Case Costing and Benchmarking for Orthopedic, Spine and Pain Driven ASCs. Objectives

Transcription

1 Case Costing and Benchmarking for Orthopedic, Spine and Pain Driven ASCs Susan Kizirian, RN, MBA Chief Operating Officer Ann Geier, RN, MS, CNOR, CASC Sr. VP of Operations Ambulatory Surgical Centers of America (ASCOA) Objectives Discuss the benefits of case costing Describe the information needed to complete case costing Identify and present tools to enable completion of case casting Discuss actual ortho/spine case costing examples The safest way to double your money is to fold it over and put it in your pocket. Kin Hubbard ( ) 1

2 Why do case costing? Why Do Case Costing? Snapshot of cost of doing business Allows comparison of costs by CPT codes Allows cost comparison by physicians Benchmarking against other centers Drives cost of supplies down Staffing and supplies are biggest expenses in ASCs Helps determine if reimbursement covers cost of doing business Demonstrates profit margin by CPT code/surgeon 2

3 Use the Data to Increase the Bottom Line All Road Lead to Case Costing Human Resources Schedule Efficiency Charge Master Cost Drivers Surgeon Recruitment Eliminate Losses Case Costing Implants & Prosthetics Carve Outs Payer Contracting 7 Some of Best Paying ASC Procedures Best specialties: Neurosurgery, General Surgery, (hernias, lap choles, lap banding), Urology (slings and ESWLs), Orthopedics (shoulder arthroscopies) Neuro, ortho, and neurostimulators lead the way Matt Lau, Director of Financial Analysis, Regent Surgical Health, Becker s ASC Review Feb. 24, 2010 Some of Best Paying Neurosurgery ASC Procedures Procedure Average range of reimbursement Diskectomies $17,000-$34,000 Laminotomies $9,000-$11,000 Vertebral corpectomies $17,000-$20,000 Insertion/repair of neurostimulators $11,000-$18,000 Matt Lau, Director of Financial Analysis, Regent Surgical Health, Becker s ASC Review Feb. 24,

4 Payors Costs are known when negotiating contracts When negotiating retrospective payments, you know exactly what it costs you to do the case, the time it took, etc. & provides data to improve payments It s all about chasing the $$$$$$ First Steps Appoint ONE person to gather/enter data 4

5 First Steps Allow several days/weeks to enter all data Enter up-to-date preference cards Begin with most often-performed procedures Goal: All procedures are entered for every physician Train staff to enter complete case history reports (clinical logs) What You Need to Start Good computer system What You Need to Start Computer literate employee 5

6 What You Need to Start Accurate pricing on supplies What You Need to Start Knowledge of overhead costs: total cost of running the center What You Need to Start Benchmarks allowing the ASC to compare itself to others 6

7 COST DRIVERS Cost Drivers Rent Service Contracts Labor Supply Costs OR Utilization Physician Variables OR Time & Utilization Supplies Surgeon Preferences Anesthesia Preferences 19 Supplies Disposable Medical Case Specific Preop, OR, PACU Routine supplies Standard Packs & Custom Packs Pharmaceuticals Gases Surgeon Preference Procedure specific supplies Pharmaceuticals Implants & Prosthetics 20 Supplies - 2 Anesthesia Routine Supplies Pharmaceuticals Gases Supplies Other Necessary to provide services either non-medical or not directly tracked to a specific patient Implants & Prosthetics Demand vs. Preference Device Benefits Managers 21 7

8 Case Costing Methodology Intermediate Method: (OH / OR Minutes) + Supplies = Case Cost Simple: Everything revolves around the OR Minute Calculating the OR Minute Step 1: By accounting period (month) *Overhead (minus supplies) / OR minutes = OH per OR minute Step 2: By 1 CPT/Surgeon: (OR mins x OH per OR minute) + Supplies = Case Cost *Overhead is the total expense for the month from the P & L statement (cash accounting) minus medical supplies 8

9 Analyzing Case Cost Sample Form Where Does the Information Come From? Vendors Software reports OR times, operating costs, etc. Preference cards 9

10 Knee Arthroscopy $ - ABC AMBULATORY SURGERY CENTER DATE: 2/20/06 Procedure: Knee Arthroscopy COST COMPARISON SUPPLIES IN COMMON Doc Name 1 Doc Name 2 Doc Name 3 Doc Name 4 ITEM PRICE ITEM PRICE ITEM PRICE ITEM PRICE 2 Adaptor, Spike $ Adaptor, Spike $ 3.50 Bandage, Coban 4" $ 8.57 Bandage, Coban 4" $ 8.57 Bandage, Coban 4" $ 8.57 Bandage, Coban 4" $ 8.57 Blade, Surgical #11 $ 0.22 Blade, Surgical #11 $ 0.22 Blade, Surgical #11 $ 0.22 Bandage, Esmark 6x12 $ 4.61 Bandage, Esmark 6x12 $ 4.61 Light handles $ - Light handles $ - Needle, Spinal 18x3 1/2 $ 1.08 Needle, Spinal 18x 3 1/2 $ 1.08 Needle, Spinal 18x 3 1/2 $ Suction Tubing $ Suction Tubing $ Suction Tubing $ Suction Tubing $ 1.06 Arthroscopy Tubing $ Arthroscopy Tubing $ Arthroscopy Tubing $ Arthroscopy tubing $ Canister, Sctn 2000cc $ Canister, Sctn 2000cc $ Sod Chl, 2000 ml $ Sod Chl, 2000 ml $ 8.20 Drape, Arthroscopy Pak $ Drape, Arthroscopy Pak $ Drape, Arthroscopy Pak $ Drape, Arthroscopy Pak $ Dressing, Kerlix 4" $ 1.08 Dressing, Kerlix 4" $ 1.08 Sponge, Gze 12 ply 4x4 $ 0.79 Sponge, 12 ply 4x4 $ 0.79 Suture, Ethlon H $ 3.07 Suture, Ethlon H $ 3.07 Suture, Ethlon H $ 3.07 IV Catheter 20g $ 1.61 IV Catheter, 20g $ 1.61 IV Catheter, 20g $ 1.61 IV Catheter, 20g $ 1.61 IV Adm set primary $ 4.35 IV Adm set primary $ 4.35 IV Adm set primary $ 4.35 IV Adm set primary $ 4.35 IV Adm set secondary $ 1.01 IV Adm set secondary $ 1.01 IV Adm set secondary $ 1.01 IV Adm set secondary $ 1.01 Cefazolin Duplex $ 5.05 Cefazolin Duplex $ 5.05 Cefazolin Duplex $ 5.05 Cefazolin Duplex $ 5.05 Tegaderm w /w indow $ 0.30 Tegaderm w /w indow $ 0.30 Tegaderm w /w indow $ 0.30 Tegaderm w /w indow $ 0.30 Lactated Ringer 1000ml $ 1.03 Lactated Ringer 1000ml $ 1.03 Lactated Ringer 1000ml $ 1.03 Lactated Ringer 1000 ml $ 1.03 LMA $ - LMA $ - LMA $ - LMA $ - Adult Circuit 60" $ 7.92 Adult Circuit 60" $ 7.92 Adult Circuit 60" $ 7.92 Adult Circuit 60" $ 7.92 Propofol $ 7.72 Propofol $ 7.72 Propofol $ 7.72 Propofol $ 7.72 Fentanyl $ 0.65 Fentanyl $ 0.65 Fentanyl $ 0.65 Fentanyl $ 0.65 Torodol $ 1.00 Torodol $ 1.00 Torodol $ 1.00 Torodol $ 1.00 Adult mask anesthesia $ 3.20 Adult mask anesthesia $ 3.20 Adult mask anesthesia $ 3.20 Adult mask anesthesia $ 3.20 Dressing, 2 x 2 $ 0.03 Dressing, 2 x 2 $ 0.03 Dressing, 2 x 2 $ 0.03 Dressing, 2 x 2 $ 0.03 Large Ice Bag w /ties $ 0.83 Large Ice Bag, w /ties $ 0.83 Large Ice Bag, w /ties $ 0.83 Large Ice Bag, w /ties $ 0.83 Knee Arthroscopy (continued) SUPPLIES THAT DIFFER ITEM PRICE ITEM PRICE ITEM PRICE ITEM PRICE Arthrowand Covac $ Agg Plus Shaver $ Needle Counter, Foam $ 1.17 Glove, Surg Est Sz 6 1/2 $ 1.97 Blade, Surgical #15 $ 0.22 Betadine scrub brush $ 0.60 Needle, Hypo 18gx1 1/2 $ 0.03 Glove, Surg Est Sz 7 1/2 $ Gloves, Surg Est Sz8 $ 7.88 Needle, Hypo 22gx1 1/2 $ 0.03 Raytec $ 0.65 Needle, Hypo 22gx 1 1/2 $ Lac Ringers 3000ml $ Sponge, Raytex 4 x 4 $ 0.65 Bandage, Kling 6" $ 0.57 Scrubbrush, W/Iodophor $ 0.66 Marker, Skin $ 0.61 Tape, Adhsv Foam $ 2.80 Marcaine.25% W/Epi $ 1.81 Sponge, Gze 4x4 12 ply $ 0.79 Sponge, Gze 4"x4" $ 0.03 Ace Bandage 6" $ 1.82 Closure, Steri-strip 1/4x3 $ 0.69 Gown, XL $ 3.00 Pad, Abdominal Tender $ 0.36 Bupivicaine.25% - 10 ml $ 1.57 Towel, Str Blue 4-pack $ 2.78 Suture, Prolen G $ 3.77 ABD $ 0.12 Bupivicaine.5% w/epi $ 1.34 Bacitracin Ointment $ 0.06 Dressing, Adaptic 3x3 $ 0.28 Bupi w/epi.25% 30ml 20 $ 2.52 Epinephrin multi-dose vial $ 4.85 TOTAL COST $ $ $ $ AVERAGE OR TIME 48 min 73 min 68 min 42 min (Based on 13 cases thus far) far) far) (Based on 10 cases thus (Based on 5 cases thus (Based on 4 cases thus far) OPPORTUNITIES: ANNUAL REALIZATION IN REVENUE Proposed change times number of cases annually equals =potential annual savings to facility 10

11 ACDF (continued) ACDF (continued) Next Steps Carefully review data Look for outliers Ensure accuracy Present at monthly Board meetings Blind the doctors names Allow the doctors to see their own case costs in private Lead discussion on lowering costs 11

12 Sample of Board Report for Spine Surgeon Results Physicians are competitive Don t like being the high cost doc May challenge findings To err is human and to blame it on a computer is even more so. Robert Orben 12

13 Bottom Line Discussion usually includes: What they don t use on preference cards What they could change Implants that could be substituted Why is Doctor A so much higher than the rest? Why is Doctor D so much lower? Physician Variables - Surgeons Surgeons OR Time on time, speed and efficiency Preferences start time staff supplies implants instruments & equipment medications 38 Physician Variables - Anesthesia Speed & Efficiency: degree integrated into patient & schedule flow Preop review Preop protocols Preop testing Preop meds PACU protocols PACU meds Pt recovery time OR Medication protocols Discharge protocols N/V management Pain management 39 13

14 Stakeholder Planning What financial or emotional interest do they have in the outcome of your work? It is positive or negative? What motivates them most of all? What information do they want from you? How do they want to receive information from you? What is the best way of communicating your message to them? 40 Stakeholder Planning - 2 What is their current opinion of your work? Is it based on good information? Who influences their opinions generally, and who influences their opinion of you? How will you win them around or manage their opposition? Who might be influencing their opinions? 41 Power-Interest Grid with Stakeholders Marked Controlling OR Costs POWER High Low Manage Closely Non-Engaged Staff & Board & Surgeons Monitor Keep Satisfied Committed Staff & Surgeons & Board Keep Informed Payers, Patients Low INTEREST High 42 14

15 Benchmarking Comparisons to others and to yourself National benchmarking is available: ASCA, MGMA, VMG Intellimarker from VMG Health, Becker s ASC Review (online & free) Accreditation organizations require it ASCA Salary & Benefits Survey The leading and only comprehensive ASC salary survey National, Regional and Select State Data Salaries for 17 ASC Positions Bonus Information Employee Benefits Data 44 ASCA Financial Benchmarks Key ASC Indicators Performance Ratios Accounts Receivable Costs Per Case Salaries and Benefits Medical Supplies and Drug 45 15

16 ASCA Financial Benchmarks Cost Per Case - All ASCs Miscellaneous 31% Salaries & Benefits 36% Building Lease & Depreciation 8% Medical Supplies & Drugs 25% Key ASC Indicator, Costs Per Case, page 12, ASC Financial Benchmarking Survey, 2006, Foundation for Ambulatory Surgery in America. 46 ASCA Financial Benchmarks - 2 Operational Information Accounting Method Anesthesia Professional Type Anesthesia Service Arrangements ASC Location Facility Accreditation & Organization Facility Size (Total Square Feet) Facility Size (Square Feet per OR/Procedure Room) Patient Encounter Distribution Payer Mix 47 ASCA Financial Benchmarks - 3 Procedure Specific Data Gross Charges Per Case Net Revenue Per Case Costs Per Case Medical Supplies & Drugs Minutes Per Case 48 16

17 ASCA Financial Benchmarks - 4 Procedure Specific Data CPT Shoulder Arthroscopy CPT Knee Arthroscopy CPT Remove Tonsils & Adenoids CPT Colonoscopy with Biopsy CPT Cataract Surgery w/iol CPT Create Eardrum Opening Others 49 ASCA Financial Benchmarks - 5 Financial Statements Per Case Per Case by Specialty Per OR/Procedure Room Hour Per Patient Hour Per OR/Procedure Room Per OR: 1-2, 3, 4-5, > 5 By Ownership Multi-specialty, Single Specialty Per Square Foot Years in Operation: 1-3, 4-6, 7-10, > High Impact Metrics Actual cases as % of projected cases Case per day Collections as % of charges Supplies as % of collections Payroll as % of collections AR days outstanding AR & AP % current 17

18 Supplies % of Collections Medical Supplies as a Percent of Collections 30% 25% Poor > 24% 20% Industry Median 20%* Average 19% 15% 10% Good < 13% 5% Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 *Industry median is a sample median reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado ; Copyright Supplies % of Collections Always one of top two ASC costs Largely physician driven - but you can guide them Reduce cost by sourcing through group purchasing organizations (GPO) Case costing critical to reduce Provide recommended preference cards 40% Payroll % of Collections 35% 30% Industry Median 29%* 25% Poor > 27% 20% Average 22% 15% Good < 17% 10% Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 *Industry median is a sample median reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, CO ; Copyright

19 Payroll % of Collections Typically the largest single cost of an ASC. Compress your schedule to reduce. When the work is done, turn off the lights and send people home. Use PRN staff when possible. Pay more per hour for the right people Supplies and Payroll Can be controlled Change thought processes Track savings Calculate annualized savings Share information with staff Present to the Board Computers can figure out all kinds of problems, except the things in the world that just don t add up. James Magary 19

20 Summary Case costing takes time Information is priceless Diligence & Commitment are required Train your Board and Medical Staff regarding the reports.and. Managing the Bottom Line Human Resources Schedule Efficiency Charge Master Cost Drivers Surgeon Recruitment Eliminate Loss Procedure(s) Case Costing Implants & Prosthetics Carve Outs Payer Contracting 59 Questions? 20

21 Contact Information Ann Geier, RN, MS, CNOR, CASC Sr. VP of Operations ASCOA Susan Kizirian, RN, MBA COO ASCOA 21