10 Winning Ophthalmology Strategies For Hospitals And Surgery Centers Alike

Whether you're in a hospital or freestanding facility, here are 10 small and not-so-small things you can do to make your outpatient ophthalmic surgery services flourish.

1. Dedicate yourself to eyecare. An administrator who makes the success of the ophthalmology service a crusade is mission-critical. "The responsibility rests on my shoulders," says Linda Phillips, RN, the administrator for Castleman Surgery Center in Southgate, Mich., a single-specialty eye center. "I have to be able to see the big picture and always be thinking about what I can do next to bring about further improvement." When Castleman needed to raise its volume and add a second OR, Ms. Phillips set out to recruit additional surgeons, offering them shares in the surgery center.

2. Commit the facility to quality. Many surgery centers submit to quality assurance (QA) studies in a perfunctory manner as part of the credentialing process, says Gina Stancel, HCRM, CST, COA. That, she says, simply isn't good enough. An ongoing QA program is the only way to identify weaknesses and improve, says Ms. Stancel, the surgical administrator at the Eye Centers of Florida in Ft. Myers, Fla., which handles 6,000 cases per year. "We have ongoing studies to monitor all facets of our operation from patient satisfaction through visitor satisfaction," she says. Surgeons are encouraged to visit the center to watch surgery, and their reactions are recorded and analyzed. "We learn a lot about what we could be doing better by listening to these surgeons and hearing about practices that they've implemented, and I think they learn from us. When they come back for a return visit and bring some of their staff, we know we're doing something right," says Ms. Stancel.

3. Be a model of efficiency. The efficient use of resources can make or break your eye services. Castleman's newly added second OR means there's always a room ready for a surgeon. This has lead to increased volume and decreased costs. "The surgeon can go back and forth between rooms and never have to wait for set-up," says Ms. Phillips. This, she explains, lends itself to further efficiencies in staffing costs. "I don't have to have a second staff in that second OR. All we need is one extra technician to open up the table. The technician from pre-op rolls the patient into the OR, and then the scrub technician and surgeon walk in and everything is ready for them," she explains. Since opening the second OR, Ms. Phillips says overhead has decreased by about 10 percent.

4. Grow your cases, control your costs. The two key determinants for financial success of an ophthalmic ASC - or any outpatient surgery setting for that matter - are an adequate case volume and a cost- and time-sparing mentality, says ophthalmology practice management consultant John Pinto of J. Pinto & Associates, Inc. "With anything under 50 cataract cases per month, it's increasingly difficult to cash flow an ophthalmic ASC," he says. "By the same token, you can do all the cases in the county and still lose money if you don't contain costs in all areas: facility, capital equipment, supplies and staffing," he says. Above almost everything else, Mr. Pinto points out, an ASC will be a more successful business if the affiliated physicians are thrifty with their time. "It's impossible to reach standard profit margins if you can only perform one or two cataract cases an hour. Three and four cases per hour are now the gold standard, and the most efficient practices periodically exceed this tempo," he says.

5. Appreciate your staff. There's a clear advantage to showing staff appreciation - less time wasted hiring and training new employees. There's a less obvious benefit, as well - patient safety and satisfaction. Sheryl Mortweet, RN, center director of the Shepherd Eye Center in Las Vegas has been running the center for 15 years, and most of her staff has been there for at least a decade. "When we notice that someone is going the extra mile, we show our appreciation by giving her movie tickets or some other tangible acknowledgement," she says. It doesn't cost nearly as much to show nurses and technicians that they're valued as it does to replace a disgruntled employee. "These people know each other and they know what they're supposed to do. That longevity benefits the ASC in innumerable ways," says Ms. Mortweet.

6. Bask in your autonomy. Administrators who are empowered to make a surgery center be all it can be consistently take those facilities to new levels of success. "It's very important for the physician to give the administrator the freedom to do the job," says Ms. Stancel. The basis for this, she says, is respect and communication. "If the physician hired the administrator, he or she probably respects that person's judgment, and respects what the role of administrator entails. If the administrator communicates when her authority is being undermined, you can maintain an effective relationship," she says. Surgeons will gladly relinquish business and personnel matters to administrators so they can keep busy doing surgery.

7. Satisfy patients. Patient satisfaction rates high on the list of goals toward which the most successful ophthalmology ASCs aim. For instance, Ms. Phillips sends out monthly postage-paid patient-satisfaction surveys that ask if the patient's wait time was too long; if they were comfortable during their stay; if they were treated courteously; if the recovery room instructions were clear; if there were any unexpected experiences; and if they would use the service again or recommend it to others. She averages about a 25 percent return rate, with 95 percent of the returns being positive.

8. Know what's new. Ms. Stancel says her efforts to keep abreast of developments within both health care and practice management have taken her surgery center to the top of its class. "It's crucial to stay ahead of the information curve with respect to knowledge of equipment, trends and changes in coding, among other things," says Ms. Stancel. Ivan Jacobs, MD, an ophthalmologist at the Eye Care & Surgery Center of New Jersey, agrees. Besides going paperless with computerized electronic medical records, Dr. Jacobs and staff have streamlined their operation by using an integrated database of patient information to create operative charts that they e-mail to the surgical center. "The information only needs to be input one time. This lets our one secretary handle our annual volume of 1,700 cataracts, 300 Nd:YAGs and 300 various other ophthalmic plastic and reconstructive procedures," says Dr. Jacobs.

9. Control costs. Containing supply and equipment costs is key. Ms. Stancel deals with as few suppliers as possible, but never limits herself to one. "If a better price comes along, I want to have the option of taking advantage of that," she says. Tom Mitros, MD, on the other hand, deals strictly with one supplier for equipment and disposables, and says that strategy works out perfectly for the Surgery Center of Salem County, in Salem, N.J. "We have a deal that is very competitive. It's never been worth our while to switch out of our contract," says Dr. Mitros, an anesthesiologist and the administrator of the center. Christina A. Kennelley, practice administrator of the Shepherd Eye Center in Las Vegas, relies on the bargaining power of AmSurg, a partial owner of the surgery center. "AmSurg is a publicly held company that has partnered with more than 100 surgery centers - most of which are ophthalmology or GI centers. With that kind of buying power, we can count on them negotiating pretty favorable costs for us," she says.

10. Be prepared. Dr. Mitros says preparation equals safety and success. "The more prepared you are and the fewer distractions or delays there are on the day of surgery, the more efficient the unit runs," says Dr. Mitros. "It's not only about quick turnover time. If the patient goes home with the wrong IOL, it really doesn't matter how quickly the procedure was performed," he says.

Ms. Nataloni ([email protected]), a freelance writer specializing in ophthalmology, lives in Sewell, N.J.