THIS WEEK'S ARTICLES
Simulation Training Reinforces Classroom Learning
Providers at ASCs can benefit from hands-on educational opportunities that address new equipment and techniques.
Healthcare providers learn by doing, so asking them to absorb information in a classroom is far less stimulating than simulation training.
"During my anesthesia training, instructors would often compare the complexities of administering sedation to learning how to fly a plane," says Robert W. Simon, DNP, CRNA, CHSE, CNE, chief nurse anesthetist at Huntington Valley Anesthesia Associates and assistant program director/didactic education coordinator at the Frank J. Tornetta School of Anesthesia at Einstein Medical Center Montgomery in Norristown, Pa. "Anesthesia providers must complete a minimum number of clinical hours before sitting behind the controls of an anesthesia machine. Even after flying solo in surgery, they still log numerous hours learning how to improve patient care and manage potentially life-threatening situations."
By combining hands-on learning with imitations of real-life patient scenarios, providers can internalize a holistic view of how and why to use their equipment in ways that provide better outcomes and prevent patient harm. Simulation training allows learning to take place in an environment where patient harm cannot occur.
The nature of simulation training can vary depending on the educational requirements or refreshers that need to be reinforced at your facility. Some simulations focus on learning clinical tasks and skills while using the machines and tools that go with them. Obviously, this can be highly beneficial when bringing in unfamiliar equipment, but it can also help providers get more out of the equipment they've been using for months or years.
For anesthesia providers like Dr. Simon, that can include performing an anesthesia machine safety check, practicing standardized intubation techniques on an airway trainer, performing a correct induction sequence or troubleshooting the intraoperative care of a patient with poor hemodynamics. Simulation training can also focus on enhancing "soft" skills such as provider-to-provider communication to decrease possibilities of medical error or patient harm.
A key aspect that drives the "stickiness" of simulation training is what comes after the session. "The overall simulation experience, specifically the debriefing portion, allows for participants to observe and reflect on their actions and thought processes within a safe space," says Dr. Simon. "Overall, simulation creates opportunities for experiential learning that further enhance higher order cognitive skills such as application and analysis."
Simulation training can take place at an offsite location, but it can also be done in your facility. "By conducting simulations onsite, participants can better understand their roles as they relate to their current work environment," says Dr. Simon. "Such simulations can help unmask potential hazards, such as not being able to locate necessary medications and equipment, or realizing communication was not clear or complete."
Simulation training can benefit even the most experienced providers. "Simulations involving some of the most basic tasks such as room setup, anesthesia machine checks and patient positioning have had the greatest impact on my practice," says Dr. Simon. Now a simulation educator himself, he has designed various simulations of his own and calls simulation training an art form. "It provides a unique opportunity to marry didactic knowledge with clinical skill and acumen in a judgment-free zone," he says. "It allows for the educator to enhance the curriculum beyond words written on a page, and the learner to improve their affective, cognitive and clinical skills."
Spreading the Word About Your Friendly Neighborhood ASC
The onus is on surgery centers to initiate relationships that establish trust and awareness in their communities.
For the great majority of residents of the communities they serve, ASCs are just another medical building they might see during their travels around town. While a small remaining percentage of the local population has actually undergone surgery in an ASC, or is employed by the center, most others don't give these facilities much thought.
In a surgical marketplace that is more competitive than ever, the onus is on individual ASCs to establish themselves in their communities and build their brands. Barring an expensive ad campaign, the best way to do this, in addition to providing safe and effective patient experiences, is to engage directly with the community.
Over the last year, ASCs have shared numerous stories with Outpatient Surgery about how they're reaching out. If you're looking for ideas on how your facility can best do this, perhaps these examples will prove helpful:
- When San Luis Obispo (Calif.) Surgery Center instituted a day of service in commemoration of Martin Luther King Jr. Day, its staff responded by creating a Pay It Forward Campaign, cooperating to donate more than 600 pounds of food and $2,500 in cash to the local food bank. "Our team enjoyed the project and knew that many other local groups needed help, so we decided to keep the initiative going by donating to a different charity in the community each month," says CEO Cindy Novak, RN. The facility has also donated to a local canine rehabilitation group and a GoFundMe campaign for a pediatric cancer patient; when we spoke with them, they planned to do a beach cleanup. "We hope to raise awareness of our efforts so local businesses and our neighbors will join in to help," says Ms. Novak. "Helping those in need throughout our community puts everyone on our team in great spirits, and we're proud of their dedication to an attitude of gratitude.
- Many facilities over the last few years have repurposed blue wrap to make sleeping mats and blankets for the homeless. The blue wrap used at the Livonia (Mich.) Outpatient Surgery Center, however, was too small for that purpose, so staff found the perfect alternative: local animal rescues. The center partnered with a rescue that stops by the center every week or two to pick up excess clean blue wrap, which scrub techs and circulators collect and place in a designated box. "On top of reducing the amount of waste we send to landfills and bolstering pride and teamwork among our staff, we're helping an organization that is grateful for the free material," says Donna Reynolds, QAPI, medical records specialist at the center. "We even get the occasional visit from a furry friend or a letter featuring photos of the animals we've helped."
- During the depths of the pandemic, Proliance Eastside AUA Surgery Center in Kirkland, Wash., went about supporting its fellow local businesses. Says ASC Director Carmen M. Wilson, RN, "A lightbulb went off in my head: We have ties to many local businesses that are struggling through the pandemic. Why not help us both by ordering food from area restaurants for the staff?" The surgeons loved the idea and agreed to sponsor it. Management asked staff for their favorite dishes from nearby eateries and had several individually packaged meals delivered throughout December. Staff and management are now accustomed to ordering treats from local restaurants to boost staff morale as well as the local economy.
- About one in five patients at Mountain Empire Surgery Center in Johnson City, Tenn., speak Spanish as their primary language. To better serve those patients, the facility partnered with East Tennessee State University's (ETSU) Language and Culture Resource Center (LCRC)to arrange for onsite interpreters to be present for Latino patients when they arrive for surgery. The facility then expanded its relationship with LCRC to translate paperwork for its Spanish-speaking patients and add Spanish-language content to its website. "Many ASCs use commercial translation services to do this work, but we felt partnering with ETSU in our own community was the right way to go," says OR Manager Lisa Rickman, RN. "It barely cost us a thing to make our patients feel much less confused, overwhelmed or scared about their upcoming surgical experience. That's worth it, every time."
How can your center better engage with your community? As you can see, it's all about imagination and effort. We'd love to hear about your successful ideas and feature them in future issues of Outpatient Surgery! Just send us an email about your initiative to [email protected].
Building and Renovating ASCs Takes Planning Before, During and After Your Facility Opens
As the ASC market continues to grow, so does the need for collaboration with trusted partners.
As the ambulatory surgery market continues to evolve and more procedures are migrating to ASCs, the need for partnerships when planning a new facility from the ground up or renovating an existing space – to bring it to the state-of-art standards that patients expect – is more important than ever. A comprehensive plan should also include support after the facility is launched to provide smooth transitions and continuous improvements as the business evolves. An attractive solution is to work with one company from start to finish and beyond.
The ASC offers many advantages for the patients, staff and surgeons who commit to this environment, so it is not surprising that there is growing activity and interest in building new or renovating existing facilities. By virtue of being a more focused environment than the hospital, ASCs make it significantly easier to spend more time with patients and their families both pre- and postoperatively, vastly improving the patient and physician experience.
Working with a trusted partner
Responding to this emerging market, Stryker's ASC business has helped to build, expand and update ASCs across the country to meet the growing need for these facilities. As a one-stop service partner, their team collaborates with OR leaders to develop tailored solutions for the build, equipment and workflow using a unique eight-step process.
Stryker is committed to providing the latest operating room equipment and accessories with flexible options for technology to keep equipment state-of-the-art for years to come. With thousands of unique products spanning more than 20 procedural specialties, and a wide range of flexible financial options, Stryker has positioned itself to meet the complex needs of ASCs while continuing to add value to healthcare. As they work with customers, their ASC team shares their expertise every step of the way and creates tailored solutions that help maximize clinical, financial and operational outcomes.
Ongoing support for success
Stryker's ASC program doesn't stop with a tailored solution, and includes services designed to meet the evolving needs of ASCs to ensure the long-term success of the business. Customizable marketing tools are available to all Stryker ASC customers to help promote the ASC brand in the community, which expands its reach in local markets and positions the new facility as a leader in outpatient surgery. Resources include web banner ads, social media posts, print ads, sample radio scripts and a comprehensive "Marketing Your Practice" guide that equips facilities with the tools and steps to properly and effectively market their practice.
To keep the new facility's schedule on track, Stryker also offers implementation services including equipment delivery and installation coordination, onsite product training and implant and disposable procurement support. The key to sustaining success is ongoing education for the team – and Stryker tailors educational programs to the specific needs of the staff, whether they are getting started or need a refresh on current equipment and workflow. Education includes in-depth programs across all specialties, site visits, peer-to-peer mentoring and product-specific educational events such as Mako SmartRobotics™ certification training.
An eye on the future is part of the vision, too, with a partnership with Stryker. They facilitate collaborative business reviews which include discussions post-implementation on key performance metrics and opportunities for future growth. Through this process, Stryker is providing ASC leaders with the information they need to evaluate their ongoing business and develop plans for the future.
Note: Learn more about Stryker's ASC business here.
Patients Appreciate Same-Day Surgery
Leapfrog Group survey finds ASCs have slightly higher patient experience scores than HOPDs.
An annual patient experience survey conducted by The Leapfrog Group finds that patients much prefer outpatient surgeries to inpatient procedures performed in hospitals.
Leapfrog's nationally standardized Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys purport to offer healthcare consumers fair comparisons across providers. The CAHPS Hospital Survey (HCAHPS) results are publicly reported by the Centers for Medicare and Medicaid Services (CMS) on its Care Compare website. The less widely known CAHPS Outpatient and Ambulatory Surgery Survey (OAS CAHPS), however, isn't publicly reported by CMS, so Leapfrog reports those results to provide patients with critical data on quality and safety at outpatient surgical facilities.
Leapfrog, which estimates that more than 60% of all surgeries are now performed either in an HOPD or ASC, centers questions on four aspects of care in the OAS CAHPS survey: Interactions with the facility and its staff; communications about the patient's procedure; overall rating of the facility; and willingness to recommend the facility to family and friends.
"Adult patients report more favorable experiences from their same-day surgery facility than among those that had a same-day surgery performed at a hospital," says Leapfrog. "In all four areas of patient experience, ASCs were rated statistically significantly better by their patients than patients of HOPDs."
The most eye-catching statistic: Patients at both ASCs (97.3%) and HOPDS (96.4%) gave their most favorable responses to how they were treated by staff and the cleanliness of the facility, but gave less favorable responses on definite willingness to recommend, with scores of 87.6% for ASC patients and 82.1% for HOPD patients.
CMS' 2022 Proposed Payment Rule Produces Shockwaves
About-face on eliminating the inpatient-only list and removal of 258 ASC codes rocks the surgical industry.
In the surgical industry, the general theme of the last four years of political upheaval and the subsequent COVID-19 pandemic response has been the steady addition of ASC codes to CMS' Covered Procedures List, which reached its pinnacle when the Centers for Medicare & Medicaid Services (CMS) announced plans to eliminate its inpatient-only list entirely by 2024. Now, with the pandemic under greater control and a new government in Washington, that process appears to be suddenly reversing.
CMS' 2022 proposed payment rule for ASCs and hospital outpatient departments (HOPDs), released on July 19, is a massive 863-page document that has industry insiders buzzing. After several years of adding hundreds of ASC codes, CMS is now proposing for 2022 the removal of 258 codes it added to the ASC Covered Procedures List in 2021. The Medicare payer is also proposing not only to halt its recently announced plan to eliminate its inpatient-only (IPO) list over a three-year period, but to actually add 298 codes back to it for 2022.
According to the Ambulatory Surgery Center Association (ASCA), however, CMS did propose to continue to align the ASC update factor with that used to update HOPD payments. CMS would continue to use the hospital market basket to update ASC payments for calendar year (CY) 2021 through CY 2023 as the agency assesses this policy's impact on volume migration, ASCA reports.
"The decisions by CMS over the past two years to add and remove hundreds of provisions from both the inpatient-only and ambulatory surgery center payable lists have been jarring," says ASCA CEO Bill Prentice. "Clinicians deserve a better system for advising them on which settings they can use to provide care for Medicare beneficiaries. We hope that a clear process can be codified to allow clinicians to submit data on procedures that they believe can be safely performed in the ASC and to assure transparent decision-making by the agency in response."
There's much more to consider in CMS' document. Read ASCA's full preliminary reaction and analysis to the proposed rules changes here. ASCA says it will be provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.