ASC is meeting them. Also, share stories from industry publications and discuss best practices.
2. Conduct mock surveys Conduct mock accreditation surveys periodically to identify and shore up potential shortcomings with compliance. During these mock surveys, a member of your team or an outside consultant knowledgeable in your accreditation standards would simulate the survey experience. Mock surveyors should observe staff practices, speak with team members about their job rules and responsibilities, and review documentation. Following completion of the mock survey, share the results with your staff and address shortcomings and concerns.
3. Invest in resources to support compliance efforts Empower employees to follow standards by investing in various resources. The use of technologies, such as ASC-focused clinical documentation and analytics software, can help improve many areas of operations (e.g., documentation, benchmarking, reporting, communications, medication reconciliation, and quality improvement studies). Consider sending staff to local and/or national ASC meetings to learn the latest recommended practices and network with other ASC representatives. Encourage and support your employees to attend educational webinars and subscribe to industry publications that cover current accreditation news and guidance.
4. Adopting electronic health records (EHR) The right ASC-specific electronic health record can help ambulatory surgery centers effectively and consistently complete their charting and documentation requirements. When accreditation, state, and CMS surveyors visit, you can quickly and easily produce documented proof of patients receiving consistent, high-quality care according to standards and regulations. Choose an EHR vendor that keeps its software current with the latest regulatory and accreditation standards to help ensure that you remain compliant with rule changes.

5. Perform regulatory compliance checks

Compliance checks are required or at least strongly recommended by numerous regulators, including CMS, state health departments, accrediting organizations, OSHA, CDC, local authorities (fire, food safety, etc.), NFPA, and CLIA. Here is a checklist to help you get started:

Delegate compliance check tasks to your managers and staff members, then establish processes to hold them accountable. You can also outsource some of these checks to outside vendors to ensure compliance without adding burdens to your staff's workload.

Achieving QAPI Objectives

While the purposes of quality assurance and performance improvement (QAPI) for ASCs are clear, achieving QAPI objectives can be challenging. Failure to properly conduct QAPI studies can put an ASC into regulatory hot water with CMS and jeopardize accreditation status. Furthermore, a poorly performing QAPI program can cause you to miss critical improvement opportunities. Here are some areas to focus on that will help you maximize the benefits of QAPI while meeting regulatory requirements. 

Collect and analyze data Data is pivotal to identifying worthwhile QAPI topics. Capture performance data to generate insights into areas of strength and weakness, which represent strong opportunities for studies. The good news for most ASCs, particularly those using ASC software and technology, is that they are already collecting a tremendous amount of data on their performance. The information may come from monthly monitoring of your financials, patient and staff satisfaction surveys, as well as incident and employee accident reports. Rather than reinventing the wheel, you can often find great study topics by examining your data.
Seek impactful improvements ASCs typically only perform a few studies annually. Each of them should have the potential to introduce worthwhile improvements in areas such as patient experience or staff satisfaction. When narrowing down potential areas of focus for a study, solicit feedback from staff and engage all stakeholders in the decision-making process. This will help achieve buy-in for the study and the changes you subsequently make based on the insights.
Plan and execute your studies Perform your QAPI studies carefully to ensure that they receive the attention and effort required for proper completion. Develop a calendar for each QAPI study — plan when the QAPI committee will meet as well as when you will choose a topic, begin the study, review its results, and complete the study — then do your best to follow the schedule.
Review quality program performance regularly Your quality program should receive ongoing evaluations to ensure that you are monitoring the right areas and studying the right issues. You should know what studies are currently in progress and what you have on deck as well as how many studies you plan to complete each year. Also, identify new topics from different sources, such as surveys (with patients, staff, and surgeons,) data analysis, employee suggestions, and online reviews.
Learn from other ASCs, but don't just copy Learn from quality studies undertaken by other ASCs to identify potential areas of focus for your center. However, do not choose a QAPI study area based solely on the work of other ASCs as their topics may not represent areas in need of such attention within your facility. Step back, look at your data, and identify issues that make a highly relevant QAPI topic for your ASC. Furthermore, align your studies with the talent level and capabilities of your staff.
Avoid common mistakes Here are 6 common reasons that cause QAPI studies to go awry: Choosing a topic with no upside that does not lead to improvements. Selecting an outdated topic that is no longer relevant. Confusing "monitoring" with "performing a study." Monitoring is an ongoing activity, while a study has a beginning, middle, and end. Failing to include a conclusion on how improvements can and will be made. Not completing a worthwhile study or only pursuing easy topics, leading to missed opportunities to make significant and positive changes. Copying another ASC's study topics that may not apply to your operations nor yield meaningful insights.

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Chapter Six

How ASC Managers Are Using Novel Technology To Improve Performance

Incorporating new software and technologies can help improve your ASC's cost-efficiency, productivity, and patient satisfaction. However, it is not always easy to navigate the fast-evolving IT landscape. Here are four key points to help you maximize ambulatory surgical center software and technology investments.

Recognize the Hallmarks of Effective ASC Software

Look for these 8 benefits associated with best-in-class ASC technology platforms:

1. Comprehensive functionalities: Choose a solution that integrates all the features you need into a single database and caters to all ASC stakeholders. It should be provided by a single vendor to eliminate a fragmented user experience while delivering maximum value at a lower total cost.
2. Mobile access: Your software should provide secure mobile access to users so you can easily coordinate physicians and partners that do not station at your center. This can improve productivity, increase accuracy, facilitate communication, and eliminate bottlenecks.
3. Patient engagement: Use ASC software that helps strengthen patient engagement. It should allow you to collect patient information, automate appointment reminders, ensure pre-surgical compliance, and effectively communicate with patients before and after surgery.
4. Cloud-based: Cloud-based ASC technology alleviates some of the stress and responsibility for ensuring technology security and disaster response. The subscription service model, which typically accompanies a cloud-based solution, helps reduce infrastructure costs and IT support significantly.
5. Intuitive interface: Choose ASC software with a user-friendly interface designed with insights and guidance from ASC experts, human factors experts, and end users. Your staff should be able to easily find and process information, such as grouping information in trackers and using color judiciously to highlight key information.
6. Configurability: Your ASC platform should be easily configured and updated to support and improve your center's clinical, patient, operational, and financial workflows. Furthermore, it should deliver a personalized experience to maximize staff productivity and satisfaction.
7. Robust data processing: Select ASC software that simplifies data analysis and reporting through graphic-focused, easy-to-consume dashboards that are frequently refreshed. It should allow managers to quickly drill down into specific areas and correlate various factors to derive accurate insights.
8. Streamlined implementation and training: A good platform should have a short implementation timeline (e.g., the ASC software should be up and running at full capacity in 12 weeks or fewer) while end-user training should take hours, not days or weeks.

Understand Ambulatory Software vs. Hospital/Practice-Focused Software

You may notice there are many choices when it comes to electronic health record (EHR) systems. But many of these options are not designed for ASCs. Rather, they are hospital- or practice-focused systems that have been modified for use in ASCs.

Attempting to implement such software in an ASC can lead to significant problems. Below are some of the most common issues that can arise.

Shortcomings of hospital-focused ambulatory software

Hospital systems and their EHRs are designed to support an extensive variety of complex surgical procedures, resource needs, and billing/coding rules in an inpatient setting. Meanwhile, ASCs typically specialize in high volumes of specific types of procedures performed exclusively in an outpatient arrangement. Hospital-focused EHR platforms may be too complex for ASCs — their functionalities may overwhelm your staff and you'd likely be paying for many features that you do not need.

Your staff may even need to find manual, time-consuming, and error-prone workarounds to meet the specific scheduling, resource, supply, and billing requirements of a busy ASC. Ultimately, a hospital system may slow down employees and negatively impact an ASC's efficiency.

Moreover, CMS regulations, state-specific audit reporting, and benchmarking and accreditation typically require different data from ASCs than hospitals. If you implement a hospital-focused system, you may have to incur extra cost to reconfigure the software so you can capture and share the detailed data needed to comply with various ASC reporting requirements.

On the other hand, the right ASC software is built for ambulatory surgery center workflows and contains all the functionalities that an ASC needs to run efficiently "out of the box," so you do not have to spend money on modifications. Since there is a significantly reduced need for configuration and training, it is much more affordable and provides a much faster return on investment.

Shortcomings of practice-focused ambulatory software

ASCs must record a lot more information than medical practices when scheduling surgeries. An ASC software needs to capture procedure name, anesthesia type, authorizations, CPT and ICD-10 codes, allergies, preoperative testing, supply/equipment requests, and preoperative medication orders, and more. Expanding practice software scheduling capabilities to account for the additional information that must be captured and integrated into ASC workflows requires cumbersome workarounds. These can reduce staff efficiency and increase the likelihood of data entry errors.

Also, practice software does not accommodate the management and clinical documentation required by ASCs, such as patient assessment, operative notes, preoperative questionnaire, anesthesia, medications, surgical time-out, supplies, risk assessment, and others. Manually adding these documents and tasks is likely to be an expensive and laborious process. Furthermore, such an undertaking can prove risky if documentation is omitted, contributing to safety and compliance issues.

Finally, the patient experience at a medical practice is very different from that at an ASC. While a visit to a doctor's office is often rather simple and uneventful, a surgical process is much more complex. The potential risk often increases patients' anxiety levels, yet practice software does not offer features designed to alleviate the stress.

Well-designed ASC software can send preoperative questionnaires and surgical instructions via email or text message for ease of completion. Tracking boards help move patients efficiently through the surgical process and reduce wait times at each stage. Waiting room boards show family and friends a patient's progress. Electronic insurance verification and patient responsibility estimation inform patients of their upfront costs to help reduce anxiety about unexpected medical bills. These and other features can improve a patient's experience and overall satisfaction with an ASC.

Value of ASC-focused software

To summarize, here are some of the most significant benefits of using software designed specifically for ambulatory surgery centers:

• Maximum efficiency. A single solution built for ASC workflows will be more intuitive, include the components a surgery center needs, and remove the burdensome and unnecessary work required to retrofit non-ASC-specific software.
• High configurability. By investing in the latest in ASC software, surgery centers will receive a solution that's easily configurable to meet their specific documentation, scheduling, billing, and other needs. In addition, there will be no functionalities that must be worked around/bypassed or added on for the solution to work as needed. For ASCs in joint-venture partnerships with a hospital or health system, today's ASC software has the ability to easily share the surgical information requested by the hospital/health system partner.
• Ease of accessibility. As COVID-19 further highlighted, there is tremendous value when ASC physicians and staff can access their surgery center's software from any location. Cloud-based, ASC-specific software with such capability can help with everything from remotely scheduling surgeries, communicating with patients, and managing the revenue cycle to providing surgeons with the mobile access that allows them to view their surgical schedules, review and sign documentation, and assess patient records, all without needing to physically come to the center. Other benefits of today’s cloud-based ASC software: enhanced security and disaster recovery, reduced infrastructure costs and IT support, and ongoing software updates that occur automatically.
• Fast implementation and staff training. Cloud-based ASC software is designed to get up and running fast compared to hospital software implementations that can take many months or even years. In addition, for ASC-specific software, end-user training typically only takes a few hours rather than days or weeks. The result: ASCs that add surgery center-specific software can take advantage of its many benefits quickly, contributing to reduced costs, enhanced productivity, improved profitability, and other significant benefits.
• Improved regulatory reporting. ASC-specific software is designed with ASC regulatory requirements in mind, helping surgery centers generate the data and reports they need to maintain regulatory compliance and meet accreditation standards.In addition, some solutions take into consideration the data that a hospital or health system partner might need from the ASC to meet requirements. As noted earlier, such software can make it easy to document and share this data with the hospital or health system partner, saving time and effort while ensuring reporting requirements are always met.

How To Evaluate and Select Ambulatory Software

Thanks to software-as-a-Service (SaaS)-based options that do not require a substantial upfront investment, it is easier than ever to get started with an ambulatory surgery center platform. But with the many ASC software types available, it is critical that you perform due diligence to make an educated decision.

Here are five tips to help you ensure the ASC software you implement meets your ambulatory surgical center's short- and long-term requirements.

1. Choose ASC-specific software As previously discussed, ASC software is designed to meet requirements specific to surgery centers, such as surgical supplies and implant management. If you purchase a solution that is not designed for ASCs, you could be paying for features and functionality that you do not need. Your staff may also need to put in extra effort to come up with workarounds. Additionally, software designed for other care settings may not be able to support unique ASC workflows, such as block scheduling and documentation of short cases.
2. Seek vendors that specialize in ASCs Look for vendors with a history of serving ASCs to ensure that the solution includes the specific features and functionalities that ASCs require. Such a history is also a good indication that the provider knows how to keep the software current to meet ever-changing ASC requirements. Also, a company that is actively engaged in the industry is more likely to be abreast of the latest trends and developments, which is essential for keeping the software current.
3. Consider the software's market penetration Software vendors with a significant number of ASC customers will have more experience and understanding of workflows and specialty requirements. ASC software vendors should be willing to share information about their number of ASC customers and case studies. A large client base means the vendor is more likely to invest in keeping current with the latest requirements, which will help you stay compliant.
4. Request a software demonstration Website content, online videos, and marketing collateral can tell an impressive story about a solution. But you will not know what it is like to interact with an application until you see a demo, which should show you the features most relevant to your ASC. Attend the demo knowing what you want to see, what you are hoping to learn, and what questions you want to be answered. A good demo should eliminate almost all doubt about whether a solution is a good fit for your ASC.
5. Speak with references Speaking to other customers who have been using the ASC software helps you understand what it is like to use the software over an extended period and work with the vendor. Ask the provider for a few references, preferably ASCs with similar specialties and case volume as yours. Take the time to talk to these references and prepare a list of questions to help you focus your discussion.

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Conclusion

Software and technology can help ambulatory surgery centers improve physician and staff engagement while performing at the highest level. It can help you enhance patient safety, increase cost-efficiency, boost profitability, improve patient experience, and ensure employee satisfaction. 

The right ASC software solution allows you to leverage data to drive more accurate decision-making and improve the revenue cycle to achieve better cash flow. It can help you enhance billing performance, facilitate the patient collection process, improve coding accuracy, increase clean claims, and stay compliant with the latest regulations. 

For ASCs looking to enhance their performance and streamline their operations with technology, there is great news: There is a growing number of solutions designed specifically for ASCs with new, cutting-edge features. It is worthwhile to explore options that will enable your ASC to migrate from paper to electronic documentation and reap the benefits of data analytics.  

Learn more about our all-in-one ASC solution that includes an award-winning ASC clinical documentation function, a mobile EHR, patient tracker boards, patient engagement features, and more. Get in touch to schedule a demo and see how we can help you optimize your ASC operations. 

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