Ophthalmology Business

DEC 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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continued from page 17 AAO, the Outpatient Ophthalmic Surgery Society, and the ASC Association. If you haven't previously done so, strongly consider enrolling in these organizations' ASC-specific listserv forums. • Agencies that monitor and evaluate changes in regulations, guidelines, and standards promulgated by agencies such as CMS, OSHA and your center's accrediting body. Ensure that you are up to date with regard to changes effected by HIPAA, the HITECH Act, and other relevant legislation. Develop a scope for the clinical portion of your assessment, based on the information you have acquired. Concentrate on areas where you think weakness may exist or substantial changes are being mandated. Over time, the areas of emphasis for regulators may change, but certain key clinical areas remain constantly relevant, including infection control, governance and quality assessment and performance improvement. Evaluate infection control. For the last couple of years, substantial emphasis has been placed on handwashing policies and practice, utilization of devices labeled for single use (particularly knives and phaco needles), and items labeled for single patient use, like medications. • "Secret shop" hand-washing activities by surgeons, anesthesia providers, and clinical staff. Your observations should be documented in writing in the form of a periodic quality assessment study. • Regulators are increasingly including many staff members in their compliance surveys. They often focus interview questions on how your center handles single use and single patient devices and medications. Your evaluation provides an opportunity to conduct some mock interviews yourself, to 18 prepare staff to answer these questions appropriately. Evaluate clinical management and operations. Increasingly, the governing body is expected to exercise broad and effective oversight of clinical management and operations. We recommend auditing the performance and documentation of these activities. Documentation of these activities should include a periodic review of: • Credentialing files, employee files, quality assessment studies, and peer review: Written summaries of these activities should be reported directly to the governing body and documented in regular meeting minutes. • Quality assessment and performance improvement programs: These programs must be effective, ongoing, data-driven and designed to identify problematic areas, develop remedies, and follow up on remedial actions to determine that they were effective. Take advantage of this opportunity to ensure that your QAPI program and documents fulfill all of these requirements. • The results of your patient satisfaction survey program: Patient responses shine a light on particularly sensitive issues, e.g., excessive waiting times for a small number of surgeons, personality issues with surgeons or specific staff members, etc. Objective data directly from patients provides the support needed to confront and resolve such matters. Financial factors It is easy to become overwhelmed by the myriad factors, both internal and external, that impact the financial health of the center. Avoid becoming so enmeshed in the data that you begin to suffer "paralysis by analysis." Focus on Ophthalmology Business • December 2013 these truly critical financial factors that you must develop, compute and compare to benchmarks over time. Begin by capturing and summarizing critical data in a useful, timely, and concise format. Decision-makers can use this data to objectively evaluate your center's business operations, to identify trends that impact current and future profitability, and to support and enable managerial decision-making. With the federal Medicare system as the primary payer for most ophthalmic ASCs, long-term success depends on surgical volumes and management of operating expenses. Evaluate surgical volume. Typically, surgical volumes will be somewhat seasonal, often low in the first calendar quarter and high in the fourth, and an individual ASC's patterns become apparent over the period of a few years. Track your surgical volumes, both incisional and laser, at least monthly, with close focus on the trends. A substantial decrease in surgical volume is a major red flag that danger is ahead. Review the volume trends and identify any other single events that have impacted volume adversely or might do so in the future, e.g., the retirement of a major producer. Highlight changes in trends or these material events in your report. With the cooperation of the governing body, develop strategies to cope with these changes. Evaluate operating expenses. Many of the center's operating expenses are, for all practical purposes, "fixed" and cannot be controlled in the short run. Examples include the monthly rent, utilities, property taxes, and debt service. Two major categories, however, comprise the bulk of your operating expenses and must be carefully managed. Review: • Fully burdened labor costs, which include salaries, wages, and other

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