Here are five considerations for building a strong surgery center.
1. Define “start time”
According to Larry Teuber, MD, president of Medical Facilities Corp., the company conducted a poll that asked surgeons to identify the correct definition of “start time” out of a list of five selections:
- Patient leaves pre-op
- Patient enters the room
- Anesthesia begins induction
- Surgeon is called to the room
- Surgeon starts the incision
He says the surgeons’ responses ran the gamut, demonstrating that no clear standard existed. Different surgeons had different practices for interacting with the patient prior to surgery. “In the past, surgeons may not have seen the patient in preop before surgery, and now surgeons have to come in and sign the extremity [to decrease the incidence of wrong-site surgery],” he says. “So when you poll surgeons ages 30-60, the old ones show up in the OR according to the old rules, and the young guys think it’s a matter of routine to have a discussion and confirm site of surgery.” He says these differences make standardization all the more crucial.
“We now define start time as when the surgeon physically walks into the pre-op room and engages the patient in conversation,” he says. “That’s when the clock starts.”
2. Hire and train staff to excel in your subspecialty
In a multispecialty center like NorthStar, training OR staff to specialize in orthopedics improves efficiency in the OR and in providing supplies, says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. When staff is well trained, “the room turnover is better and physicians are satisfied,” Mr. Brock says. At NorthStar, staff members are still cross-trained in other specialties but there are crews whose primary focus in orthopedics. “This is not so much for clinical competency as for process competency,” he says. “They understand the nuances of certain products.”
3. Minimize coding mistakes
Physicians may list certain procedures in the procedure heading of the op note but will actually document different (fewer or more) procedures in the body of the operative report, says Jessica Edmiston, coding manager with National Medical Billing Services. You can tell the coders who don’t read the entire op note because the coding will match the procedure heading. She says coding from the procedure heading alone is incorrect. Coders must always read the entire operative report and question and discrepancies.
4. Embrace simplicity
“The latest and greatest technology often comes with higher expense and extensive and long learning curves,” says Chris Zorn, vice president of sales for Spine Surgical Innovation and executive director of Minimal Incision-Maximum Sight (MIMS) Institute. “Stick to what is proven, accepted and think about how much trial and experimentation with the newest technology really costs you, not only in the cost of the devices but the most important fact, your and your OR team’s time.”
5. Understand for meaningful use
ASCs are becoming increasingly aware of the meaningful use provisions — specifically as they relate to the perceived need to deploy a certified EHR as opposed to a system that may be more appropriately aligned to their environment, says Sean Benson, Cofounder and Vice President of Consulting, ProVation Medical. Since ASCs are not eligible for stimulus payments, and MU certification criteria for ASCs were never developed, there has been no real incentive or benefit for them to invest in certified systems. However, some ASCs are now feeling pressure to purchase a certified EHR and make costly technology decisions in order to satisfy the needs of their physician base. This pressure is the result of a little-known clause in the meaningful use regulations, referred to as the 50 percent rule. A clear understanding of the 50 percent rule and four other aspects of MU is imperative for ASCs and EPs as they weigh their responses to the mounting external pressures to deploy certified EHR technology.
Ref. Becker’s Healthcare
This post was first published January 30, 2012 and was updated July 29, 2020.