THIS WEEK'S ARTICLES
What Is Your ASC's 'Fluid Situation'?
Closed mobile collection units present a safer, easier alternative for managing and removing bodily liquids in ortho ORs.
Arthroscopy cases are not for the faint of heart. The spilled, splattering bodily fluids they generate present safety issues not just surrounding infection control, but also the potential for slips and falls on wet floors.
Hudson Valley Center at St. Francis in Poughkeepsie, N.Y., had employed a time-consuming, aggravating and clinically distracting process for fluid collection and disposal that involved double-bagging three-liter canisters that nurses or techs then carried to dirty rooms. It was not only heavy lifting for staff, but also presented ample spillage and splashback issues. In particularly messy cases, a dozen canisters might be required, says clinical coordinator Caryn Solomon, RN.
Recently, the facility purchased closed mobile fluid waste collection systems for each of its ORs and procedure rooms, and she says the situation immediately improved. Here's why she believes closed mobile collection units are a no-muss, no-fuss, no-brainer solution for busy ortho centers:
- It saves time. The mobile systems can be rolled into and out of ORs, and positioned to collect fluids efficiently without obstructing OR staff during a case. Instead of lugging and bagging heavy fluid-filled canisters, a staffer simply rolls the device wherever it needs to go. Reduced turnover times have resulted, says Ms. Solomon.
- It's safer. The wheelable systems' internal reservoirs can hold 20 liters, taking the place of nearly seven of the old three-liter canisters that needed to be lifted and carried. When full, or at the end of a procedure, they're simply detached from arthroscopy pumps, surgical drapes or floor wicking devices, pushed to a docking station, hooked up and emptied into the sanitary sewer system. Staff never touch the fluids and simply wipe down the outside of the machine after each use.
- It's eco-friendly. Ms. Solomon says the closed systems reduce the amount of regulated medical waste generated, while eliminating thousands of single-use canisters, along with chemical red bag waste from associated solidifiers.
- It can double as a smoke evacuator. St. Francis' closed fluid collection systems also protect staff and patients from harmful surgical smoke. "Their filters are changed periodically throughout the year to help remove as many burning carcinogens in the room as possible," says Ms. Solomon.
- It's a high-value investment. St. Francis' systems cost $10,000 to $15,000 each, but Ms. Solomon says they've been worth all that and more. The facility no longer needs to purchase hundreds of three-liter cannisters and spends less on solidifying agents and red bag waste disposal. OR staff spend less time prepping, transporting and emptying fluids, and less time cleaning floors. Nurses are less aggravated because they don't need to carry heavy canisters and risk injury. Surgeons are happy about quicker turnovers. Slips and falls are much less of a worry.
It all adds up. "Our transition to closed fluid collection systems has had a positive impact on the entire OR team as well as the planet," says Ms. Solomon, "which is priceless."
Build Your Network to Grow Your ASC
In a market that's rapidly evolving, it's more vital than ever to lean on knowledgeable peers.
It's remarkably easy to develop tunnel vision when you're running a busy surgical facility, so it's important to get fresh outside perspective that can shine a different light on various issues you deal with every day. "If you're not regularly seeking a broad range of perspectives on approaches to patient care and staff education, training and compliance, your efforts are bound to get stale over time," says Anjal Pong, RN, NPD-BC, MSN, CNOR, clinical nurse educator for the pediatric OR in the Institute for Nursing Excellence Department at the University of California San Francisco.
Her advice: Start or join a network of your peers from outside of your facility. Ms. Pong, for example, is a member of what she calls an invaluable asset: the Bay Area Perioperative Educators (BAPE), an informal professional networking group for perioperative nurse educators in the San Francisco area that has met at least quarterly since 1984. "We spread new ideas and provide rapid responses to questions about standards in practice," she says.
She offers these tips on how to create a productive networking group of your own in order to better meet the challenges of running a surgical facility:
- Stick to a schedule. Regularly scheduled meetings will help the group gain momentum. "Hold meetings on a quarterly basis," she says. "Before each gathering, finalize a date on which the maximum number of members can attend and send out detailed agendas in advance."
- Embrace structure. Networking meetings should follow a familiar pattern that puts members at ease and encourages them to focus in advance on the value they can add to the conversation. For example, after introductions, members of Ms. Pong's group present their facility's current projects and policy changes and discuss staffing or education changes and needs. Then, as a group, they discuss the latest accreditation survey requirements, changes to AORN guidelines and pressing issues involving policies, procedures or regulations. At the end of the meeting, the date and location of the next gathering is announced.
- Keep it loose. The atmosphere should be fun, informal and relaxed. "For these types of meetings to work, the group has to want to get together on a regular basis," says Ms. Pong. "For many of our members, the greatest benefit of the group is the comradery we've developed." Because members speak the same clinical and operational language, they can better share ideas and openly voice frustrations to peers who understand their perspective.
- Focus on the takeaways. Your group should provide its members with actionable information and solutions to real-world problems, advises Ms. Pong. "At one meeting, we discovered every educator had been using a surgical fire risk assessment that wasn't validated and didn't account for a number of factors that could contribute to a fire," she says. In response, her group assembled an interdisciplinary team to develop an assessment tool that met all AORN recommendations.
- Designate a point person. Don't let entropy dissolve your group. "You need someone with exceptional organizational skills to make sure the group remains actively involved and each meeting runs smoothly," says Ms. Pong. As the months and years go by, this person can track membership coming and goings, keep meetings collaborative and on time, take minutes and more.
- Leverage virtual meetings. Even during "normal" times, group members get caught up in personal and professional responsibilities that prevent them from physically attending meetings. COVID-19 has placed even more obstacles to getting together in person, so leverage tools like Zoom and Teams to keep your group connected and engaged. "Virtual meetings ensure our group remains sustainable and active, which is especially important right now," says Ms. Pong.
As patient volume and competition continue to grow in the ASC space, keeping tabs on best practices and developing trust-based, fruitful relationships with knowledgeable peers can position your facility to exceed expectations.
Staying the Course in Troubled Waters With Smart Post-pandemic Business Strategies
The importance of equipment leasing for ORs and financing of daily use products for the sterile processing department.
Post-pandemic financial planning within the ASC community continues to evolve, even as COVID-19 still poses a serious health threat nationwide. The crisis in not over in 2021, despite the appearance of vaccines and state-by-state restrictions and testing. So it is not surprising that the patient volume and revenue growth that ASCs had experienced in recent years was interrupted in 2020 as patients elected to postpone elective surgeries – and the healthcare reality surrounding the pandemic continues to be disruptive.
In this highly fluid and uncertain financial environment, Michael Rhodes, Getinge Strategic Sales Director, ASC, discusses ways in which Getinge Financial Services is helping ambulatory surgical centers acquire the capital assets they need to survive and prosper in the age of COVID-19 and beyond.
2020 has had many disruptions. How have events impacted the capital budgets and financial strategies of ASCs?
The fact is, 72% of all ASCs are independently owned and many of these are recent start-ups and highly entrepreneurial by nature. Relatively few have vast capital reserves, so when revenues took a sudden downturn, infrastructure and capital equipment projects were put on hold. Available funds had to be redirected in order to keep the doors open.
How would you characterize the financial dilemma that ASCs are facing?
The equipment leasing and finance industry's Horizon Report shows that roughly one-half of all private-sector equipment acquisitions are financed with secured loans or lines of credit. Unfortunately, cash is now scarce for many ASCs that in the past might have eschewed equipment financing of any kind. Compounding the problem, secured loans may be harder to obtain, be more expensive, and less flexible given market uncertainties and a financial institution's perception of increased business risk during the pandemic. At the same time, ASCs are forced to look at existing or future lines of credit to fund operational losses, and not capital equipment purchases.
Where does that leave ASCs that want to move forward with their pre-COVID strategic business plans without additional delays?
The good news is they don't have to wait, because Getinge Financial Services' lending sources understand these temporary market dynamics, and have worked with our company to offer attractive leasing options that optimize cash flow, reduce or eliminate upfront costs, and lower scheduled payments. In many instances there are associated tax benefits as well. Just as importantly, an equipment lease helps eliminate the very real concern of equipment obsolescence in a technology-driven field.
Can you point to a few examples of these creative financing options?
Getinge's innovative pay-for-use option allows our customers to pay a caseload, or cycle rate, for the use of their equipment. These options help align leasing payments with revenues generated by the billable fees for treatment in a given period of time. This same concept is applied to the financing of daily use products for the ASC's sterile processing depart¬ment, and takes into account the peaks and valleys of patient throughput. It's also important to point out that within our wide portfolio of flexible operating capital and finance leases, our lending sources will (in many cases) approve lease terms up to 84 months – where others will not exceed an amortization period of 60 months.
What type of equipment can be financed using any one of these options?
When you walk through any ASC and take note of all the OR and infection control equipment in the facility, you'll find that Getinge can serve as a single-source provider for everything you see. I can't think of another supplier that can make that claim! Surgical tables and lights; anesthesia machines; sterilizers and washer-disinfectors; OR integration systems; OR management solutions; daily-use products for the CSD; and even modular room systems…we offer it all. In short, ASCs can buy it, finance it, service it, and design it through Getinge as a truly strategic – not transactional – partner that can unlock the maximum value of purchasing decisions.
Legal and Regulatory Trends Continue to Drive ASC Growth
Expert sees continued migration of both inpatient and HOPD procedures to freestanding centers.
CMS has added numerous procedures to its ASC-approved list over the last several years, and this year it announced it will eliminate its inpatient-only list in 2024. Meanwhile, commercial payers have long embraced ASCs for increasingly complex procedures because of their lower cost structures. Kara M. Friedman, a Chicago-based shareholder with national law firm Polsinelli who advises healthcare providers on regulatory issues, does not see these trends reversing. She sees them accelerating, particularly in terms of movement of procedures from HOPDs to ASCs.
In an article published last week in The National Law Review, Ms. Friedman wrote that despite ASCs' lower cost, inpatient procedures to date have been mainly steered to HOPDs rather than ASCs for their health systems' financial and competitive purposes. But she says reimbursement policy trends among commercial payers and CMS are generating unprecedented enthusiasm for migrating procedures out of HOPDs to less costly ASCs. She says more policies are being implemented "to restrict health systems and physicians from retaining elective outpatient surgical services in the hospital setting."
Ms. Friedman points to payers such as UnitedHealthcare (UHC) and Anthem that are restricting sites of care for elective surgical procedures to reduce costs. "UHC pays only for surgical procedures performed in an outpatient hospital setting if such setting is medically necessary based on the acuity of the patient," she explains, noting that qualification of individual patients for the most appropriate settings remains paramount.
She points specifically to total joint replacements and their recent approvals in ASCs as part of an overall initiative by CMS to cut costs and keep Medicare solvent. "As suggested by several studies, the potential savings of moving total joint replacement procedures to ASCs is substantial, with the cost of treatment being about 40% less in an ASC when compared to hospital surgical care for the same procedure," she writes. UnitedHealth Group found that migrating half of routine total joint replacements to ASCs could yield $1 billion in savings for Medicare, while also reducing the risk of hospital-acquired infections, she reports.
"It is unsurprising, then, that certain projections suggest that by 2028 approximately 57% of joint replacement procedures will be performed at ASCs," says Ms. Friedman.
CEO makes the case to business leaders in Forbes.
The continued growth of ASCs is a natural outgrowth of the mechanics of a healthy, robust economic system, according to the head of a Midwestern chain of facilities. "I believe nothing is more emblematic of capitalism at its best than the emergence of the ambulatory surgery center in health care," says Shakeel Ahmed, MD, founder and CEO of St. Louis-based Atlas Surgical Group, which describes itself as the largest privately owned ASC group in the Midwest.
Dr. Ahmed writes in Forbes that ASCs embody the capitalist notion of dynamic evolution driven by ambition. In the process, he says, ASCs are driving costs down while increasing productivity, all while providing the superior outcomes that patients and payers demand. "ASCs are evolving to improve patient care in the healthcare landscape through efficiency, results and customer satisfaction," he says. "Patients are happy when they have less pain and faster recovery times, and business is happy with cost savings from efficiency."
The ability for ASCs to specialize and run lean gives them a significant advantage over inpatient hospitals, he says. As general purpose institutions, hospitals face strict regulatory and accreditation challenges, as well as what he calls "a colossus of financial processes: income, overhead, unexpected losses, variability in demographics, unpredictability in census, utilization deviations, inventory turnover, changing government regulations, accreditation and more." At ASCs, he says, the final bill for a surgery doesn't need to account for subsidizing unprofitable parts of a hospital.
Dr. Ahmed says same-day procedures combined with technological advancements such as telemedicine and smartphone apps for rehab that enable patients to recover at home is further boosting productivity while lowering costs. "The capitalism that has created the ASC has been on a tandem course with improvements in technology that have dovetailed beautifully with the speedy turnover motif of the ASC," he writes. Another technological driver for ASC growth has been minimally invasive surgery, which he calls "a crucial ingredient that has made the ASC a legitimate player medically, ethically, financially and politically in health care."
Dr. Ahmed writes that ASCs must still overcome hurdles, including the hospital lobbies and the lack of public awareness of the cost savings ASCs provide. "People just don't know the difference, to put it simply," he says. "If every company executive shopping for healthcare services started paying attention to our '50% less' stickers, this would be a slam dunk. Unfortunately, it isn't that easy."
His advice to ASCs? "Offer great experiences and results for patients, and let capitalism do the rest," he says. "The win-win, inevitably and naturally, comes full circle in benefitting the industry as much as the patient."