FEATURE


ology procedures such as angioplas- ties and stenting upon approval, but it has stalled.” The California Ambu- latory Surgery Association, a spon- sor of the legislation, is continuing to push for its adoption.


Pay Close Attention to Profit Margin At the Outpatient Surgery Center of Central Florida in Wildwood, Flor- ida, a procedure's financial implica- tions are closely scrutinized before the case is added to the surgical schedule, says Brock Kreienbrink, RN, the hybrid cardiology ASC's administrator and director of nurs- ing. “Unfortunately, ASC reimburse- ment is significantly lower than the hospital setting, and we are operat- ing on small profit margins. Knowing our case profit margins and compar- ing them to the average case length and admit-to-discharge length helps us determine which cases to sched- ule more of and which to minimize.” For example, he says, a loop implant admit-to-discharge time is less than 60 minutes and has a good profit mar- gin compared to a left heart catheter- ization with average


admit-to-dis-


charge time of 267 minutes, which means more overhead is required.


Invest in Clinical Staffing


When filling clinical staffing positions, Dees recommends looking for profes- sionals with relevant experience— preferably 10–15 years in a cardiol- ogy cath lab—and compensating in a commensurate manner. “We are put- ting catheters or implantable devices in people's hearts.”


Implement Scheduling Safeguards With the help of a series of safe- guards, Kreienbrink says his ASC reduces the likelihood that proce- dures will not meet Medicare require- ments and lead to non-payments. “We do not allow a patient to be placed on


Success for cardiology in ASCs will boil down to proceeding intelligently and strategically.”


—Janet Dees, American Vascular Associates


our schedule until we obtain authori- zation. We also have a checklist for all of the codes associated with each pro- cedure. If no authorization is required for a code, we still request documen- tation stating that no authorization is required.” The ASC biller and Kreien- brink check the surgical schedule the night before a procedure and the front desk verifies patient insurance cards the morning of procedures to ensure nothing has changed.


Be Opportunistic Keeping with the state restrictions, The Cardiovascular Surgical Center performs only cardiac implantable electronic devices and endovascular treatment of peripheral vascular dis- ease. “This focused approach is key to our success,” Atkisson says. “Our volumes and highly specialized cases drive our operational decisions. For example, we strategically limit our purchased inventory and only stock


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