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It's Good To Be Frugal
A collection of our readers' best cost-saving ideas.
Outpatient Surgery Editors
Publish Date: February 9, 2008

What's a Washing Machine Doing in This Orthopedic ASC?
Swish-slosh-swish. The washer and dryer at Academy Orthopedics ASC in Cumming, Ga., get plenty of use and save this one-OR facility lots of money, says administrator Karen Bennett, RN, ONC.

Around five years ago, Academy decided to rid itself of its $100 monthly scrubs rental and reprocessing bills. So it bought 50 sets of scrubs and spent $700 on a water-saving washer and front-loading dryer, both of which fit perfectly in an upstairs room that was already plumbed. A tech is responsible for washing and folding scrubs. He uses a household detergent.

That's not all. Quite by accident, Ms. Bennett discovered that scrub caps come out like new when you wash them. She found this out when somebody tossed a scrub hat in the hamper. A box of 100 hats costing around $100 lasts a whole lot longer now that Academy is washing and reusing them.

Staff ask discharged patients if they want to keep the footies that they wore for 15 minutes. "Many don't and we launder them for reuse," says Ms. Bennett. "At $1.12 a pair, the savings can add up quickly."

Finally, when staff transfer a patient from the recliner to the OR bed, they take up the sheet that was on the recliner and, so long as it's not soiled, use it to make up the patient's stretcher.

Where Does the Buck Stop at Your Facility?
Who's the bulldog in your business office, the person who'll latch on to an unpaid claim and won't let go until the check arrives? Whoever it is, just be sure you dedicate one person to review all insurance claims and patient statements and promptly refile and correct deficiencies, says Hylmar Karbach, MD, the medical director of the McKenna Ambulatory Surgery Center in New Braunfels, Texas. Dr. Karbach suggests that this person be detail-oriented, pleasantly persistent and bright. Also have this person track the upcoming surgery schedule to see if any patients are carrying outstanding balances. His advice: Call and arrange for payment of past due amounts ahead of time.

Reuse That Extra Report Paper
Wondering what to do with all that extra continuous-feed computer paper that spools through the printer after people run reports? Linda Terry, the executive director of the Naugatuck Valley Endoscopy Center in Waterbury, Conn., finally figured it out: Take it home, rip the perforated ends off the sides, tear it apart and stick it in the laser printer to print such internal documents as deposit slips and daily schedules. "It's perfectly good paper," she says. "We have hundreds of sheets to use in the laser printers as miscellaneous paper." She figures she saves her facility $500 a year in copy paper.

Behold, the 4-day Workweek
Mondays or Fridays off? Now there's an idea your staff will surely love. And it will do well by you, too, giving you full five-day coverage and a happier, more productive team. Here's how it works for Rosalind J. Loyd-Chisley, RN, the ambulatory surgery supervisor at LSU Health Science Center in Monroe, La.

On a rotating basis, five of the nurses on her 10-person staff work four 10-hour days and then take off either Monday or Friday, her facility's two slower days. Here's what a typical monthly work schedule looks like for half of her nursing staff:

  • 1st week. 8:30 a.m. to 5 p.m. Monday to Friday.
  • 2nd week. 5:30 a.m. to 2 p.m. Monday to Friday.
  • 3rd week. Mondays off. 6 a.m. to 4:30 p.m. Tuesday to Friday.
  • 4th week. 6 a.m. to 2:30 p.m. Monday to Friday.

Ms. Loyd-Chisley credits this schedule with producing "a more satisfied, more cost-conscious, happy and motivated staff." What's more, there are fewer call-ins and less overtime, she says.

Any problems? "Yeah, I don't get to do it," she says. "I work 8 to 4:30, every day." One thing more: Ms. Loyd-Chisley points out that this modified schedule was the staff's idea. "One of the best tools to being a good manager," she says, "is remembering what's it like when you weren't."

How to Profit From Pre-surgical Physicals
When she was running an ophthalmology surgery center, nothing frustrated Marilyn Sampson, RN, more than a dreaded day-of cancellation. More often than not, she discovered, the history and physical were the culprits. Either they weren't in the chart or were incomplete. Or patients would arrive on the day of surgery with high blood pressures or blood sugars.

So she decided to outsource H&Ps. She ran an ad in the local newspaper for a family practice nurse practitioner or physician assistant to perform all pre-surgical physicals. She hired a NP to work full-time, doing full workups (including bloodwork and EKG) — as many as 12 per day — on all surgical patients, on site, at the surgery center a week before the case was scheduled.

"We had next to no cancellations after that," says Ms. Sampson. "Patients felt safe and secure. And there were no expenses to have her there." As an added bonus, the ASC earned a profit off the H&Ps. The NP would submit her claims to Medicare and other carriers and be reimbursed, on average, $75, which went to the surgery center. The ASC paid the NP $50 per H&P and kept the rest. Just be sure the NP or PA is a provider for all of your carriers.

Have All Charges Been Applied Correctly?
At the end of each surgical day at Higgins General Hospital in Bremen, Ga., a tech and an RN perform counts in the three ORs and one GI room to maintain par levels and to ensure that all charges will be applied correctly, says Eloise Whitton, RN, BSN, CNOR, manager of surgical services. The materials manager then checks charges against what's missing from the room to make sure the charges are correct. "Our losses are very, very minimal," says Ms. Whitton. "It works."

Make Your Own Prep Kits
You know how sometimes procedure packs come with more sponges and sponge sticks than you need? Kelly Foudray, RN, BSN, the nurse manager at the Mid America Surgery Institute in Overland Park, Kans., knows just what to do with them. Take the ones you don't need out before you start the prep and put them aside. Then save emesis basins or square basins from packs that you don't use. Put them together and you have the perfect prep kit, she says. Once you wrap them yourselves and autoclave them, just add the cleaning solution of your choice and you have minor or local case prep kits ready to go at a minimal cost, adds Ms. Foudray.

Get Paid to Conduct Research
Ever think of your surgical center as a research site? A pharmaceutical company pays the Mooresville (Ind.) Endoscopy Center to collect data for a colon cancer study. The admitting nurse asks patients if they'd like to participate, which involves staff either measuring hip and waist circumferences or drawing blood. The drug company pays the center $15 for either test, says clinical director Connie Taylor, RN, CGRN, who estimates that three patients per week volunteer for the study. The endo center uses the money to sponsor needy families around the holidays and for staff education.

Know the Price Before You Order
When staff at the Louisiana Cosmetic Surgery Center in Metairie, La., order supplies, they keep a spreadsheet in front of them that lists every vendor, item and price. This way, staff can verify that the rep is giving the price they've been quoted. "Many lessreputable vendors try to change pricing with every order," says Gregory W. Pippin, MD, the director of the ASC. "We keep them honest by having our spreadsheet in front of us as we're ordering." If the first vendor can't supply the center's needs in a timely manner, staff have a second vendor from which to choose. "This cost comparison saves us thousands each month," says Dr. Pippin.

Print Your Own Forms
Take the time and invest the manpower to build your forms into your computer system so that you can print them when you need them instead of paying a printing company, says Tracy Scota, RN, DON, of the Delaware Valley Orthopedic and Spine Surgicenter in Bala Cynwyd, Pa. "We did this on an individual basis when we were revamping each form," says Ms. Scota. "It's busy-work on down days for both the clinical and clerical staff."

Lower Those Shipping Costs
The Lowcountry Outpatient Surgery Center in Summerville, S.C., requests ground shipping on most of its supply orders, as opposed to overnight or second day delivery. "With one supplier alone, I save about $50 per week," says materials manager Miriam Jenkins.

How We Saved on IV Supplies
Doctors Hospital OhioHealth in Columbus, Ohio, conducted a nursing research project on the use of anti-reflux valves for peripheral and central lines. By using the devices and leaving peripheral lines in place for 96 hours, the hospital saved $60,000 per year in IV supplies and also decreased the incidence of phlebitis by more than 50 percent, says Marcy Conti, RN, the vice president of operations and chief nursing officer.

Consign High-priced Implants
Consign such high-priced implants as ortho anchors, fixation screw sets and even IOLs, says Ken Hammer, RN, clinical coordinator of the Surgery Center of Kalamazoo in Portage, Mich. "This saves your center the high upfront costs, reduces storage space and lets you keep a close watch on your inventory," he says.

Guarantee Staff a 35-hour Workweek
Leave when you're finished. That's been the unwritten rule for the 10-person staff at George M. Hancock Surgery Center in Lenoir, N.C., since the facility opened in 1999. You see, they're paid for 35 hours regardless of whether they worked less. "They get what they need and I get what I need," says director Anne Gragg, RN, BS, CNOR, RNFA. "They don't mind a short day because they're getting paid for seven hours a day. Plus, they're motivated to be productive and efficient."

Ms. Gragg has 10 bodies to do the work, but only pays for seven, according to the spreadsheets and full-time equivalent (FTE) numbers. "A lot of weeks, they're only working 29 hours a week," says Ms. Gragg. "It sounds like you're paying money to people who aren't working, but you're also keeping a full-time staff available for when you have cases booked."

As Ms. Gragg explains, it's a bit of a numbers game. She is budgeted for 10 FTE. At a 40-hour workweek, that's 2,080 hours per year. But when you drop to a 35-hour workweek, that's 1,820 hours per year, which gives you the flexibility to add bodies to fill gaps in the schedule. It's also important to note, she says, that guaranteeing a set number of hours per week lets you retain a staff even if you don't have enough cases to give staff secure hours.

Two caveats: Staff have to work at least four hours per day to be paid for seven and staff are paid the same if they work more than 35 hours in a week.

"It's an incentive and a good marketing tool when you can tell somebody that you'll guarantee this amount of time and you can go home when you're through," says Ms. Gragg. "I've got people waiting in lines for jobs. We have three or four in-house applicants for any opening."

Drawbacks: People get used to working short hours, says Ms. Gragg. Sometimes staff will moan and groan, she says, if the center has add-on cases and they have to work longer hours.

Preemptively Renegotiate Payor Contracts
Medicare's new ASC payment system is going to hit small single-specialty endoscopy centers hard, so the Eastern Pennsylvania Endoscopy Center in Allentown, Pa., took matters into its own hands. Instead of waiting until its managed care contracts ended, it started renegotiating them right away. "We prepared sheets with data tallied from last quarter's patient satisfaction surveys along with some patient testimonials to make sure they knew the value of our center," says administrator Patricia Lombardo, BS, RN.

For the most part, this was enough to show that patients valued the facility and to convince payors that the endo center needed higher payment rates to continue to offer this level of service, says Ms. Lombardo. "Sometimes we needed to bring out one or two specific surveys with comments on them, and once in a while a payor will inspect our facility to be sure we're up to speed before committing to higher payments," she says. "Overall, taking charge in renegotiation and working to show that we are worth more money has helped us secure the increased payment rates we'll need to stay in business during the coming year."

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