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00:00:01
QAPI Studies: What Surveyors Are Looking For
2 Plays9 minutes ago
We are continuing our three-part series about QAPI studies. Last week, we heard from Becky Ziegler-Otis, who shared some fantastic insights into how you can generate new ideas. And today, I had the chance to talk with Tina DiMarino. Tina is the CEO of Custom Surgical Consultants, a Board member of the Maryland ASC Association, and an AAAHC Surveyor. So Tina will give up the inside scoop on what specific aspects of QAPI studies surveyors typically focus on during an inspection.
After my conversation with Tina, we’ll switch to our Data & Insights segment. In September, HST released our annual State of the Industry report, which analyzed client data from 590 surgery centers. Today, I’ll share the cardiology trends we saw from 2023 to 2024, specifically around OR duration, revenue per case, and revenue per OR minute.
Resources Mentioned: HST’s State of the Industry Report
Brought to you by HST Pathways.
Recommended
Transcript
Introduction to ASC Podcast
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Co-op Studies with Tina DiMarino
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode. We are going to be continuing our three-part series all about co-op studies. Last week, we heard from Becky Ziegler Otis, who shared some amazing insights into how you can generate new ideas for your studies. And today, I had a chance to talk with Tina DiMarino.
00:00:46
Speaker
Tina is the CEO of Custom Surgical Consultants, a board member of the Maryland ASC Association, and an AAAHC surveyor. So Tina is going to give us the inside scoop of what specific aspects of QAPI studies surveyors typically focus on during an inspection.
State of the Industry Report on Cardiology
00:01:05
Speaker
After my conversation with Tina, we will switch to our data and insight segment. HST released our annual State of the Industry report this past September, which analyzed client data from 590 surgery centers. So today I'll share with you the cardiology trends we saw from 2023 to 2024, specifically around OR duration, revenue per case, and revenue per OR minute. Hope everyone enjoys the episode and here's what's going on this week in surgery centers.
00:01:37
Speaker
Hi, Tina. Welcome to This Week in Surgery Centers. Hi. Thank you for having me, Erica. Great to be here. Yes. Before we get started, can you please share your ASC background with our listeners?
Enhancing Processes with QAPI Studies
00:01:50
Speaker
Absolutely. I've been in the ASC industry for 24 years now, mainly all in leadership roles. I'm a certified administrator and certified OR nurse and have my doctorate in nursing practice. So we just had Becky Ziegler Otis on last week to kick off our three-part QAPI studies.
00:02:11
Speaker
And she did a great job of kind of laying the foundation of what QAPI studies are, why they're important, how to generate ideas for new studies. And today we're just going to take a closer look with you at what surveyors are looking for when they do come by. But first, from your experience, what role do QAPI studies play at a surgery center?
CMS Mandates and Accreditation Flexibility
00:02:33
Speaker
So they are the very tool that the Quality Assurance Department uses to create improvements within your center. So if you're having a trouble with any process, anything to do with risk management, safety, infection control, we'll utilize, the quality team will utilize a study to help implement corrective actions to champion change and bolster those processes.
00:03:01
Speaker
Got it. and How do CMS requirements differ from accreditation bodies in terms of what is required? so CMS really regulates what we need to do to meet those conditions of participation. so They delineate, hey, you need to study high-prone, high-risk areas. They also mandate that the studies need to be quantitative,
00:03:28
Speaker
that they need to actually have corrective actions implemented. And the the reason being is they don't want, CMS doesn't want like a one-off solution. Oh, the nurse made an error. So we fired her. We don't need to focus in on that anymore. That's not what they want. They really want you to dive in, figure out what needs to improve in any of your processes. and then they also delineate that they want those um changes to be sustainable. So they really regulate what they want to see in that where an accrediting body certainly wants to see an efficient and an effective quality program. And they have standards for which you know the ASCs are to meet, but they let the ASC delineate more on how they reach those standards.
Frequency and Focus of QAPI Studies
00:04:17
Speaker
So the differences in one's really regulated while the other is
00:04:21
Speaker
given you standards from which to work in. Got it. And do they have requirements in terms of frequency and how often you, or how many you have to do in a year? So I know CMS really wants to see it commensurate with your volume. I know that the very limited benchmark would be at least one a year. And then with certain accrediting organizations, you may have to do one or two.
00:04:47
Speaker
within your accreditation interval. So we always recommend at the very least that you're doing at least one study a year. Got it. Perfect. So from your experience, what specific aspects of the study are surveyors focusing on during their inspection?
00:05:06
Speaker
I think that surveyors really want to see that what you're working on is meaningful for your organization. I know, and Becky probably went over this, that ASCs have a really hard time figuring out, okay, what do we need to study? And so when a surveyor comes in and they they read your studies, they want to see, first off, is this something meaningful meaningful for your center? Are you really trying to improve a process? They're also going to look at what changes did you implement and did they work?
00:05:36
Speaker
Did you look at it again to see six months down the line? Was it sustainable? I think from a surveyor's perspective, they really want to dive in to make sure that what you're doing is actually helping your center. I know maybe you get challenged with trying to figure out, okay, what do we study? And you do things maybe in a rote manner.
00:05:58
Speaker
that really isn't improving anything in your center. You're just going through those motions. So really making it meaningful is helpful.
Common Errors in QAPI Studies
00:06:08
Speaker
Gotcha.
00:06:08
Speaker
and Are there common mistakes or oversight surgery centers make when preparing their QAPI studies? I think there are two that we see quite often. so One is not making that performance goal. so What you're taking from a benchmark, either an external benchmark or an internal benchmark, and you don't relate your performance goal in a way that is quantitative, sets your whole study up for not meeting the metrics. so You can take a retroactive chart study and find a quantitative percentage performance goal to meet with that. So we see that as something quite often is just taking taking whatever it is you're studying and and making it quantitative. Another thing that we see is that the ASC is they want to do a really good job. They want to really nail these studies.
00:07:02
Speaker
Oftentimes it's a mystery. How are we doing? Why are we doing it? what are How are we approaching it? And so we see them get lost in all of this data and detail instead of really succinctly just spelling out in a few sentences, what was the problem?
00:07:19
Speaker
What did they implement? What were those results and did it make an impact? And so we'll sit down and there'll be like an eight pages to a study. And by the time you get on page two, you're really lost in.
00:07:32
Speaker
What did they work on here? What did they actually implement? So I say one of the things that we see that is challenging is when they try to do too much detail or too much data instead of really focusing on the actual crux of what it is that they're trying to improve. So simpler is better in in my opinion.
00:07:55
Speaker
Yeah, for sure. And that just sparked another question. What is the format that you typically present your're your survey results to to the survey or or the study results to? Is it a Word doc PowerPoint spreadsheet? Do they provide a template? how does What does that look like?
Effective Presentation of Study Results
00:08:12
Speaker
I think that Plan Do Study Act, so PDSA, is a good format. I think that some accrediting organizations may offer a template or instructions or six steps or things like that, but really just plan, do, study, act. So focusing in on what's your performance goal? What did, what was the problem? Why is it important for your center? What are you going to implement? How are you going to re-measure it? So making sure that when you do your study and then re-measure it, you're comparing apples to apples.
00:08:46
Speaker
I think that any format is is appropriate as long as it's readable and simple. So you don't have to go through these elaborate steps and measures to really make a good study. It's just really focused in answering those simple questions and answering them as succinctly as possible, I think makes it more meaningful and impactful for the surveyor not to get lost in all of the other data or information that you're providing that may not be necessary. I hope that helped. Sure. Yeah. No, that makes a ton of sense. You've mentioned this a few times, but how can surgery centers ensure that their QAPI studies are both meaningful, which we obviously want them to be, but also aligned with the surveyor's expectations?
00:09:35
Speaker
Excuse me. So I think really focusing in on, ah i I would say start off with benchmarking, really comparing yourself if it's with another colleague with a similar ASC or a peer reviewed journal article, really, because we hear it all the time when we go into a center. Oh, we do everything great. We really don't have anything that we need to study. And I think that everyone honestly has room for improvement and how to find that information first off would be to really look at external benchmarks. Is your turnover time longer? Are you having any you know serious near miss events that you need to focus in on? But I think um making it meaningful would really be to dive in and find an area
00:10:21
Speaker
where um improvement can be obtained. So if you're not if you're looking at a benchmark, albeit external or internal, if you're not meeting that median, they' me if you're below it, there may be an area there or an opportunity for improvement. And I think that certainly garnering members of your team for help with this, because your team, if you're the administrator,
00:10:47
Speaker
They're in the weeds. They see things all the time where they're like, Oh, we could be doing this better. Or, Oh, I have a friend that said that they do it this way. So really champion that champion or empowering your team to really get involved. I know we're all busy administrators of are busy. So dividing up that work amongst the team and empowering them to participate is also really helpful and can make it more meaningful to the center because it with empowering them, they, they buy in and then changes become more fun. if If they're the ones that, Hey, let's look at this. And then they've realized we can make it better. If we do X, Y and Z, then the buy-in amongst them is a hundred percent more than if I come in and say, Hey, I think we need to change this or do that. but If it's actually coming from them or they're a part of it, you can ah champion it a lot better. Yeah. Yeah. I would imagine if the whole.
00:11:45
Speaker
team or office is all working towards the same goal, then it does almost become fun. How are we doing? You're all checking in, staff meetings, whatever it might be, could be exciting. Yeah. When you can do that, it it really does. I know it sounds whatever, but it can be fun and having everybody on that same mission and vision.
00:12:04
Speaker
Yeah. Do you ever run into a situation where let's say the QAPI study, easy examples use case cancellations.
Recognizing and Addressing QAPI Failures
00:12:12
Speaker
We're going to try to improve our cancellation rate when the next 90 days, whatever it might be. Do you ever run into a situation where it actually didn't, the numbers didn't improve and du what do you do in that case? Does that look bad to the surveyor or do you just say, Hey, we're going to continue this for another 90 days and now try X, Y, and Z instead?
00:12:35
Speaker
That's a really great question, Erica, and I'm glad that you bring that up because we see it all the time and I'm just going to change the topic a little bit to say on time starts. This is something that when I was a new nurse and a new administrator and docs were coming in late all the time and everybody was complaining, I was like, I'm going to impact change here. We're going to do an on time start study and we're going to make this happen.
00:12:59
Speaker
And I would you know do it and we'd get a minimal improvement and then 90 days later we would do it again and get minimal improvement. And it took me a good year before I realized that in certain instances where these surgeons are the owners and they're going to come in when they're going to come in, it doesn't matter what you do or what you're going to implement, change is not going to happen.
00:13:22
Speaker
And so, you therefore, you have to live with it. You either change that schedule to meet when the surgeon's actually going to walk in the door or not study that because you're really not going to affect change in that regard. To your point on case cancellations, that can be seasonal. Everybody's coming down with viruses now. You're going to have cancellations. There's really not a whole lot you're going to be able to do to affect change there. So really knowing when to stop a study as well is paramount because we'll see going into certain centers who've been established and doing things. They'll they'll do things out of root. We're studying this again because we haven't met our mark and they'll keep doing that in ah in in my mind.
00:14:06
Speaker
That's like a little bit of wasted man hours because change is not going to be affected. It's just something that you learn to, this is how it's going to be. And you try to change things to meet that if you will, and not really that you're going to bolster up the score to meet something, a metric that you put out there.
00:14:24
Speaker
Yeah. And I think at the end of the day, they did you did learn something. There's nothing we can do about this on time start issue. And yeah, so we're going to try to negate it in other ways. I think that's there's a lesson in there there somewhere as well. Yeah. It took me a while to learn that one, but then I finally got the hang of that. Yeah, for sure. The doc wasn't coming in any early, no matter what I said. Yeah. Yeah. I'm sure there's a lot of people listening who can definitely relate to that. Yeah.
00:14:55
Speaker
For sure. All right. Final
Team Involvement in QAPI Studies
00:14:57
Speaker
questions. You know, we do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers? I think empowering team participation. I think that as administrators and with as busy as everything seems to be these days with staffing and surgeries picking up and things like that.
00:15:18
Speaker
really considering empowering your team and and delegating out things evenly along the way. It does twofold. It helps ah your administrator not be so overburdened as to doing all of it on his or her own, but it also empowers the team to buy in more. So really targeting the team to help with different things that interest them, infection control or quality or risk or safety. so I really think empowering the team to participate will really help your ASC in its improvements and then also help just in an overall teamwork aspect of everything. Love it. Thank you. That is great advice. Thank you so much for coming on today. We really appreciate it. Thank you, Erica. Thanks for having me. It was great talking with you.
Cardiology Trends and Payer Contract Advice
00:16:10
Speaker
HSC Pathways released an updated version of our annual City of the Industry report this past September, highlighting best practices, key process steps, and KPIs for every step of the patient journey and for nearly every recurring administrative duty. Most importantly, using our own unique data set from our clients, we were able to extract data points so that anyone in the industry could compare themselves to their peers. To disclaimers, we only pulled data from clients who gave us permission and we omitted any extreme outliers.
00:16:39
Speaker
So today we're going to take a look at cardiology trends from 2023 to 2024. If you've been paying attention to cardiology and ASCs, you know it's been a super hot topic, especially with revenue per case being one of the highest among all specialties, second only to ortho. But there are some interesting shifts happening that we should break down.
00:17:01
Speaker
So let's start with three important metrics to know. Between 2023 and 2024, cardiology procedures saw a 20% decrease in OR duration, going from an average of 48 minutes per procedure to 34.7 minutes per procedure. Also from 2023 to 2024, cardiology saw an 8% decrease in net revenue per case.
00:17:26
Speaker
Now at first glance, lower revenue per case might seem like a red flag and it's definitely not ideal, but here's where things get interesting. Thanks to those efficiency gains in OR duration, despite revenue per case dropping, the revenue per OR minute actually increased by 27% from about $104 per minute in the OR to $132 per minute in the OR. So that's a huge win.
00:17:54
Speaker
So what's driving these trends? First, let's talk about efficiency. With more experience performing these procedures in the ASC setting, surgeons and staff are naturally moving faster. They've had time to refine workflows, optimize processes, and adjust to an outpatient environment. That experience translates to shorter OR times while still maintaining quality and safety.
00:18:16
Speaker
Then of course, there is the technology factor. Advancements in system, imaging systems, tools, minimally invasive techniques are making it possible to complete cases faster without sacrificing outcomes. And these innovations are a major reason why we're seeing shorter OR times.
00:18:33
Speaker
But what about the decrease in net revenue per case? So this is where things get tricky. One possible explanation is, of course, payer reimbursement policies. So even though technology is improving and procedures are becoming more efficient, payers may not be fully recognizing these advancements in their reimbursement rates.
00:18:52
Speaker
If contracts haven't been updated to reflect the value of quicker, higher quality procedures, centers might be leaving money on the table. Another factor could be shifts in case volume. If ASEs are handling more lower complexity cardiology cases or increasing volume overall, but at a lower price point, that could contribute to the drop in revenue per case as well.
00:19:15
Speaker
So if you're performing cardiology cases or recently started offering them, take a close look at your payer contracts, see if there's room for a renegotiation, especially if your case mix has shifted or your OR efficiency and your outcomes have improved. And hopefully when we pull these numbers again in 2025, we'll see that this trend will start to correct itself.
00:19:37
Speaker
But the bottom line is that cardiology and ASCs is growing, becoming more efficient and still generating strong revenue. Staying on top of payer policies and contract negotiations will be key to making ah sure those revenue gains aren't lost. If you're interested in more data points and use cases, subscribe to our podcast so that you don't miss any upcoming segments, or head to our website to check out the full state of the industry report to get your hands on even more data.
Conclusion and Call to Action
00:20:03
Speaker
And that officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we will see you again next week.