How to Succeed in Running a High-Volume GI Center

Strategic case scheduling, strict reprocessing practices and savvy business staff who know how to get reimbursed quickly are all staples of top-performing ASCs in gastroenterology.

The volume potential in a GI center creates unique challenges and opportunities, whether you are just starting out or have been offering GI cases for years. “There is always room for improvement, but you can’t go it alone,” says long-time ASC Administrator Susan Cheek, CPA, CHCC, CASC.

Case in point: Dallas Endoscopy Center (DEC). This freestanding, physician-owned ASC focused on GI endoscopy and colorectal surgery procedures that opened its doors in 2005 continues to grow. Last year they completed over 16,000 GI cases and this June they moved to a larger space to accommodate continued growth.

Having joined DEC right after it opened, Ms. Cheek has helped work through the center’s growing pains with three key components: a well-coordinated team; tools to organize scheduling and billing; and a careful eye on metrics to look for ways to do things better. Here are her proven steps toward success for a growing GI center:

Step #1: Take charge of your schedule.
Running a high-volume GI center requires an equally high level of coordination orchestrated at multiple levels to keep cases flowing. “Staffing, equipment reprocessing, supply management and overall patient throughput must work in concert, or you will quickly develop bottlenecks that create a domino effect of inefficiency and dissatisfaction,” Ms. Cheek explains. Here are scheduling tips she suggests can help.

• Use automated scheduling software. Thanks to an integrated scheduling software system they developed in-house in 2007, DEC can sync patient health information, insurance details and plan the needs for its procedures automatically the moment a physician’s office schedules a case. The system also automatically notifies the patient of their financial responsibility within two weeks of their procedure, which helps reduce cancellations owing to financial surprises, Ms. Cheek explains. She says, “The more quickly you can know a patient is going to be scheduled at your ASC, the more quickly you can schedule your nurses, techs and anesthesia providers and know if you need to bring on PRN staff or not, which is a win for cost control and staff satisfaction.” Another added benefit with this automated scheduling interface is ease of use for the physician’s staff to schedule with DEC, which serves as a marketing tool to attract cases because “the easier it is to schedule with us, the more the physician offices will do so.”

• Compress your schedule. Having a clear outlook for upcoming cases allows DEC to tighten the surgical schedule if needed to close a room or shorten a day and capture the associated savings. In addition to their scheduling software supporting these schedule changes, another key tool is a very firm block utilization tracking policy that requires surgeons to be diligent with filing block times and releasing block times if needed. “You need to work at your fullest capacity at all times,” stresses Ms. Cheek. “When I talk to other ASC administrators struggling with inefficiency, it’s often tied to unfilled blocks or two or three rooms open at a time. This must be prevented to protect your bottom line.”

In addition to compressing the number of cases to prevent empty rooms, Ms. Cheek suggests being smart about which cases are scheduled and when to ensure instrument availability and efficient patient throughput. For example, a smaller center that is growing can alternate upper and lower GI procedures to ensure the sterile processing team can have scopes ready for upcoming cases. She also suggests staggering first-case start times to help the front office and pre-op staff with getting patients checked in and ready for their procedure.

Step #2: Build and maintain a top-notch team. Having a friendly, professional staff helps create a reputation for safety and satisfaction, which will help secure consistent volume, says Ms. Cheek. For DEC, longevity is a trend among her staff that helps her facility run like a well-oiled machine. Even with the staff shortages plaguing health care, she’s managed to hold on to experienced talent through the pandemic. Even retiring staff have chosen to stay connected and work PRN. Here are some key roles that Ms. Cheek confirms are essential in a high-volume center:

• A savvy business manager. For Angela Hunter, CPC, MA, director of revenue cycle management and office manager at DEC, it’s important to have good front-end “scrubber” technology (which is part of their automated scheduling software) to ensure that information is entered correctly and also that patients are notified in a timely manner of financial responsibility. This increases collections and helps to avoid any claims errors. Their claims are then reviewed carefully before submittal to make any payer-specific edits that will ensure a claim is processed and paid the first time. Ms. Hunter also monitors reimbursements for any trends that need to be addressed to avoid future delays, although she notes this hasn’t been an issue with such scrutiny before their claims are submitted.

Having a strong business manager like Ms. Hunter who is also a certified coder is extremely valuable, according to Ms. Cheek. GI centers looking to ramp up their volume need to have their eye on business team candidates with high levels of expertise. Depending on where you are located, if certified coders are not available in your hiring pool, she suggests offering coding certification training to grow this expertise and ensure clean claims.

“Whether you do 300 or 1,000 cases per month, you will have the same coding risks to catch,” acknowledges Ms. Cheek. She suggests two additional areas that could risk improper reimbursement: over-coding and under-coding. “You will need your best coders to catch anything a doctor may have missed, and you also need to watch for over-coding, which can trigger a claim review for your practice.” If you do get a claim rejection, Ms. Cheek suggests using this as a learning opportunity to immediately review and make any necessary changes to prevent a chain of rejections that could mean delayed revenue. Another reimbursement consideration is to analyze your patient insurance mix. For example, if you have a majority of older patients and Medicare is taking longer to pay than a private insurer, you need to build this into your financial management plan.

• A quality-focused infection preventionist. Ten years ago, Ms. Cheek created a full-time equivalent position for a manager to oversee quality and infection control, which Tina Grove, RN, quality control manager, filled and still holds. In their work together over the past decade, they have continually refined a tight scope-processing approach that includes very specific parameters to meet before a processed scope can go back in use. “Tina’s work has helped us be much more efficient by immediately identifying any bottlenecks we can address before it causes a delay. We have also streamlined our policy and procedure for reprocessing,” says Ms. Grove.

Because Ms. Grove’s full-time role is focused on quality and infection control, she has the time to oversee annual competency training of techs with an endoscopist specialist that covers the processing of endoscopes manually and using automated endoscope reprocessors. She also collaborates with her lead tech who observes reprocessing practices in real-time through a recorded video feed used for auditing and training.

Staffing, equipment reprocessing, supply management and overall patient throughput must work in concert, or you quickly develop bottlenecks.
Susan Cheek, CPA, CHCC, CASC

• Engaged physicians and staff. Ms. Cheek describes her physicians as solid in terms of buy-in to policies, procedures and practices she and her leadership team implement to make sure high volume can be facilitated safely and efficiently. For example, leaders and physicians meet quarterly to review efficiency metrics such as block utilization.

Beyond physician buy-in, Ms. Cheek stresses the importance of teamwide buy-in to make sure every team member is engaged in the mission of the center. This includes any team member being willing to step in where needed to create a positive experience for every patient. “Remember, a patient coming in for a GI procedure is apprehensive — so treating them as an individual — not a number — throughout the entire process shows you care.”

Step #3: Live by your metrics.

“You might think you are doing great, but you can always do better,” stresses Ms. Cheek. She suggests benchmarking key metrics and following them closely to identify areas for improvement. Here are a few basic metrics she says are critical for a high-volume GI center.

• On-time start of case. On-time starts help efficiency for the entire day, and a knowledgeable manager with a solid scheduling plan can be key to this metric, especially in a GI center with relatively short cases in general. “If cases are trending toward starting later than planned, you need to take a closer look at ways to do things better,” says Ms. Cheek. For example, track the time from when the patient arrives and paperwork is completed, then look at how long the patient is waiting before being taken back, then look at ways to improve efficiency and patient flow on the front end.

• Turnover between cases. Turnover can have a major impact on efficiency that directly influences patient satisfaction and your ability to draw volume in your market, advises Ms. Cheek, noting that a 20-minute versus a 10-minute turnover could make a competitive difference. She suggests looking at turnover from several angles, including factors such as room cleaning, equipment readiness and how long it takes the physician to do the case.

• Overtime prevalence. Overtime is a known source of additional cost than can come with increasing case volume, but overtime is unnecessary if efficient patient throughput practices are in place, says Ms. Cheek. To help prevent days running long, she suggests leaving a surgeon’s first slot open for urgent cases and/or allowing overbooking at time slots that make sense, to allow for an extra case.

• Infection rates. In addition to these key metrics, Ms. Cheek suggests having an eagle eye on your key quality and safety metrics, especially to track infection. This comes back to her close collaboration with her quality and infection control manager. “We have a strong reputation for safety because we have such strict reprocessing practices. This reputation brings in volume because physicians know we provide high quality care and happy patients help us keep our doors open,” she says. OSM