Advances in medical technology, pain management, and anesthesia now make it possible for surgeons to perform outpatient operations that were once considered too risky to do anywhere else but in a hospital OR. Last year, for example, the Centers for Medicare & Medicaid Services (CMS) finalized the removal of total knee arthroplasty from its inpatient-only list, indicating that some ASCs will experience higher patient volume, require additional surgical supplies, and take on more inventory management responsibilities than usual. To succeed, some ASCs may need to modify current processes and practices.
“More complex procedures are moving to the ASC requiring more supplies and technology to support those services, including instruments, sterile processing support, etc.,” said Bilinda Garlock, RN, BSN — Manager of Clinical Operations at Cardinal Health, Ambulatory Surgery Centers. “There’s more competition, more ASCs being opened that are connected to hospitals to reduce the strain on hospitals.”
New research suggests a 4 percent decrease for inpatient surgery with outpatient procedures expected to increase by 11 percent now through 2022.1 The 2016 21st Century Cures Act, which gives Medicare beneficiaries a public database to compare the costs of surgical procedures at outpatient and ambulatory surgical centers, also adds to the competitive dynamic. Plus, as more complex surgical cases continue to shift from hospitals to ASCs, these smaller facilities will also need to comply with new and changing regulatory requirements, reimbursement rules, and patient satisfaction expectations.
Gearing up for future growth
For ASCs to thrive in a changing healthcare climate there are many significant factors to consider. ASCs and surgical hospitals need dedicated supply chain management practices to guide and sustain good clinical outcomes, optimal workflows, and keep a positive reputation amongst a rapidly increasing patient population. Is your ASC poised to embrace what’s coming? Consider a few questions:
- Are the medical supplies in your ASC used only where and when they are required?
- Is the charge-capture process accurate on every case, or are there too many missed billing opportunities?
- Are preference cards current and custom packs filled exactly right?
- Do you have appropriate technology in place to collect and analyze the data needed to make strategic decisions, standardize items and maximize purchasing?
- Are patient satisfaction scores where you want them to be?
If you can answer these questions affirmatively and accurately, that’s great news. But for many ASCs — maybe even yours — the answers to some of those and other questions are either unknown or nebulous at best. What the majority of ASCs do know is that they could probably do better if they knew how, and could find the time needed to focus on making improvements. If you can’t measure what you don’t know, you can’t determine the necessary steps to achieving better outcomes. Which means realizing progress first requires a careful and meticulous examination of your ASC’s clinical operations to identify hidden opportunities.
Identifying your needs
A comprehensive, no-cost2 to you clinical assessment of your ASC from Cardinal Health can give you the answers — and the solutions — you need to identify problem areas, implement effective solutions, and accomplish your goals. Supply chain and clinical experts from Cardinal Health know how to help increase quality and advance the bottom line with inventory management processes designed to work in your ASC’s favor, not against it. The clinical assessment process helps ASCs find ways to support safety standards, increase compliance, optimize procedure packs and eliminate surgical waste. You will learn how to maximize your existing space and capitalize on current or new technology. A clinical assessment with Cardinal Health can also point out and address inefficiencies that you may not have been aware of before. You might discover ways to reverse poor turnover time, enhance physician satisfaction and more — all while keeping costs down and patient satisfaction scores up.
“We can bring our vast knowledge from being in many ASCs across the country to offer solutions to issues identified; inventory management, case pick, custom pack solutions, and standardization opportunities,” said Marvella Thomas, RN, MSN — Sr. Consultant of Clinical Operations at Cardinal Health, Ambulatory Surgery Centers.
ASCs are different
While ASCs and hospital ORs do share some common ground, there are distinct operational and purchasing differences between them. A clinical assessment by the supply chain and clinical experts at Cardinal Health help those working in the ASC arena determine those dissimilarities and better understand why processes that work well for one facility could actually be a disadvantage to the other. “These are two entirely different environments,” said Garlock. In fact, under certain circumstances, Garlock says ASCs are in a somewhat better position to implement lasting improvements faster and with less difficulty than a hospital would. “ASCs are more streamlined and less complex,” she said. “They can change practice and process quicker with less layers of complexity to get through and can be quicker to make decisions.”
Strategies that work well in the hospital environment don’t always produce the best results when practiced in the ASC. For instance, outpatient settings rely on fewer staff to manage varying responsibilities. To achieve efficiency and savings requires that ASCs take a different approach. “Hospitals have more defined roles, where ASC staff wears many hats,” said Garlock. “ASC staff must accomplish more with less. This can narrow the amount of time ASC staff would ordinarily take to focus on supply chain management activities. As a result, it’s not uncommon for ASCs to rely on manual processes (e.g., using pen and paper or visual eyeballing) to order supplies instead of ordering based on actual usage. Hospitals, on the other hand, have dedicated IT teams that can access and utilize data and technology to manage their inventory.”
Leveraging your uniqueness
The clinical assessment process is designed to help ASCs recognize their strengths and use them to their advantage. But even ASCs are unique and can differ widely. “Every ASC is different and identifying issues in one center doesn’t mean all centers are having the same issue,” said Thomas.
One example is Madison Outpatient Surgery Center, a Mississippi provider that realized it was generating lots of waste and relying on too many off-the-shelf items during procedures. Yet, they had trouble pinpointing just how much waste they were creating and why. Cardinal Health performed a clinical assessment and found that the ASC was using procedure packs modeled after the ones used by a sister ASC, despite the differences in procedures each one performed. After making changes recommended by Cardinal Health the facility was able to save several thousands of dollars a year by reducing per-case supply costs, standardizing products, improving room turnover time and other changes.3
ASCs that undergo a clinical assessment also learn to maximize existing space — an ongoing challenge for most facilities — with a variety of creative solutions including ideas that may seem simple at first but only thought of during evaluation. “For example, hanging instruments on the wall using something as simple as a peg board instead of storing them in drawers results in better space utilization and decreases the potential for breaks in sterility,” Garlock said. “We also find some ASCs with limited time could benefit from adopting a different process for following regulatory requirements. We might remind them of certain processes they need to take during a clinical assessment and suggest solutions that will ensure they stay consistently on track.”
More specialized surgeries taking place in the ASC — right now and in the future — also means there will be a need for more medical equipment and supplies. A clinical assessment can help determine where to focus your cost-cutting strategies. For example, “What resources can an ASC lease, consign or borrow to lessen financial burden of a new specialty?” said Garlock. “There are enhanced IT offerings available for the ASC space; many vendors are offering barcode technology to order supplies, etc.,” added Thomas. “Tap into IT vendor resources, especially if you have new staff, or materials managers, who have never been trained on how to use technology to manage inventory.”
As you can see, numerous opportunities for improvement exist — it’s just a matter of discovering what they are. If you want your ASC to do better, a clinical assessment from Cardinal Health can show you how. For more information, or to request a clinical assessment for your facility, visit cardinalhealth.com/surgerycenter or email Cardinal Health directly at ASC@cardinalhealth.com.
- Sg2 Impact of Change (IoC) 2017
- If customer receives any “discounts or other reductions in price” under Section 1128B(b)(3)(a) of the Social Security Act (42 U.S.C.1320- 7b(b)(3)(a)) from Cardinal Health, Customer may be required to disclose the discounts or reductions in price under any state or federal program which provides cost or charge-based reimbursement to Customer for the products or services Customer buys from Cardinal Health, or as otherwise requested or required by any governmental agency.”
- Cardinal Health case study, “Ahead of the Pack: How Madison Outpatient Surgery Center optimizes its procedure pack program,” 2016. Customer release on file.