In times of decreasing reimbursements, ASCs need not lose heart: they can increase profits by using a variety of innovative products, processes, technologies, and strategies. Read on for some true stories from ASCs that did just that.

First, the Products

When one ASC transitioned from using retrobulbar and peribulbar blocks to topical anesthesia for cataract patients, for example, the shift led to significantly shorter patient wait times and a notable increase in patient satisfaction because patients could now see out of their operative eye immediately after surgery, says Stephanie Carlile, MBA-HCA, BSN, RN, a nurse consultant for Medical Consulting Group, LLC, a health-care consulting company in Springfield, Mo. Expenses related to cataract cases also decreased. “This was a $17 per case savings, not including that we decreased staffing by one FTE which is about an $80,000 savings annually on staffing,” she says.

Key-Whitman Eye Center in Dallas, found benefits when using a topical anesthetic (i.e., phenylephrine/lidocaine) in the operating room, as it reduced surgical times and throughput. Patients can be taken to the operating room without first being fully dilated. “The additional cost is minimal considering how many more cases we can complete per day,” says Nikki Hurley, RN, MBA, COE, director of surgical services. “Patients are happy to have the full surgical process completed within an hour.”

The introduction of the light-adjustable lens (LAL, RxSight) in 2019/2020 prompted a shift toward increased same-day bilateral cataract surgeries, or immediate sequential bilateral cataract surgery (ISBCS). With adjustability, the need for staged surgery to assess the refractive outcome of the first eye in planning for the second eye is eliminated, says Stephanie 
P. Chen, MD, a cataract, cornea, and refractive specialist at Peninsula Eye Surgery Center in Mountain View, Calif. The number of ISBCS increased from rare cases before 2020 to 171 in 2023, the majority of which were bilateral LALs. The shift toward ISBCS provides flexibility in surgeons’ scheduling of cases (including more complex cases), Dr. Chen explains.

“Moreover, specifically for bilateral LALs, it improves scheduling efficiency for surgeon’s who have limited block time each month since it enables both eyes to be operated on simultaneously, and therefore both eyes adjusted at the same time,” she says. 

Patients remain in the operating room after the first eye is completed while the room is cleaned and a new sterile field is opened. The second eye is separately prepped and draped. Turnover time is significantly reduced because patients don’t have to leave the operating room before a new patient is brought in. On average, turnover for ISBCS between eyes was halved from approximately 10 to 5 minutes, Dr. Chen reports. 
“It has given us the option to add maybe one to two additional cases per surgeon discretion," she says.

An additional advantage for patients electing bilateral LALs with ISBCS is reducing their number of visits to an ASC.

Process Improvements

ASCs can also reap benefits from process improvements. Carrie Jacobs, COE, administrator and executive vice president of operations at Chu Vision Institute in Bloomington, Minn., says using Shareable Forms has been a game changer. The platform digitizes existing clinical forms into smart documents which team members can access through a secure app.

By eliminating paper records, the ASC realized significant savings on the cost of paperwork and secure storage because records are stored in the cloud, Ms. Jacobs says. Time spent preparing charts for surgery was reduced by 65%. Smart features ensure accuracy and streamline chart auditing. Charting, documentation, and signing is done on an iPad, which enables team members to stay focused on patients.

Chu Surgery Center also uses Microsoft Teams, which offers workspace chat and video conferencing, file storage, and integration of proprietary and third-party applications and services. The ASC uses the platform to communicate internally regarding everything from the team roster for surgery day, to updates to patient schedules, supply needs, and more.

Todd Albertz, CASC, director of healthcare solutions at Eckert Wordell, a health-care consulting firm in Kalamazoo, Mich., says using an electronic patient tracking system rather than paper methods can improve efficiency. The system, incorporated into an EMR (NextGen), allows an ASC to track patients’ journeys during their stay in real time. He advises positioning monitors with touch screens in sterile corridors as well as pre-operative and post-operative areas, so staff can see where patients are and manage schedules accordingly.

“This can eliminate confusion and multiple calls to different staff throughout the day, especially on bad weather days when many patients cancel,” Mr. Albertz says.

Improving Workflows, Team Coordination

Having consistent staff in specific areas each day can make a huge difference in streamlining workflows and improving coordination among a surgical team. “Consistency helps ensure smooth operations and enhances the overall efficiency of procedures,” Ms. Carlile says. 

“Keep staff engaged and motivated in order to maintain high efficiency and productivity by offering lunch on busy days and awarding ‘employee of the month’ gift cards, which both staff and physicians vote on,” Ms. Carlile says. “These gestures make staff feel valued and recognized.”

Before each surgery day, staff members at Chu Surgery Center have a team huddle for
5 minutes to review the day’s schedule and any changes, discuss if any visitors or VIPs are coming, and ensure that everyone is ready to go.

After cases are completed, the team meets to discuss the day. Weekly team meetings and monthly staff education on different educational opportunities from clinical to surgical topics are also held. “Communication is one of our strongest pillars and is the cornerstone to employee engagement and retention,” Ms. Jacobs says.

Adding a concierge at check-in is another recent change that has increased efficiency at Chu Surgery Center. The concierge greets patients and obtains the responsible adult’s name and phone number, which is entered into a Google document. Then, they’re assigned a parking space. When a patient is ready to leave, the responsible adult is called and given discharge
instructions. “Communication on the front end allows discharge to be smooth, and efficient,”
Ms. Jacobs says.

Ms. Jacobs also recommends hiring an expeditor to turn over and set up operating rooms with a scrub tech. “Investing in this person pays off in dividends, especially when an ASC has efficient surgeons,” she says.

Mr. Albertz suggests implementing a robust training program for onboarding staff, which should include job shadowing during the interview process. “This allows potential hires to experience a high-volume ASC’s fast pace, and helps a center to weed out candidates and ensure that new hires can keep up,” he says.

Adding New Technologies

New technologies can also impact efficiency significantly. When Peninsula Eye Surgery Center implemented Johnson & Johnson Vision’s Compact Intuitiv phaco machine for its highest-volume surgeons, the ASC realized significant cost and waste savings. J&J Vision has the only reusable phaco pack on the market, which is compatible with its Compact Intuitiv machine,
Dr. Chen says. After the first use, each pack, including the tubing and cassette, is cleaned and sterilized per protocol, and can be reused 19 times for a total of 20 uses before discarding. 
Whenever a new technology is added, staff members at Key-Whitman Eye Center identify potential pitfalls and how to avoid them. When the implementation day is completed, the group discusses how things went.

“This engages the group to help them problem solve and make execution a better experience for patients, doctors, and the team,” Ms. Hurley says.

Ms. Jacobs has found that one of the biggest challenges of employing a new, insurance-based technology is determining how reimbursement works. “Understanding a payer’s position and conditions for coverage is critical in order to ensure that an ASC receives payment,” she says.
Evaluate how a new technology would benefit your facility before purchasing it and try it out if possible, Ms. Jacobs says. Determine the amount of disposable costs, click fees, service agreements, and so forth. Try to negotiate volume discounts.

Ensuring Investments are Worthwhile

Most innovations have an associated cost with implementation. “Strive to select changes that you expect will significantly reduce staff time on monotonous tasks such as chart automation products and using artificial intelligence where possible for data entry,” Erin Malloy, managing principal, Medical Consulting Group, LLC, in Springfield, Mo., says. “Keeping core staff happy drives down costs associated with turnover and overtime.”

Performing a return on investment (ROI) analysis for new initiatives is an important part of the process. “I have discarded many initiatives because the ROI didn’t make sense,” 
Mr. Albertz says. “The key is to do your homework, ask questions, perform a complete analysis, and involve all key stakeholders in making decisions.”

Don’t Miss a Beat

Attending major society meetings such as the Outpatient Ophthalmic Surgery Society, American Society of Cataract and Refractive Surgery, and American Academy of Ophthalmology and exploring their exhibit halls is a great way to stay abreast of new technologies and trends,
Ms. Jacobs says. Smaller meetings such as Caribbean Eye have specific ASC tracks. Networking is also key. 

Mr. Seals says his organization’s innovation is often inspired by ideas that team members see in other health-care settings or service industries. “One of the greatest opportunities in the ophthalmology space will be the ability to leverage technology and the pace of innovation enabled by artificial intelligence,” he says. OASC