Business Strategies for Navigating the Pandemic (November 17, 2021)




Charlie Leonard of ASCA’s public affairs team talks with Jocelyn Gaddie, chief executive officer, and Hannah Hagan, business development manager, of in2itive Business Solutions about a range of business strategies for ASCs navigating the challenges of the COVID-19 pandemic, including staffing, coding and billing-related matters. in2itive Business Solutions is an ASCA affiliate partner and a full-service healthcare revenue cycle management and consulting firm that specializes in helping ASCs improve their coding, billing, claims processing and collections.

Narrator: 0:06
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Charlie Leonard: 0:37
Hello, and welcome to the Advancing Surgical Care Podcast brought to you by the Ambulatory Surgery Center Association, or ASCA. My name is Charlie Leonard, I’m a member of ASCA’s public affairs team and the host of this episode. On this podcast, I’m pleased to welcome Jocelyn Gaddie and Hannah Hagen, the CEO and business development manager, respectively, of in2itive Business Solutions, one of ASCA’s most valued affiliate partners. in2itive is a full-service healthcare revenue cycle management and consulting firm that specializes in helping ambulatory surgery centers improve their coding, billing, claims processing and collections. Jocelyn and Hannah agreed to come on the podcast to share some of their insights, as well as several strategies for navigating some of the more difficult challenges that ASCs have experienced through the COVID-19 pandemic. Specifically, we will be talking about surgery center staffing, a particularly challenging issue for virtually every ASC today. We’ll also discuss how to get the most out of billing checklists and in2itive’s advice for uncovering hidden revenue opportunities. With that brief introduction, let’s get the conversation started. Jocelyn and Hannah, welcome to the Advancing Surgical Care Podcast.

Jocelyn Gaddie: 1:50
Thank you so much, Charlie. We’re excited to be here and excited for the conversation today.

Hannah Hagen: 1:55
Thanks for having us, Charlie. It’s good to be here.

Charlie Leonard: 1:58
Well, thank you both again. So, let’s jump right in on this question of staffing. At ASCA, we’re involved in discussions every day with ASC administrators all across the country. Universally, the one challenge they all share is recruiting and retaining the staffing they need to meet the needs of their patients. And they tell us this is not just because of the tight labor market. They have employees who left during the pandemic who have indicated they are not returning to the workforce. They’re also facing unprecedented levels of staff poaching by competing healthcare providers who, unlike most ASCs, have the ability, sometimes without restraint, to raise their wages and their prices. First, can you share with our listeners what you’re hearing and learning and then, more importantly, the advice you’re giving your clients on how to deal with this challenge?

Jocelyn Gaddie: 2:44
Sure, absolutely. So, I know, Charlie, we’re hearing much of the same in these surgery centers—staffing is difficult, and it’s really started since the pandemic. Whether it’s on the clinical side or it’s on the business office side, staffing is definitely an issue. And one thing that we have realized is you’ve got to be flexible with your staff. How can you make it work, that it’s give and take in this scenario of providing that flexibility? Now, when we look at the clinical side of things, there’s not a whole lot of flexibility there, right? But when you’re looking at the business office—and really what we focus on as an organization is being flexible with the staffing—the pandemic, it sent employees home, right? So, they had to work from home, or they weren’t working at all. And now in our environment across the country outside of healthcare, that flexibility is key. So, finding ways to be flexible with your business office, specifically in the surgery center arena. We’re having to be flexible with our employees, providing that work-from-home opportunity. So how can you be effective in your business office, still be successful, still be productive, but providing that flexibility with some work-from-home options during this pandemic.

Charlie Leonard: 3:58
Thank you, Jocelyn. I was just going to ask Hannah if you’d like to also comment?

Hannah Hagen: 4:01
Sure. And those are some great points brought up by Jocelyn. I would add to keep in mind—what is your long-term value proposition to your staff? Why does it benefit them long-term to stay with your surgery center or your organization, as opposed to hopping next door for a slightly higher wage? So, give that some thought. And also, don’t hesitate to look to the service providers in the industry and ask for a more creative solution than they have offered in the past. As you look to meet the unique needs of your center or organization, review what staff is available to you and then reach out to your solutions provider and say, “Hey, I’m seeing this problem area, this gap in my staffing—how can you help me solve this problem specifically?”

Charlie Leonard: 4:48
Well, that’s very helpful. And I guess another concern and a question that we hear: Is this a temporary situation? I was curious what your thoughts are—is this temporary? Or is this what we might consider a new normal? This kind of flexibility with your workflow and with your staff and going forward, is it something that we’re going to emerge from the pandemic? Or is this what people need to adjust to and accept as a new normal?

Jocelyn Gaddie: 5:10
Yeah, Charlie, I think that is a great follow-up question. I do think it’s the new normal. During the pandemic, as an organization we sent our staff home and we worked from home, and we learned a lot during that period. I always said, as a president of this organization, we are not a work-from-home model. It’s just not something we’re capable of doing. But when we went to work from home, we saw people excel, we saw more productivity. So, if you’re able to truly understand your business, what works and what doesn’t work, and then capitalize on that while keeping your staff happy. I mean, employees are leaving for 25 cents for more flexibility for whatever the case may be. So, when we have good staff and it works well, we’ve got to adjust to this “new normal” that is taking place, and it’s remote staff working from home.

Charlie Leonard: 5:58
Well, thanks for that. Hannah?

Hannah Hagen: 5:59
Yeah, I’ll piggyback on that. I completely agree. While employees I do believe will continue to want more flexibility in their working model, I think this immediate problem in the economy and in the staffing, specifically at surgery centers and healthcare facilities, will self-regulate, as things typically do in a market economy. So, I think as an industry, though, we also will adapt and will emerge from it changed. I think it’s a great time for surgery centers to have a second look at their model and see how and where they can use technology as well to meet some of the needs of their surgery center. But all in all, we’re extremely optimistic about the position ASCs are in moving forward. And as always, we’re really happy to be part of such an exciting industry, with so much growth and opportunity yet to be realized. So, we’re feeling pretty good moving into the future.

Charlie Leonard: 6:53
Well, thanks for that. I want to move on to another topic. One of the management tools that I know you both subscribe to is a billing checklist. Interestingly, when we typically talk about checklists in ambulatory surgery centers, we refer to safe surgical checklists that are vitally important to keeping surgical teams focused on the details that contribute to a safe outcome for their patients. They cover the fundamentals, like multiple confirmations of patient identity and site of care, as well as accounting for all of the surgical instruments and materials that have been used during a procedure. Like a surgical checklist that goes into considerable detail on every case, my understanding is that a billing checklist appropriately deals with the periodic follow-ups and in the aggregate. But let me give you each the floor to talk about this important tool.

Hannah Hagen: 7:39
Yeah, that’s a great point, Charlie. And I think this is going to be extremely helpful, as we might find our surgery centers both hiring new staff to fill some open positions or also, as Jocelyn suggested, pursuing a more flexible working model. So, a billing checklist—we have one on our website that I would encourage everyone to take a look at—but this is really going to help whoever is overseeing the staff and your revenue cycle, your business office as a whole, really stay on track. So, it just kind of breaks things down into what we should be accomplishing daily, weekly and monthly, and even annually to make sure that your business office and revenue remain in a really healthy position.

Charlie Leonard: 8:24
Jocelyn, anything you’d like to add?

Jocelyn Gaddie: 8:25
Charlie, the one thing I love about this tool is when you’re in something every day—so let’s say revenue cycle, the billing process and the follow-up—you tend to get in a routine, in a groove, in a motion. A billing checklist really takes you out of your comfort zone to ensure all aspects of the revenue cycle are covered. So, you can be an expert, 20 years in the medical field providing revenue cycle solutions. But utilizing a tool that hits every piece of the revenue cycle, it’s going to ensure you’re exploring new ways to go after that revenue, to bill to the best ability that you can, and ensure you’re getting quality measures and hitting KPIs when it comes to your revenue cycle.

Charlie Leonard: 9:10
I want to follow up on that. Over the course of a couple of years, I was involved with ASCA’s industry-wide effort to help ASCs adopt safe surgical checklists. And what I recall learning is that it wasn’t enough for us to simply just distribute these tools. It took a lot of effort and commitment to embed these ideas in organizational culture and in the daily routine of ASCs. And so, we worked at it for quite a while. Can either of you comment on that in terms of how you get organizations again to embed this into their culture and make it part of a routine?

Jocelyn Gaddie: 9:42
Yeah, culture is one of the hardest things to change or to keep the direction if it’s working well, right? But constantly keeping it in the forefront. So, what do they say, 28 days to create a habit, but 28 days to create a bad habit. So, it’s ensuring these checklists, it’s the rule, it’s the way of the organization to ensure that we’re utilizing these, as Hannah mentioned, on a daily, on a weekly, on a monthly basis. So, we have the checklist in place, but then we’re auditing all of those pieces of the checklist to ensure what is taking place is actually happening and it’s being done right and it’s fitting in with the culture and the routine of the organization.

Charlie Leonard: 10:23
Thank you. Hannah, anything else?

Hannah Hagen: 10:24
Yeah. And I would just add to that the phrase, “people don’t fail, processes do” is something that we’ve all heard, and we really take that to heart. So, what we do is take a checklist such as this and create processes around it so that it’s second nature, and it’s just the way your office and your revenue cycle is built.

Charlie Leonard: 10:45
Recently, I took note of one of your company blog posts titled “Uncovering Hidden Revenue Opportunities in Your ASC” and I thought, that’s certainly an idea that every ASC administrator would want to get behind. The question is, how do you do it? The blog touches on things like coding and accounts receivable and cost controls. But rather than me repeat your blog here, why don’t I give each of you an opportunity to discuss some of your tips and advice for uncovering this revenue?

Hannah Hagen: 11:12
That’s a great point, Charlie. And when we’re visiting with ASCs across the country, we’re hearing what’s heavy on the mind of administrators. And a lot of times, that is recruiting physicians and cases to improve their revenue. Well, we kind of have a different area of specialty—let’s take a look at the case volume and specialties you do have and make the absolute most out of that. So, there are a couple different places we look. One of the first things is take a look at their aging report—how much is sitting out there that just isn’t even being focused on? So that’s an area we look at. On top of that, there’s been a big emphasis lately on collecting up front. A lot of medical facilities are competing for patient dollars, and so the more clearly you can communicate with your patients up front, I think that’s a great way. So, the more clearly you can communicate with your patients up front, the better. There are a lot of technologies to be used in this space as well. On top of that, making sure that you’re capturing all the revenue that your physicians are generating. So, if you’re not auditing your coding and your revenue cycle as a whole, make sure you’re doing that because we’re seeing a lot of coding left on the table. Jocelyn, what else are you finding?

Jocelyn Gaddie: 12:33
Yeah, I think, Hannah, you covered a good portion of that blog post. I think the follow-up to your response is reduce costs. So how are you measuring your employees to ensure you’re as profitable as you can be in your surgery center? I’m going to speak specifically on the revenue cycle side, so the business office side of things. Ensuring that you’re hitting KPIs, and there’s expectations on those KPIs, production numbers, running reports on your employees to ensure they are being productive and that you’re getting the most out of the efforts and the work being done to ensure that revenue is coming in the door and, again, you are as profitable as you can be.

Charlie Leonard: 13:16
Well, Jocelyn, Hannah, thank you both. This is a great discussion, some great advice, and I’m sure one that will lead to lots of inquiries from ASCs that want to go deeper with you on some of these strategies because they’re really essential at any time, but particularly during this pandemic when we faced a lot of new challenges. So, I want to thank you both for your time and for your advice. And I also want to thank in2itive for being such a valued ASCA affiliate.

Jocelyn Gaddie: 13:43
Well, we appreciate all that ASCA does for the industry. We enjoy those in-person conferences and we sure can’t wait to get back face-to-face.

Hannah Hagen: 13:51
Yes, thank you, Charlie. It’s great to be a partner of ASCA’s and we really appreciate all you all are doing for our ASC community.

Charlie Leonard: 13:59
Well, hopefully we’ll all be together in Dallas for a great meeting in the spring. So, until next time, I want to encourage all of our listeners to please stay safe and continue to follow all of your local public health guidance.