Shannon Smith's blog

Have you had a really good conversation that you thought about long after it was over? Last week at the Freestanding 100 Conference just such a conversation took place during the Ambulatory Surgery Centers (ASC) roundtable.

I opened the session with a quote by Regina Herzlinger, Harvard professor and accountant: “It is possible to make health care cheaper and better in this country, if we would give consumers more power, more information and more choice.”

Needless to say it was the beginning of a very lively discussion. I was inspired by the conversation and wanted to continue the discussion with more input from healthcare industry leaders.

We look forward to connecting with you at ASC’s educational conference of the year--FASA. We’ll be in New Orleans from April 18-21, 2007.

See you at the opening reception on Wednesday!

Do you have career goals, but are unsure how to attain them? Maybe you don't know exactly what it is that you ultimately want to do, but you know that you don't want to do what you're doing now for the rest of your life. Great. You've already taken the first step in realizing your career path!

Take 30 minutes to assess your strengths. Struggling with this one? There are a lot of books and tools available to help you, but you can also ask friends, co-workers and your managers what they think you're good at. Write down what they tell you. Then look at the lists for patterns. Think about how your strengths have helped you do so far in your career. Which ones would you like to build upon?

The Pickle Option. A member of my family owns a chain of delis. After assessing ways to reduce costs, he decided to make the pickle that accompanied every sandwich an option. That decision alone saved him $100,000 a year. And, the customers who didn’t like pickles were happy because the pickle juice didn't soak into their sandwich. So what do pickles have to do with medical supplies?

Messy drawers. Several years ago I performed an assessment on an underperforming facility. As I walked around, I opened supply drawers and found every drawer stuffed to the brim. Just by reorganizing their supplies, setting a par and creating a real ordering system, they could reduce their budget by thousands of dollars a year. Not to mention that fact that supplies would be where they needed them when they needed them. Simple changes like making pickles optional or organizing supplies can have a big impact.

Have you ever thought, wow, that’s the best thing I’ve ever done? I have and fortunately, I’m glad that I was wrong.

National Surgical Hospital. I remember completing the first version of the Business Office Series and thinking that I wouldn't be able to do any better. Needless to say, I had completely underestimated myself.

We were working on customizing the Business Office Series for facilities owned and operated by National Surgical Hospital (NSH). As I began making the changes requested by NSH’s taskforce members, I was pleasantly surprised to find that I was seeing the course in a whole new way. Getting feedback from customers and having time away from the program enabled me to see new possibilities. We began making significant enhancements to the program.

When I first start the RUSH GROUP, I was working almost every waking moment. There were many obstacles to me reaching my goal. E-learning was new, many surgical facilities didn't have high-speed internet connections, few participants had computers at home and few healthcare providers offered job training to business office staff. At times, I was discouraged and uncertain as to what kept me moving forward.

Sometimes you need others to see your reflection. While I was developing the Patient Accounting Certification program, many of the virtual classroom participants would tell me how passionate I was about what I was doing. At the time, I didn't think that I was all that passionate. I was just trying to make a great program. Yes, that meant spending hours upon hours reviewing assessments, providing feedback and coming up with creative examples to ensure people grasped the lessons’ core concept. I would have described myself as driven and determined. Was that passion? Now that I have the vantage point of time, I have to say YES! It truly was a labor of love.

I am pleased to say that the Business Office Series is complete and ready for release. It has become 9 courses rather than the 7 courses originally planned. We've added a separate course that covers Payment Posting and another for Managing the Business Office.

The Payment Posting course is incredibly important because too often staff post payments without evaluating the accuracy of the payment. Unfortunately, insurance companies make mistakes too and pay either too little or too much. Statistically approximately 30% of all claims are paid incorrectly. The primary reason is that some terms cannot be automatically adjudicated by most information systems. Implants, high dollar supplies and exceptions to the grouper rates are routinely paid incorrectly and more often than not, underpaid. If a Payment Poster isn't familiar with the key terms of the payer contracts, a lot of money can be simply written off and if no one is analyzing the reports carefully, that money is gone forever unless a recovery system and/or service is used. Consequently, the course reviews the key terms of most payer contracts, gives participants plenty of practice calculating the expected payment and patient portion and provides detailed instruction for proper posting technique.

The World Research Group is sponsoring the Building and Streamlining Ambulatory Surgery Centers conference in Boston, June 26-28th.   

I will be leading a 3 hour workshop during this conference titled: How to Enhance Profitability for the ASC: Bottom Line Case for ASCs.  The workshop will teach participants how they can improve the financial and operation performance of ambulatory surgery centers by increasing reimbursement, cutting costs and enhancing profitability.  In particular, this interactive forum will stress strategies to:

It has been quite an undertaking, but I pleased to say that our new Business Office Series of courses is almost complete. 

I am rather excited about this series, in part because I think they are some of the best courses that we have designed to date and in part, because these are the courses that I intended to do first.  Long story short, I started the orignial Collections course with the Fundamentals of Patient Accounting thinking that I needed to start by telling Collections Specialist how they fit into the bigger picture.  Well...the Fundamentals of Patient Accounting became the 5 courses of the Patient Accounting Certification.  Likely a little more explanation than any Collection Specialist wanted or needed.  Anyway, the Patient Accounting Certification is a great program, but is now more geared for those in management or staff wanting to work into a management position. 

I attended the American Association of Ambulatory Surgery Centers (AAASC) meeting this week.  I didn't get to attend all lectures but of those that I did attend, it was clear reimbursement issues are on the minds of most providers.   

Many ASCs are still struggling to negotiate fair contracts with third party payers and consequently, are continuing to provide services on an out-of-network basis.  This strategy is working for some, but most acknowledged that the payers are fighting back.  Many payers are limiting out-of-network benefits for outpatient surgery by implementing daily maximum benefits of $380, $500 and $600, or by separating the deductible pools so that patients have to satisfy a large out-of-network deductible before their plan benefits apply.  The limits can deter patients from using non-contracted providers.  One executive from a surgery center management company acknowledged that their non-contracted facilities loose about 5% of the cases scheduled.  To limit the number of lost cases, he as well as the other participants in the session acknowledged that as a non-contracted provider, they offer courtesy discounts so that patients are not financially penalized.