GRAND PRIZE

Best Vendor Negotiating Tip
The key to getting the best price for contracted services such as equipment maintenance and service, housekeeping, telephone and internet providers, or for other substantial and continual expenses, is routine competition, says Stephanie Martin, BSN, RN, CNOR, administrator of the St. Augustine Surgery Center in St. Augustine, Fla. "Bid, bid, bid!" she says. "Unless they provide absolutely superb service and a great price, we [put the services] out to bid every year." And once providers know they'll be competitively bidding to keep your business every year, they'll respond accordingly and even offer advice, she says. While a regular review of contracts can be useful in determining the worth of a service or your utilization, it can be a huge effort to undertake all at once, so Ms. Martin advises staggering the reviews at intervals throughout the year.

BEST BID An annual review of contracts can keep vendors' prices competitive, says Ms. Martin.

How can you secure reimbursement for pricey surgical implants? "Never give up!" says Ms. Martin, who once hounded a payor for 6 months until she got paid. "We contact payors often by phone and in writing. And no matter how crazy the request for documentation, we send it." Ms. Martin warns that insurance companies are looking for new and interesting ways to not reimburse for implants, or at least slow down payments enough to frustrate facilities into submission. She suggests you contact payors weekly and provide letters of necessity from physicians, typed invoices from vendors and implant purchase orders. "Pursue claims until you're reimbursed," says Ms. Martin. "You provided the service, and patients received the implants, so payors need to pay."

Best Employee Morale Booster
If you ask them, you'll find that your clinical and business staff can be a rich source of ideas for cost savings, and they'll likely appreciate the opportunity to participate in your facility's fiscal decision-making. But letting them share in the savings is even more motivational. In 2011, the Golf Surgical Center in Des Plaines, Ill., pooled 50% of the money saved thanks to homegrown ideas into a fund to be shared among the center's employees. The $132,000 collected meant a 6% bonus check for each of the 43 employees, says financial director Mark Del Rosario. Following that success, this year the center's employee advisory team implemented a profit-sharing program that sets aside 10% of net income in an incentive fund, encouraging collaborative thinking on how to keep operating costs low.

Best Tip for Reducing Case Costs
When using a camera for a scope procedure, you need a light cord at the same time. Likewise, you always use arthroscopes and shavers together. These device pairs are reprocessed the same way, through low-temperature sterilization. But when a tech at Skyway Surgery Center in Chico, Calif., recommended wrapping and reprocessing cameras and light cords, and arthroscopes and shavers, together as a cost-saving idea, OR manager Andrea Thompson, RN, wasn't sure it'd make much of a dent in the budget. She was pleasantly surprised. While using 2 sheets of blue wrap instead of 4 and less indicator tape made only a few cents' worth of difference, the disposable cartridges that deliver the hydrogen peroxide sterilant agent are expensive — costing about $12 per load — and getting more use out of them has added up. "We did the numbers, and we saved $4,300 per year," says Ms. Thompson, "and it's so easy."

Best Tip for Reducing Staffing Costs
In Santa Barbara, Calif., perioperative nurses cost about $45 an hour, and surgical techs about $20 an hour. If the Summit Surgery Center's caseload is light for a day due to surgeons' vacations or late cancellations, it doesn't make fiscal sense for the full staff to stand idle while OR time goes unused. So manager Sylvia Sherry, RN, MSN, CNOR, who e-mails schedule assignments to her staff at the end of each day, asks if any employees want to volunteer for a "low-census day" if a day's schedule is looking light. "This works great, as many staff like being asked if they want a day off rather than being forced to," she says.

Best Tip for Staff Bonuses
Make sure employees are aware of bonus criteria, make the bonus program easy to understand and constantly update your staff on where they stand with respect to meeting the goals that pay, says Angela Laux, BSN, MSOLQ. "We identify 3 goals with specific metrics attached to dollar amounts," explains the administrator of the Bellin Orthopedic Surgery Center in Green Bay, Wis. "Each goal includes 0%, 50% and 100% payouts." For example, her staff earns 100% of a bonus tied to staffing costs as a percentage of total revenue for landing in the 25th percentile or better of national benchmarks, 50% of the bonus for matching the median percentile and no bonus if results exceed median scores. Dole out bonuses on a quarterly basis to keep goals fresh in employees' minds, says Ms. Laux, and make sure the goals aren't overly aggressive or too easily reached. "They should be obtainable, but your staff should have to think critically and look for ways to make improvements to accomplish them."

Best Tip for Negotiating
Managed Care Contracts
Get to know insurance reps and negotiate win-wins for both your center and their carriers, suggests Susan Cheek, CPA, the chief financial officer of the Dallas Endoscopy Center in Texas. "Developing personal relationships with the people you do business with is a huge plus," she says. "That builds trust and credibility." Get involved in your industry, says Ms. Cheek, by attending local and national gatherings of ambulatory association leaders. "A lot of insurance reps go to those meetings, so you'll be able to build relationships with them there, away from the office," she says. In fact, she recently finalized a deal when a busy rep who she'd been unable to get on the phone approached her at a state ASC meeting.

"Be patient in building relationships with reps and be respectful of what they're dealing with," says Ms Cheek. "Don't forget, a lot of them work in big corporate environments with a lot of red tape. It might take a couple weeks for them to respond during negotiations." And always, always sell what your center offers. "Show that you provide cost-effective, high-quality care. Reps appreciate that and will go to bat for you."

Best Tip for Patient Financing
Give self-paying patients a 40% discount off your fee schedule, says Vangie Dennis, RN, BSN, CNOR, CMLSO, administrative director of the Spivey Station Surgery Center in Jonesboro, Ga. "That will help you capture payments from patients without insurance, while also giving patients with extremely high deductibles the option to pay cash," she says. The deductibles for some of Spivey's colonoscopy patients are higher than what they'd pay out of pocket. Offer patients the option of working with a third-party healthcare financing firm. Ms. Dennis also suggests you arrange 3-month payment schedules for patients who have trouble covering deductible costs — but carry insurance that gives your center excellent reimbursement rates — so you don't lose profitable cases to the competition.

Best Use of SUD Reprocessing
Cindy Holden, BS, sends trocars, biopsy forceps, burrs, rasps, multi-clip appliers, saw blades and quick-coupling drill bits out to a certified third-party reprocessor of single-use devices. The administrator of the Fleming Island (Fla.) Surgery Center recently compared the price of new biopsy forceps to the cost of reprocessing. By reprocessing just that 1 item, the center saves $4 per forceps and an average of $400 each month. In addition, Ms. Holden discovered she could slash about $14 off the per-item cost of bladeless trocars. She says they haven't experienced any issues with reprocessed items and recommends the practice as long as you work with a company that returns high-quality devices, marks the number of individual reprocessing cycles on each item and provides FDA documentation of SUDs that can be safely reprocessed.

Best Tip for Physician Recruitment
Ask your physician-partners if they know of any surgeons who are interested in brining cases to your center, says Carol Cappella, RN, MSN, CNOR, clinical director of the Delray Beach (Fla.) Surgery Center. Schedule a dinner meeting so you can meet with your surgeon and his prospect to discuss what your facility has to offer and determine if there's mutual interest in bringing the new doc on board. If there is, invite the prospective physician for a tour of your center, with the physician-partner acting as tour guide. During the tour, show off your instrumentation, staff expertise and the latest capital equipment in the ORs. Accompany the surgeons during the visit so you're nearby to answer any questions that arise. Surgeons aren't necessarily interested in state-of-the-art facilities — your center should be clean and clutter-free — it's the know-how of the surgical team that will most likely seal the deal. "Show off your staff's clinical expertise and discuss detailed information about the cases the touring surgeons perform and their special equipment, scheduling and staffing needs," says Ms. Cappella. "Also make sure they meet the anesthesia providers so they can answer questions or concerns the docs might have."

Best Tip for Case Scheduling
Surgeons' schedulers need to know they're important parts of your ultimate success, says Laura Smith, RN, LHRM, administrator of the Tampa Bay Specialty Surgery Center in Pinellas Park, Fla. Host them for catered lunches twice a year so you can get to know them on a personal level and discuss scheduling issues that need to be resolved. "I get a lot of feedback at those lunches because all the schedulers are together and feel more comfortable speaking as a group than they would individually," says Ms. Smith. Send gift baskets containing hand lotions, notepads, pens with your facility's logo, hand sanitizers, chocolate, cookies, key chains — any small trinket that shows you care — to schedulers who work hard to help you out.