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Gregory DeConciliis – Opening an ASC: Clinical Preparation
112 Plays1 year ago
Greg DeConciliis is a Physician Assistant and Administrator at Boston Out-Patient Surgical Suites. He spent time with us today to share tips and insights on properly preparing the clinical side of the house while you are opening a new surgery center. In this 5th episode of our De Novo series, we’ll cover who your first hire should be and when, which clinical team members you must have in place to receive all the necessary licensing, preparing for quality reporting, and other clinical considerations to keep in mind.
In our news recap, we’ll cover what the future holds for the outpatient surgery workforce, a decapitated boy who was saved by his surgical team, tips for working with local authorities to create an emergency plan, and, of course, end the news segment with a positive story about a groundbreaking surgery gave a woman her voice back.
Articles Mentioned:
5 ASC leaders on meeting workforce expectations
'Decapitated' Boy Saved by Surgery Team
Work With Local Authorities to Create an Emergency Plan
Groundbreaking surgery gives woman her voice back
Interesting in learning more about opening a new surgery center? Check out our related episodes:
- Michael McClain – Opening an ASC: Navigating Payer Contracts
- Wil Schlaff – Opening an ASC: Conducting a Comprehensive Feasibility Assessment
- Dawn Pfeiffer – Ask the Expert: Best Practices for Opening a New Surgery Center
- Beata Canby – Opening an ASC: Managing the Regulatory and Certification Process
Brought to you by HST Pathways.
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Transcript
Introduction and Format Overview
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. Hi, everyone. Here's what you can expect on today's episode.
Preparing Clinical Operations for New Surgery Centers
00:00:31
Speaker
Greg De Consilius is a PA and administrator at Boston Outpatient Surgical Suites, and he's on today to share tips and insights on how to properly prepare the clinical side of the house while you're opening a new surgery center. In this fifth episode of our De Novo series, we'll cover who your first hire should be and when, which members of the clinical team you must have in place to receive all the necessary licensing, how to prepare for quality reporting, and just other clinical considerations to keep in mind.
Innovations and Workforce Predictions in Outpatient Surgery
00:01:02
Speaker
In our news recap, we'll cover what the feature holds for the outpatient surgery workforce, a decapitated young boy who was saved by his surgical team, tips for working with local authorities to create an emergency plan, and of course, end the news segment with a positive story about a groundbreaking surgery that gave a woman her voice back. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
00:01:34
Speaker
Greg, welcome to the show. Thank you for having me.
Key Roles in Opening New Surgery Centers
00:01:37
Speaker
So Greg, we are doing a series of podcasts here on the de novo process to open a new facility and wanting to focus our conversation today on the clinical side of the operation. And so first question for you, at what point did the de novo process, should owners start to think about preparing for the clinical side of the house? Sure. So I look at this in a couple of different ways. First off,
00:02:02
Speaker
If it was just owners and they had nobody else affiliated with the ASC, it's a group of docs out there trying to go open up a surgery center. You should have somebody who's involved again. And this isn't like a selfish plug here, but something like an administrator or something like that, who is there, who you commit the cost to, to oversee docs are busy being docs. The management company, typically the management company may handle some of these services, but let's look at their situation and it's good to have somebody.
00:02:27
Speaker
on board a higher level person, administrator type who has the authority to function as a CEO and make some of these everyday decisions that you're going to need. So the docs can't be bogged down with all the details. And so that question of then who is that administrator? Who is that person? Administrators, I think we see as often clinical, like they're often nurses who have transitioned into this administrator role, but they could also just be business focused. And so with the clinical question that you asked,
00:02:53
Speaker
If they're not clinical, I think then you look at having bringing on some kind of manager as like a nurse manager or some kind of person who has some clinical background to answer all of these clinical questions that'll pop up. And it's not just what kind of products we have to order and all that kind of stuff. It's also like, how do we set up policies and procedures? What kind of equipment or even early on airflow and different devices we may put in the room, we build in the room.
00:03:19
Speaker
that you may need to make sure it functions to be clinically efficient and clinically approved and all that kind of stuff. And so every situation is different. And the answer is simply a clinical person should be on very early because those issues can start very early on even in design. But if somebody is listening, they've already passed design, they're at the stage of it's being built, et cetera. All those equipment decisions have to take place. Those take a while. There's lead times on some of these things. And so.
00:03:45
Speaker
I would say it would be worthwhile to make the investment as early as possible. And if that person can also handle higher level decisions, CEO type decisions, that's even better.
Clinical Expertise in Licensing and Credentialing
00:03:55
Speaker
Got it. So it sounds like in an ideal world, you've got an administrator or someone with some clinical experience that can help in the design and preparation stage. What about as you get closer to opening? What is the order of operations around hiring clinical staff?
00:04:13
Speaker
Yeah. So then if you're close to opening, there's so many clinically applicable processes that have to take place that again, if you're an administrator who's just been running the show the whole time, getting things going, you should bring a clinical person on ASAP. I feel again, it's an expense, but there's going to be so much to do bringing on somebody to the higher level, like a manager type thing is probably going to be easier. And they probably would have the skillset then to do some of the hiring and some of those processes.
00:04:39
Speaker
And so I think that nurse manager type person or maybe even somebody who if there's, you can't find a good nurse manager or the group doesn't want to make that commitment right away. It can be somebody who an OR nurse or an experienced PACU nurse, somebody who can actually help with some of those, again, policies and clinical decisions. So I think that's the first person and the second person or even one A is probably a materials manager type person who would help with a lot of the ordering from things like, again,
00:05:05
Speaker
lights and booms as big as that down to bedside tables and kick buckets. And so there's a lot of things that take place and don't forget when those things come in, they have to be put together and there's all that element. So I think there's when that decision making tree cost is probably part of it and how much to spend, how much you want to spend and at what point, my point is like the bang for the buck type thing. You may get somebody who's a little more experienced with a little more of a managerial type function in the past that they can really help you out. Sure.
00:05:34
Speaker
But what about licensing, which is certainly part of the de novo process and getting licensed and credentialed. Does clinical background and expertise important or play into that licensing process? Yeah. I think so many of those licensure and certification elements are clinical. There's certainly a lot of business aspects as well. And so having someone who's clinical to help even with the application, but to prepare for those surveyors to come in.
00:06:00
Speaker
You usually have to start with these test cases and then you have to go through the business aspects of contracting. If you don't go through test cases and your facility doesn't get CMS certified and AAAHC, whoever they're going to use, you can't get those insurance contracts. And so that clinical person tees you up for that and tees you up for those test cases and the ability to actually start performing surgery. So I keep talking about kind of spending and bringing people in and all that kind of stuff. I think where you can cut back is that there's definitely a lag between forming those test cases.
00:06:28
Speaker
Having the accreditation certifications, all that kind of stuff done, the licensure stuff. And so you don't want to just hire all your staff, assuming that on our case, we're going to open up eight rooms. All eight rooms are open. You get enough staff, a nurse, a tech, and again, support staff, sterilization, tax, all that kind of stuff.
00:06:44
Speaker
enough to just run one room and do those required test cases. And then you can take that lag time to then do hiring and bring in new folks. I think it's helpful. I always say the best way to hire people is word of mouth. And so utilize your docs. And again, bring in your best person to start. Maybe your person is more of a go-getter who's going to be willing to put some extra time into, again, build something, put something together and that type of thing. Really, they're not shy from looking at policies and procedures and doing paperwork and all that kind of stuff. Those are your first 10.
00:07:13
Speaker
And then you can start highlighting and do that second round. Well, after those test cases are done, those kinds of certifications are done. And then you're getting ready to open. Well, from your survey.
00:07:22
Speaker
Yeah. And I think that's a good tip because it sounds like those test cases are an important part of the process and the licensing process. And so, you know, staffing up for one room. And then as you get closer to opening, you know, for your facility as an example, I'm sure you didn't go day one, all eight ORs are just full go, right? Your, your case volume over time, which allows you to staff in phases. And use your head like, so if your nurse manager is also an OR nurse or also a PAC unit or pre-op nurse,
00:07:51
Speaker
have them be in the mix early on at the onset, let them realize that you're going to be managing all these things. But early on, you're going to have to be a working manager. And it's going to allow us to hold off on hiring that additional owners, that additional packiness, you're going to function that role until we have enough insurances on board, et cetera, to start opening up the volume. You know what I mean? So yeah, stepwise plan that is smart, is thought out well, and hopefully relies on somebody with some experience to help you formulate that.
00:08:17
Speaker
Yep. Yep.
Technology's Role in Efficient Operations
00:08:19
Speaker
Okay. Great. Want to talk a little bit, Greg, about the quality reporting side of it. And I think that CMS currently has 20 or so quality reporting measures that you've got to report on. I think there's another one proposed for 2024. They'll take it to 21. What tips or best practices have you seen for new ASCs to develop infrastructure groundwork systems to start measuring or reporting on those quality measures from the beginning and take that in mind as you build out the process?
00:08:48
Speaker
Yeah, it's a really good question because some things like this sometimes are on the put in the back burner. And then again, you start with your processes and you're like, Oh, I forgot about this. So I think the key piece for us has been assigning individuals to handle each quality measure that one, two, three, five, 20, whatever they are. And how are they going to be able to collect the data? How do they be able to report it? Do they have all the resources they need to go ahead and get that going? And so, yeah, I think if we're thinking about de novo projects, putting systems in place that
00:09:16
Speaker
allow you to track this efficiently to maybe even the technology reports it for you, whatever it is, but making sure that there's accountability in reporting it. And again, it's as easy to do as possible. And again, for us technologies help with that different systems that we use. We just went to an EMR in January. And so I think again, some of the smarter systems now that the newer technologies are aware of these such things and help you with the data collection, et cetera.
00:09:42
Speaker
Great. What about the clinical workflows as you get set up just in terms of, Hey, how do we treat different types of cases? Who does what? How do we get a rhythm and mojo going? Is it challenging to do that from scratch with the new facility? Yeah, definitely. I think what I find challenging, and again, we're an existing center and have been here for 19 years. And I'm fortunate to have that experience now going forward with our new project. But there's so many different technologies out there. Who can you work with?
00:10:10
Speaker
to get the biggest bang for your buck. There's just no question that the margins in our business have to be tight because of how it reimbursed. And so utilizing technology to streamline your processes and that type of stuff is really key. And so my thought would be, take that time as you're ramping up and the early stages as you're filling your days with a million different things, but looking to evaluate technologies and find out the ones that can work for you best that you can implement right off the bat. And again, they're going to help you with efficiencies and costs and staffing,
00:10:38
Speaker
all these types of things that are out there. So work smarter, not harder. Again, people say it all the time, but it's really true. There's a lot in trying to get a technology that gives you multiple offerings and biggest bang for your buck.
00:10:48
Speaker
Yep. And I think sometimes facilities that are looking to implement EMRs that are established facilities and have processes in place sometimes find it a challenge to shift to a software-based system where they may have to change some process and operations. Have you found that it's potentially easier if you're starting a facility from scratch and hey, we're going to use an EMR or we're going to use a clinical workflow system and you can design your processes with that in mind?
00:11:16
Speaker
thousand percent. I think it's just, it's the old adage. Everyone hates change, right? And so if you do it from the onset, and I think it's an important thing to think about and I'm happy you bottle up because it's one of those things where again, everyone's concerned about costs and say like, Oh, to pay this at the onset, why don't we just open up? And then when we get a little bit of some money together and we get some good volume going, we'll transition. I just think things like, again, like EMR is a perfect example. Starting from scratch is the way to go. And I actually find that companies these days
00:11:44
Speaker
If you actually talk to them and treat them as a true partner and go over your pain points and your hesitations, they'll oftentimes will work with you. Everyone wants the business right. And they'll probably understand that having you as an early adopter is key. And so, you know, so many of these EMR companies now have add-on features that you can do. And so as I mentioned, biggest bang for your bucket, I'd start there and see what those companies can add on.
Process Improvement and Adaptation
00:12:08
Speaker
And it's just a little bit of a plug for you guys, but you guys have,
00:12:11
Speaker
so much in your bag, right? And sort of some of the other companies as well. And so see what's offered under one umbrella first, and then you can go on and piecemeal some of the other things. Sure. What about working out the kinks? As you start to ramp up case volume, as you start to go from one room to two, what have you found is helpful in terms of the early days, the clinical operations in terms of working out the process and the kinks as you scale?
00:12:40
Speaker
My biggest recommendation would be don't get stagnant and just keep going. I think early meetings, as much as it can be painful, I think there's time early on, but meeting with the staff as often as possible. And for us, and I mentioned this in my last podcast, I think one of our biggest key success was having monthly meetings for not only our staff, but our surgeons as well that were owners in the facility could have some kind of impact and communicating everything to them. It was really key. Not a long meetings. It was a focus meeting.
00:13:08
Speaker
on certain topics. Some things can get brushed over, but some things they're involved in. And so I think same thing with the staff. As you get going, you figure out what went well this last case or this last week and what can we do better. And again, it sounds cheesy, but.
00:13:19
Speaker
It's really important, I think, to make sure you're running things as smoothly as possible. And then when new folks come in, even in the hiring process, you have to let them know, listen, you're going to have to be really flexible when you come in and realize this is the way we do things. And you're going to have to adopt the way we do things. We're always open to listen to change and to doing things better, et cetera. But you're going to have to listen to how we do things. And we have a process we go about and like, we turn over a room, we do it this way. When we admit a patient, we do it this way. Tell us how we can do it better, but this is our process and this is how we're going to do it. So, and we're always going to be reevaluating, but involving staff and the docs and that.
00:13:50
Speaker
I think it'll be really beneficial. Yep. Makes sense. Greg, final question for you. And we do this each week with our guests. What is one thing our listeners can do this week to improve their surgery centers? Yeah, I think it just goes hand in, which I was just talking about. I know for myself, it's the same thing. We know there's all this technology out there and they know there's all these different ways we can do things using computers and iPads and streamlining processes.
00:14:14
Speaker
But I think all of us associate it with cost. And I think people just got to take the time to evaluate some of these companies, realize that they may be putting some money out front for sure. But the return on that, on efficiencies and on doing things better from clinical quality to staff satisfaction, patient satisfaction, surgeon satisfaction, the return is exponential. And so take the time to do it. Don't be scared of it.
00:14:39
Speaker
And I think you'll find that there's going to be a lot of benefits in the back end. I know we're coming to the end of the summer here and that's when people have a little extra time to do things. It's going to get busy again in the fall, but if you can carve out some time to just evaluations early on, I think we found that we took the plunge in a lot of these things and it's really changed the way we do things for the better. Fantastic. Greg, appreciate your time. Enjoyed the conversation. Thanks. Thanks for joining us today. Thanks again for having me. Appreciate it.
00:15:06
Speaker
As always, it has been a busy week in healthcare, so let's jump right in.
Future Workforce Trends in ASCs
00:15:10
Speaker
Five administrators shared their predictions with Becker's ASC on what the future holds for the outpatient surgery workforce and how they see it changing in the next two to three years. So at a high level, here's what each admin shared.
00:15:26
Speaker
Les Jebsen from Prisma Health shared that ASEs have historically benefited from predictability in work hours and perceived overall quality of professional life. But with labor market strains and rising salaries due to limited labor pools, they suggest keeping an eye on employee turnover rates in frequency and doing a semi-annual market analysis on market compensation.
00:15:52
Speaker
Omar Shakhar from Illinois GastroHealth suggests that we meet our employees where they are, just like we do with our patients. So previously we could say hours are eight to five, Monday through Friday, but your staff might want early morning hours or evening hours. So adapting to what your limited staff wants, assuming you can accommodate it, is important to provide both routine and flexibility in order to retain the best staff.
00:16:21
Speaker
Matthew Reeder from Harris Health Outpatient Center predicts that younger individuals will be entering the perioperative arena and second career individuals will start moving to ASCs due to attractive nursing compensation. He's also anticipating an expected rise in gender diversity and increasing demands for part-time or supplemental status.
00:16:44
Speaker
Ken Schaff from Brentwood Surgery Center says some challenges are headed this way, such as early retirements, burnout, or career shifts, which will result in increased wage demands, longer surgical days, and a competitive advantage for larger ASCs or hospital systems. So, ASCs will likely need to match hospital system pay scales, abandoning the previously lesser pay compensated by shorter working hours.
00:17:13
Speaker
And lastly, Andrew Weiss from Summit Surgical Center is seeing a trend in increased competitiveness in terms of salaries, benefits, and scheduling flexibility. He's also seeing that many employees now prefer part-time hours or per DM shifts due to work-life balance. So there's definitely some trends in there that are consistent and shouldn't surprise anybody, but there's also some good reminders in there about being flexible and what you can expect to come in the next couple of years.
Remarkable Surgical Case Studies
00:17:45
Speaker
Our second story comes from Medscape and It's Wild. As a non-clinical person, I'm not gonna lie, this story did make me a little squeamish to think about, but we will get through it and it's too fascinating not to share.
00:18:00
Speaker
Solomon Hassan is a 12-year-old boy who was riding his bicycle on the West Bank, and he was involved in a car accident where he suffered life-threatening injuries. He was transported by helicopter from the scene of the accident to Hadassah Medical Center in Jerusalem. When he arrived, they realized he actually had atlantooxibital dislocation, often referred to as internal decapitation.
00:18:29
Speaker
So when i hear decapitation i think of terrible scenes for movies and things like that this is not that but when he arrived he was in a neck brace and actually fully conscious so they monitored and treated him and made sure he was stable but they did quickly realize that he had a pretty severe neck injury.
00:18:52
Speaker
So his doctor was Dr. Ohad Ainav and thankfully once he saw the CT scan, he knew exactly what needed to be done and luckily had similar experiences during his fellowship. So he went into the surgery with plan A and also two contingency plans and only allowed the most experienced members of his team to help. Now in the article, Dr.
00:19:20
Speaker
Inov explains the entire process in detail, so I highly recommend giving it a read. But basically, the surgery went incredibly well and they were able to use hardware to fuse the head and the neck back together. The 12-year-old boy spent a few weeks recovering and they were monitoring him for infections and any other complications, and everyone is doing great.
00:19:43
Speaker
So this could have been a really tragic story, but instead, thanks to the brilliant surgical team, this 12-year-old boy is alive and well. So a lot of news stories or a lot of news stations are picking this up because you hear decapitation and you hear somebody lived, and it's fascinating to see what the doctors had to do to keep this young boy alive and that they expect him to have a great recovery.
00:20:11
Speaker
Our third story comes from ASC Focus, and they're sharing tips for working with local authorities to create an emergency plan.
Emergency Preparedness Collaboration
00:20:20
Speaker
So this story has two angles to it. The first is letting local authorities know that if your surgery center is experiencing an emergency, here are the resources that you'll need. But the second angle is the reverse. If your community is in a state of emergency, here's how the surgery center can help.
00:20:39
Speaker
So let's tackle the first. Marcy Moon is the emergency coordinator for Union City Surgery Center in Union City, which is a small rural town in Northwest Tennessee.
00:20:50
Speaker
And she shared that the Center does not have access to many of the resources available in metropolitan areas, making it even more important for the ASC to collaborate with local authorities. And by sharing knowledge and experience and pooling resources, they can all be better protected and prepared for emergencies or natural disasters.
00:21:11
Speaker
Marcy did extensive outreach to various entities in her community, including the EMA director, police and fire departments, and the emergency coordinator at the local hospital. She said it's very similar to networking and they've already made recommended improvements to the ASC's plans.
00:21:30
Speaker
Now the second scenario is how can you help? What value do you bring to your community? Anne Haddix, CEO of Southwest Surgical Suites in Fort Wayne, Indiana shared that local authorities may not understand the capabilities of a surgery center and the role it can play in an emergency. So Haddix recommends being prepared to discuss your ASC's capabilities and resources it can offer during any and all meetings with your local authorities. And if faced with a public health emergency,
00:22:00
Speaker
Southwest Surgical Suites is prepared to transform into a dispensing site to assist with countermeasures and dispensing. So this definitely reminds me of that famous JFK quote, ask not what your country can do for you. Ask what you can do for your country, except swap in communities and surgery centers. And that is the essence of this article. So thanks to ASCA for the helpful reminders and tips.
Medical Breakthrough: Voice Restoration Surgery
00:22:25
Speaker
And to end our new segment on a positive note, a groundbreaking surgery gave a woman her voice back. Shirley has not been able to speak easily for over a decade. And recently her doctors diagnosed her with spasmatic dysphonia, a voice disorder that causes involuntary spasms of the muscles in the larynx.
00:22:47
Speaker
A doctor in Tel Aviv brought promising news when she shared that doctors in Japan developed an innovative surgical treatment involving taking fat from the abdomen and inserting it into the vocal fold to prevent spasms. Shirley was so excited. She had questioned it for a second and she became the first person in Israel to undergo the surgery. And as soon as she woke up, she was able to talk again. She said, I feel like I've been reborn and no one is stopping me from speaking now.
00:23:17
Speaker
So another really cool story about surgeons all over the world changing lives.
Conclusion and Listener Engagement
00:23:23
Speaker
And that news story 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.