Embracing digital technology in the ASC

March 30, 2020
Ray Raven, MD, MHCI, MBA

Physicians are still reluctant to embrace the technologies that will ease burdens.

The Centers for Medicare and Medicaid Services (CMS) are approving an increasing number of diagnostic and interventional procedures at ambulatory surgery centers (ASCs), including cardiac and total joint procedures. This uptick in CMS-approved procedures has resulted in a higher volume at outpatient centers – not just in terms of patients, but in terms of tasks required to be completed as a result. ASC owners, including myself, are thus constantly looking at new ways to efficiently manage tasks related to scheduling, provider staffing, reimbursement, medical recordkeeping, and supply chain management.

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Of these administrative responsibilities, scheduling is arguably the most demanding, and even more so than hospital surgical settings. ASCs must balance daily variations in procedures, surgeon and other clinical provider (such as anesthesiologists and specialists) schedules, operating and recovery room availability, medical devices and equipment, and patient flow. These challenges are additionally layered with completely uncontrollable factors we face in ASCs daily, such as punctuality, sudden cancellations (of both clinicians and patients), and patient medical response during and after the procedure. Moreover, considering the difficulties faced by the spread of COVID-19, solutions that allow us to manage business operations remotely are a critical part of our ability to sustain our businesses.

While our industry has progressed from dependence on phone calls, faxes, and old school personal computers, we still have a major opportunity to move from “average” to “ahead of the curve” when it comes to embracing technology from a health care business operations standpoint. Yet even though software solutions exist to help ease the burden on medical practices and ASCs, physicians are still overwhelmingly reluctant to embrace them.

A 2017 study found almost 70 percent of physicians have experienced stress related to health information technology (HIT) use, and it was cited as a major contributor to physician burnout. However, another study noted that much of the HIT-related burnout among physicians was related to perceived time spent on clerical tasks versus direct patient care, noting that “machine learning and machine intelligence algorithms may offer an opportunity for consolidation of information in the EHR and provide relevant summary of these data, sparing clinicians this clerical role.” It wasn’t the HIT that was the problem, but rather, the time required for administrative activities that proved frustrating for physicians.

In my own ASC practice, embracing HIT significantly improved the way we do business, allowing us to improve efficiencies, reduce redundancies, and take care of patients more effectively. In particular, we integrated “scheduling software” with our practice management software to fundamentally change how we do business.

We had been vetting remote scheduling software for several years, but the opportunity for bidirectional integration with our existing ASC practice management software allowed us to expand schedule accessibility to surgeons, anesthesiologists, vendor representatives (when appropriate), and even patients. That helps us maximize efficiencies for procedures. Having real-time information on schedules and provider availability at our fingertips streamlined our surgeons’ workflows and allowed us to quickly book new procedures and significantly reduce the administrative time that was once wasted on trying to coordinate schedules over the phone or on paper. More recently, the ability to manage these functions remotely has been an important part of our business continuity planning, allowing schedules to be managed without having to physically be in the office.

Real-time visibility of our schedule also helped overcome one of the main challenges in all ASCs: bottlenecks. Too often, our medical team is ready to begin a procedure, but a patient is running late, or conversely, a patient is waiting for a procedure, but the surgeon is delayed. Real-time alerts help address those bottlenecks. When a patient checks in, the surgical team can start the clock to keep the rooms moving. And when a patient is running late, the medical team can use the additional time for other tasks or get prepared for the next case.  

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Finally, as our ASC works toward greater year-over-year positive operating margins, being able to rely on consistency and adaptability in scheduling allows us to focus on other priorities, such as capital outlays to better serve a growing and diverse patient mix, and more dedicated staff time to revenue cycle management, inventory management, and reporting requirements. Far from adding to HIT-related burnout, technology adoption has been a major contributor to better work-life balance for our medical and administrative staff. For example, our ASC uses software from HST Pathways for practice management, which is integrated with a cloud-based surgery coordination app (Casetabs). The combination of these two platforms enables us to see functionalities in remote or hard to reach locations and allows us to manage schedules without having to physically come into the office.

Our ASC is running better than we ever have-and are well-prepared for a growing number of patients that we can serve. While HIT adoption can require a brief onboarding period to become familiar with the tools, I encourage other ASCs to consider best practices already being used by the rest of the health care system to ensure we’re staying ahead of, and not playing catch up with, technology that can help us provide the best experience and care for our patients.

Dr. Ray Raven, a board certified Orthopaedic Surgeon, serves as Managing Partner and CEO of Orthopaedic Surgery Specialists, which delivers care to more than 60,000 patient-encounters each year in the group’s clinic, rehabilitation center, and ambulatory surgical centers. He recently received a Master’s Degree in Health Care Innovation from the University of Pennsylvania