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Q&A from the recent panel discussion "Achieving ASC Success In an Evolving Landscape", moderated by SIS' Daren Smith, RN, BSN.

In honor of National ASC Month, SIS hosted a special panel discussion about the present and future state of the surgery center landscape. The ASC industry leaders invited to the conversation took some time to share guidance from their viewpoints and help ASCs navigate the challenges and capitalize on opportunities in an ever-changing industry.

The panelists were Katie Pierson, DNP, RN, ONC, Administrator of Spicewood Surgery Center, Alfonso del Granado, MBA-HC, CASC, Administrator & CEO of Covenant High Plains Surgery Centers, and Beth Russell, MSN, RN, CASC, Executive Director of Knoxville Orthopaedic Surgery Center. The panel was moderated by Daren Smith, RN, BSN, Vice President of ASC Solutions at Surgical Information Systems.

Below are the highlights from the discussion provided by the panelists, edited for readability. To view the webinar on-demand, please visit SIS’ National ASC Month webpage.


Q: What have been some of the biggest changes faced by the ASC industry since COVID-19?

Katie: Since the pandemic has started to calm down a bit, I think the ASC is increasingly being looked at for higher acuity cases. Additionally, we’re trying to push payers, specifically Medicare, to really understand that these procedures can be done safer and cheaper in an ASC setting.

Beth: The surgical volumes coming from hospitals into ASCs have been huge. Physicians want to do as much as they possibly can in an ASC. Another eye-opening realization for us was how fragile the supply chain can be. One day you can order materials and the next day you can’t, and prices are increasing.

Alfonso: Another leg of this is labor – we’re all suffering from a tremendous labor crunch. We have to bend over backward to keep our staff satisfied without the ability to significantly increase our compensation because we don’t receive the same kind of reimbursement that a hospital does. So, we’re coming up with creative ways to keep the staff satisfied and keep them productive.


Q: Due to the evolving landscape and higher acuity cases coming into ASCs, what have you implemented to help make it easier for your physicians and staff?

Beth: When looking at bringing those larger cases on and moving cases back and forth out of service, we’ve increased a lot of supply and capital costs. SIS Analytics, with the case costing module, has helped us pull out some good case costing data to get in front of the physicians. That’s important when we’re trying to decide which cases we can do, and which need to go elsewhere. Our physicians have been very receptive and engaged when we talk about case costing now.

Alfonso: We just implemented SIS Complete at our surgery center. Previously, everything was on paper and it took a tremendous amount of work. I’ve actually had interns from the local college come in and essentially convert stacks of paper into usable data to help us implement some efficiency programs. By putting the EHR to use, it will help us have that data available quickly and easily.

Katie: SIS Complete has two things that we’ve implemented most recently that have really been game changers for our hires, and especially the anesthesia providers. The Nextimatic devices allow us to pull vitals automatically, and now, I’m attracting CRNAs more than ever before. They’re telling their friends “If you go to this surgery center, you basically don’t have to chart anything.” The software makes it so minimal. On top of that, the SIS Anesthesia module makes it so easy for the anesthesia providers. They keep telling me that they thought the computer was going to take time out of providing patient care, but now they’re saying they can’t imagine not doing it this way. Also, a lot of the younger people coming out of hospital systems who are using computer-based systems are enjoying the synonymous workflow. This has been really helpful in offsetting some of the challenges.


Sometimes, when we show our physicians the case costing data, they’re surprised. They say, “That costs how much? Well, I’m never going to use that again!” I love it when I have meetings and we talk about case costing, and then I’ve got five doctors in my office the next week saying, “Okay, let me see mine. How much is my case compared to my partner’s case?” I really like SIS Analytics.”


What sorts of automation are you using to help gain efficiency in your surgery center?

Katie: From a preop and postop standpoint, we push out patient questionnaires and instructions so that I really only have my staff calling patients that have egregious yeses or severe health history. We’re not spending a lot of time on the phone.

Alphonso: We use automation for physicians to be able to schedule their cases themselves at our center. We also have a patient portal that enables patients to put in their histories as well as make payments, which is phenomenal. It certainly gives a lot of time back to our staff.


We’ve all seen the numbers – we’re all experiencing staffing issues. What are the things that you can offer to get staff to come to your centers over going to the hospitals?

Beth: We try very hard to sell the ASC lifestyle and culture. It’s just different than the hospitals. We’re lucky to have a building full of staff that started at the hospital, so they know the difference and can talk to their friends. We also try to be flexible with staff schedules where we can. I want people to love their job and love coming to work, so the culture is very important.

Alphonso: Employee appreciation, even daily. Whether it’s a huddle or taking the time to sit down and listen to someone’s concerns, we’re supportive and want to help them walk through whatever the problem is. Even if I’m not able to solve the problem, they’ll usually feel better at the end of it. So, it has to be real appreciation, not just money that you’re throwing here or there. No one is going to refer someone to work at your center unless they genuinely believe that this will be a better place for that person. They have to have faith in you and believe that this is the place where that person is going to thrive.

Katie: We’ve had to get creative over this past year, specifically because we lost all of our scrub techs to the hospitals. I couldn’t find one within a 50-mile radius, and I live in Austin, Texas – it almost felt impossible. Our PRN scrub tech actually agreed to cross-train our nurses to be scrub nurses, and it opened up such a world of opportunity. It’s such a great venue for that, because at an ASC you can do that kind of stuff.


“We’ve had great retention because no one is bored – everyone has a role 'plus'. In the hospital, we’ve always seen that as a daunting thing, whereas now, everyone sees it as a badge of honor. Not only is it building their resume and their experience, but they also have more vested into the facility.


Q: What kind of outsourcing are you doing at your center and how do you monitor it to make sure you’re getting the same quality as you would in-house?

Katie: We outsource with SIS RCS. They do all of our coding and claims, and manage everything from an RCM perspective. Our Business Office Manager is always in communication with the SIS RCS team – we do monthly phone calls and SIS provides the audits of their own work. There’s a lot of conversation around what and how we’re doing, and SIS makes ongoing adjustments to better optimize our revenue cycle. That’s been really helpful.

To watch the full discussion and learn more about what these panelists are doing in their individual surgery centers, visit SIS’ National ASC Month webpage.