We're able to do a large number of procedures in a short amount of time because I give every surgeon two ORs with which to work. After 20 years as a one-OR surgical center specializing in ophthalmology, we built a second OR in 2003 to accommodate the increase in case volume. We tried scheduling both ORs at the same time. The nature of cataract surgery is that it's a short process, though, and when we had two doctors operating, we found we were running out of beds for pre- and post-op. That just wasn't going to work. Within a month, we came up with a better idea.
If you've got a doctor with a lineup of short procedures - cataracts, colonoscopy, arthroscopy and so on - you schedule a block for both ORs. While the first procedure is going on in one OR, the second patient and the second OR are being prepared. Then there's no down time. The doctor walks over to the other room, the OR staff walks with him and they're ready to go. It's worked extremely well. We're able to do 15 cases before noon. We've done as many as 24 cases in a day and been done by 2 p.m.
Staff-wise, all you need is to add one, maybe two OR techs to your employment costs to get the other room ready. You don't need an entire second team. The surgeons are happy to be done in less time. The patients like it, too: They're in and they're out. We're applying to build two more ORs to meet demand, and we'll continue this double-OR scheduling with them as well.
Linda Phillips, RN
Castleman Surgery Center
Getting Paid for Orthopedic Implants
Before I began billing at a surgery center, I sat on the other side of the table, working as a claims processor for a large insurer. It was there that I learned the key to getting paid for orthopedic implants: Submit your claims with all the information the insurance company could possibly ask for. Doing so removes any excuse the insurer might have to delay processing your claim. This means when you bill with CPT Code 99070 (for supplies and hardware), include along with the diagnosis a detailed description of what implants and hardware you used.
For example, document for the claims adjuster how many screws you used in the case, the sizes of the screws and the types of screws. It's helpful to submit such cases as paper claims so you can more easily document this information. You can count on your claim getting denied if you don't give the insurer a detailed description of the implants you used. Even when you follow this advice, insurers will deny some of your implant claims. If your orthopedic implants are denied, refer to the Complete Global Service Data for Orthopaedic Surgery to see whether that implant can be carved out of the primary procedure. Always appeal denied claims. Insurers count on you not following up on denials. Be persistent. You won't always be paid at 100 percent, but chances are you'll be partially compensated if you're persistent.
ASC Biller/Business Office Manager
Shopping for a Smart Loan
Take advantage of low interest rates. We recently decided to upgrade our equipment and planned to buy new anesthesia monitors, arthroscopic towers, surgery lights, a C-arm table and computers. The purchase was going to require an equipment loan of more than $300,000. After deliberating the best way to maximize our dollars, we shopped the loan at three area banks: the one that handled our checking and savings accounts, another where most of our physician-owners had their accounts and a homegrown bank that included some of our physicians as investors. We had a two-step negotiation process. First, we sent out bid requests to the three banks. Then we returned to them and asked them to beat the numbers they had initially given us. Each lowered their interest rates even further.
We ended up with two loans on a total of $330,000 in equipment. One was a tax lease, where the bank takes credit for the depreciation but we get a lower interest rate of 3.65 percent. The other is a basic lease-to-own agreement at 4.06 percent for a five-year period. There are all kinds of different loan agreements, so you need to research each bank's terms before settling on one.
There are other ways you can save on interest rates and cut a sizable amount from your loan. If you have property and equipment loans, consider refinancing and securing a lower interest rate for the life of your loans. Or, if you're taking out a new loan, consider consolidating an existing loan with it. This could get you a better rate, especially if the older loan was from three or four years ago, when rates were higher.
Be sure you have a qualified accountant to help you make the best long-term decisions. We have one on retainer - he was selected because he has experience with healthcare businesses, a good reputation in the community and several clients who are surgeon members - but it doesn't cost much to hire one for an hour to review your loan situation and explore the options.
Terry Elquist, RN, BSN, CASC
Rocky Mountain Surgery Center
Safe and Secure Scheduling
Our clinic hosts procedures for more than 50 physicians, so the scheduling process can get busy here. Once during a monthly meeting with the physicians' schedulers, we discussed what we might do to make things run a little more smoothly. We worked together to develop what we call a "worksheet reservation" system. It's a patient information form that the physician's office faxes to us on the day it schedules the procedure. It includes basic information about the patient and the procedure he's having done, and quite a few of the schedulers have customized the form with information from their own specialties.
The worksheet reservation's most valuable role has been that of a double-check on procedures. There's less of a chance of error on the day of the patient's surgery, because if we find discrepancies between what's scheduled and what's on the form, we can call the doctor to confirm. We've incorporated the worksheet into our policy for verification, and we've prevented some potential errors in types of anesthesia uses, wrong site surgery and wrong procedure surgery. Sometimes we feel like we're being redundant, but it's a failsafe mechanism. We see 10,000 patients a year here, so we have to make sure that what we do is correct.
Janelle Oliver, RN, BSN, CNOR, CAN
Wichita Clinic Day Surgery
Hang a Left at OR1
We have a plastic toy car in among our pre-operative bays. It's how our younger pediatric patients get to the OR. We'll prep them for surgery on a litter and then ask, "Do you want to go in the car, or in the bed?" They always choose the car. They get in and drive themselves right into the OR. The only problem we have is getting them out of the car once they get there. This is an idea I brought over from a center I previously worked at. There, we let kids choose between driving the car or being pulled in a plastic wagon.
Deborah Plank Sterkenberg, MS, RN
Clinical Nurse Manager
Surgery Center at Limerick