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Optimize Staffing Costs Lessen volume unpredictability, cross-train and drive decisions with data BY ROBERT KURTZ


W


ith staff wages one of the top expenses for Mohawk Valley


Endoscopy Center in Utica, New York, Thomas P. Fiorentino, the ASC's chief financial officer, keeps a watchful eye on them. “What matters is making sure we are spending the right amount.” To achieve that goal at West-


bury, New York's Island Eye Surgi- center, Administrator Sarah Malan- iak, CASC, focuses on maintaining proper levels of staffing to accom- modate the ASC’s case volume. In the COVID-19 era, however, this has proven difficult at times. Her ASC has a good grasp of how volume is likely to fluctuate throughout the year, she says, but the pandemic has thrown a wrench into projections. “We


have had days where we


needed to cancel cases because of exposure risk or positive tests,” Mala- niak says. "When you find out that you need to cancel patients the next day, it can be difficult to change that day's staffing levels accordingly." Volume unpredictability has the


potential to drive up staffing costs because ASCs might be forced to pay for overtime and per diem staff. In a perfect world, Fiorentino says, ASCs will have enough notice to adjust staff- ing to move with their volume. “There is a fixed staff component


you must maintain when the doors are open," Fiorentino says. "The greatest opportunity to optimize salary costs is to look at the variable component. If you are doing one-third more volume in a month, you would optimally have one-third more of the variable staff sal- ary expense in that month to match.” When Island Eye Surgicenter


is


forced to make sudden changes to its surgical schedule, staff are asked to help out. "I will ask if they would like


30 ASC FOCUS APRIL 2021 | ascfocus.org


to take a day off and work four consec- utive 10-hour days," Malaniak says. “Fortunately, many are happy to get the extra day off.” On days when staffing might be a little light, Malaniak says her ASC benefits from its ongoing focus on cross-training. Malaniak's ASC also relies on data


to make appropriate staffing decisions. Leadership reviews weekly reports that provide key metrics, including staffing costs, overhead expenses and costs per case. “This has been vital to keeping costs down and ensuring we maintain proper staffing to perform safe sur- gery,” she says.


Careful management of the surgical


schedules of Mohawk Valley Endos- copy Center providers also plays a pivotal role in keeping its staff costs in check. "We want to avoid having a


few cases in the morning, a big space in the schedule and just a few cases to end the day," Fiorentino says. "Send- ing staff home halfway through the day and then calling them back for a few more cases is impractical.” In an optimal situation, the ASC


will consolidate a provider's schedule so staff can support a full day's case- load or condense a schedule to either just the morning or afternoon, which allows staff to come in and work half days. When schedule gaps are unavoid- able, staff use the time for completing outstanding work or continuing educa- tion activities. “We look ahead at our schedule to see what has been booked and then try to act upon what we see," Fioren- tino says. "When providers' sched- ules are optimized, staffing levels tend to be as well.”


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