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Archive September 2020 XXI, No. 9

Financial Management: It All Adds Up to Significant Savings

Eye 35 ASC relies on teamwork, smart supply usage and clear communication to operate in the black.

Joe Paone

Joe Paone


James D. Lehmann, MD/Karla Sanchez
BY THE WAY Karen Dargan, RN (left), and surgical tech/materials manager Dee Dee Scutt prep for an OR case by labeling syringes that will be used. Often, such interactions lead to discussions about materials the OR team uses or needs.

Keeping costs in check is the best way to maintain profitability and long-term viability in a highly competitive market where every dollar counts, and finding value at the margins has been a core component of Eye 35 ASC. The facility in Schertz, Texas, is owned by Ken Maverick, MD, and James D. Lehmann, MD, who trust in the center’s management to run their facility in a time-efficient and cost-effective manner. “We think that has a huge impact on the overall success of our facility,” says Carson McCafferty, MSN, RN, CNOR, CSSM, CSRN, the center’s clinical director.

Eye 35 ASC has taken several steps to rein in costs and operate as efficiently as possible, earning its staff the 2020 OR Excellence Award in Financial Management.

  • Partnering with patients. Members of the center’s business staff make multiple attempts to contact each patient seven to 10 days before their scheduled cases to discuss their financial responsibilities, insurance benefits and payment options. The result? Decreased day-of-surgery cancellations due to patients being caught off guard by pricing; in most cases, patients pay prior to the day of surgery. “If a patient didn’t owe any money, we weren’t initially calling them,” says Ms. McCafferty. “But due to patient feedback, we now call everybody because they don’t want to walk in wondering if they’re going to owe something.”

Eye 35 staff will call a patient multiple times, leaving messages if the patient doesn’t answer. Email is also used. “Anything just to make contact with them,” says Ms. McCafferty.

Adds Eye 35 Executive Director Jesse Alvarado, “We work closely with surgeons’ practices. They make sure patients contact us once they book surgery to get their insurance verified and figure out what their fees would be. We’re doing as much as we possibly can to make the day of surgery smoother for patients.”

  • Versatile staff. Most of Eye 35’s staff is trained to handle the responsibilities of multiple departments, which Ms. McCafferty says reduces the need for additional hires, promotes respect for each department and process, increases efficiencies and reduces staffing expenses. “If a staff member calls out, we’re able to fluidly move people around so it doesn’t slow down our efficiency,” she says.
  • A move to reusables. Dee Dee Scutt, who is both Eye 35’s head surgical tech and materials manager, is always seeking and evaluating reusable products to lower case costs. “We run evaluations on single-use versus reusables just to see where it makes sense in our facility,” she says. “For example, we now have reusable I/A tips, which vastly reduce costs per case. As long as surgical technicians and sterile processing techs have been trained on the proper care and reprocessing of the tips, we’ll get longevity out of each one without having to waste $7 to $8 per case on single-use options.”
  • Improved instrument care. A move to reusables is a money-loser if proper instrument care isn’t performed, and Eye 35 proactively stays on top of this issue. Recently, it performed a quality study to determine why its reusable phaco tips weren’t lasting the advertised 20 uses. “We found we needed to train our technicians on how to handle them postoperatively,” says Ms. McCafferty.

Besides retraining techs, the sterile processing staff was supplied with recommended cleaning and reprocessing tools that are more delicate on instruments. As a result, Eye 35 reduced its replacement and repair costs. In 2019, instrument repairs cost the center more than $1,000. After staff were retrained last December, repair costs through mid-August were $90. “We try to stay on top of these issues and address them as quickly as possible, so we can keep moving forward with everybody trained properly and getting maximum use out of every tool we have,” says Ms. McCafferty.

  • Smart shopping. The surgery center strives to avoid ordering a surplus of supplies. “We don’t want things sitting on the shelves in order to avoid wasting expired items,” says Ms. McCafferty.

The ordering process is highly strategic. “Before I make a monthly order of supplies, I always look at the projected case volume,” says Ms. McCafferty “Because I’ve worked with our surgeons for so long, I can guesstimate a little bit, plus or minus a few cases, what we’re going to use.”

Eye 35’s vendors have worked with the center during the pandemic on pricing and providing a heads-up on availability of supplies like PPE. If certain meds aren’t available, the ASC adjusts. “We always have backup plans,” says Ms. McCafferty.

Ms. Scutt even price-checks Amazon in addition to the ASC’s normal suppliers. “There have been many times we find stuff a lot cheaper online,” she says. “And Amazon’s fulfillment facility is right behind us, so that helps.” Eye 35 even works with another ASC to trade supplies to avoid paying overnight shipping costs.

Ms. McCafferty and her team also convinced the center’s two surgeons to compromise on a single, standard instrument tray, further slashing costs.

  • Going paperless. The amount of time the center’s staff spent making paper charts was not time well spent. Eye 35 finally transitioned to an electronic health record this summer. “We expect, and our goal is, that within six months this system will have paid for itself,” says Ms. McCafferty. “It helps to reduce supply and payroll expenses, it’s made us more efficient and our charts look much better.”
  • Verifying op notes. A nurse reviews all op notes at the end of each day to check for mistakes before sending them to a third-party billing department. “We’re making sure all cases are documented correctly, because coding mistakes lead to money we’d miss out on,” says Ms. McCafferty.

Fundamental success

Due to the pandemic, case volumes were down in June and flat in July compared with 2019 numbers, according to Mr. Alvarado. However, he predicts steady improvement in case volumes the rest of the year. The center’s proactive financial management philosophy helped it survive and thrive during the pandemic. Mr. Alvarado believes COVID-19 is ultimately going to make the center even more financially solvent.

“I think we’ll be more efficient moving forward and pay more attention to our benchmarking numbers as well as our forecasting and actual numbers,” he says. “If we had a lot of supply and capital expenses over the past few months, I don’t think our numbers would look as clean as they do now.” OSM

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