OR Excellence Awards: Financial Management: Making Collections a Priority


Waterbury Surgery Center now receives nearly 100% of patients’ payments before surgeries.

A management change at Waterbury (Conn.) Surgery Center took place in 2021, and it didn’t take long for the new team to identify daily collections as a problem that needed solving.

The rate of daily collections —the money owed by patients for their procedures — was 36% in December 2021 and 43% in January 2022. The next month it jumped to 81% and has only risen since, topping out at 98% in July, the most recent month for which statistics are available. The initiatives that led to those increased collections earned Waterbury the 2023 OR Excellence Award for Financial Management. Diane Youd, RN, BSN, MBA, CNOR, says simply making the issue a priority was a crucial first step — as important as the corrective actions that were taken.

“It was something the new management company identified and realized we had to make it a focus,” says Ms. Youd, the multispecialty ASC’s administrator and director of nursing.

Employees in the business office began calling each patient two weeks preoperatively to remind them how much their end of the bill will be and that it’s due in full on the day of the procedure, before the surgery takes place. Then, when receptionists at the front desk call the patients to tell them their arrival times, they say they’re able to collect any balance owed or set up a payment plan if needed.

“The people in the business office and the front desk have worked diligently to help us make these improvements,” says Ms. Youd. She notes that, in the past, the receptionists were not charged with talking to the patients about their bills at all. “Now they ‘address it and collect it; explain it and be firm.’ ” The center has also worked closely with surgeons and employees in their practice offices, agreeing to stand firm on canceling elective cases for patients who don’t meet their financial obligations or enter into payment agreements.

“Having the support from the providers, who also own the facility, is key,” says Ms. Youd. “It’s critical that they back us up.”

The amount of Waterbury’s patients who reported in patient satisfaction surveys that they understood their responsibility rose from 88% in the last half of 2021 to 93% in the first six months of this year.

Ms. Youd recognizes that the success is the result of the persistence, patience and professionalism of Waterbury’s staff. “Asking patients for money, which at times can be large sums, can be a very difficult task,” she says. “The staff work through it, and do so compassionately with patients who are anxious and need financial support.” On top of a substantial uptick in collection rates within months of implementing the changes, staff discovered many patients didn’t understand what their insurance companies cover. Hence, they had no idea what their end of the bill would be unless the facility told them. Another lesson: You’ll rarely get the money up front unless you ask, and it’s very hard to collect it after the fact. “Trying to understand co-pays, out-of-pocket expenses and deductibles leaves many patients confused,” says Ms. Youd. “It’s important that we educate them up front, so they don’t have an unpleasant surprise when they arrive on the day of their procedure.” OSM

Honorable Mention
Charting Cost of Each Case = Big Savings 
COST COMMITTEE A team of Kaiser Permanente Panorama City Medical Center employees meet monthly to compare how much products cost.

The cost of supplies are shared with surgeons and staff at Kaiser Permanente (KP) Panorama City (Calif.) Medical Center on a case-by-case basis. Drilling down that far is what it takes to make a series of savings decisions that, when added up at the end of the year, total in the six-figure range.

Doctors receive a detailed report on how much supplies cost for every case. “We share that information after our debrief so they can see all the supplies that were used and the total cost of their case,” explains Stephanie Bisson-Ortiz, MSN, BSN, RN, the facility’s OR department manager. Physicians and staff often don’t know how much items cost until seeing the reports. “We’re very transparent with our metrics because we believe it empowers them to create innovative ways to reduce surgical costs,” adds Ms. Bisson-Ortiz.

Central to this concept is the facility’s Product Utilization Action Team (PUAT), which is charged with improving budgeting and lowering costs. KP Panorama City’s PUAT team meets monthly and focuses on ways to standardize products it uses, establish per-case benchmarks, ensure procedure cards and logs are accurate and come up with ways to align product use and patient safety.

“The PUAT sets up tabletop presentations for the doctors and staff that show cost comparisons for each item we use,” says Ms. Bisson-Ortiz. “It allows them to be cost conscious.”

Nurse coordinators ensure that the preference cards are up to date and make sure duplicate supplies are removed. The staff has buy-in from physicians to not open disposable supplies until it’s confirmed during the time out they’ll be used, even if the items are something the doctors use most of the time. There’s always the chance that the surgeon will decide to not use the item for various reasons, notes Ms. Bisson-Ortiz.

One project that is expected to save $96,000 this year is replacing the plume pen the facility used in all cases with a more cost-effective one. The change saves $8 per case, and is applicable to 12,000 cases each year. Another $23,000 in savings came when the facility’s ortho coordinator realized that several implants were about to expire, so they were able to exchange them with the manufacturer for new ones before the old ones went to waste.

“The collaboration on financial strategies that takes place with all the doctors in each discipline and all stakeholders in each department helps reduce the healthcare costs for our (patients) at the end of the day,” says Ms. Bisson-Ortiz.

—Adam Taylor

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