Vol. 2, No. 3


Achieving Effective Medical Director Leadership By John D. Brock


The medical director position is a vital but often underappreciated role in an ASC. Having served as an ASC administrator


for nearly 13 years, I believe there are several key factors that contribute to the effectiveness—and ultimately the success—of a medical director.


Reasonable length of term. There’s something to be said for continuity. There’s also something to be said for change. I’m of the opinion that ASCs should set term limits of two or three years for medical directors. This is enough time for a new medical director to settle into the position, maintain a high level of energy and engagement, participate in some significant decisions and transition the position to a new medical director.


With that said, I believe there is one significant caveat. An individual tapped to serve as medical director must be passionate about the position and willing to devote the time necessary to effectively fill the role. Assuming an ASC has multiple solid and interested candidates to serve as medical director, setting a term length makes sense. However, if such candidates do not exist, an ASC is better served not by making a change for change’s sake but by keeping an effective medical director in the position until a viable successor comes along.


Importance of specialty. I’m of the school of thought that anesthesiologists often make good medical directors for multiple reasons.


They tend to be on site more than other physicians. In a multi-specialty center, they are likely to possess a better understanding of the dynamics playing out in all specialties and not favor one specialty over another. If there’s no appearance of bias, all physicians and staff will feel more comfortable approaching the medical director with questions or concerns.


There are a few caveats here as well. I believe an individual serving as medical director should be an investor in the ASC, as this naturally enhances the connection to the center and its success. In many ASCs, anesthesiologists are not investors. If an ASC chooses to go with a non- anesthesiologist as medical director, this individual (besides exuding the passion already discussed) must be very accessible—essentially on call. If a question arises at the ASC that requires insight from the medical director, this individual—if not at the ASC—must be prepared to step away from other work to fulfill his or her responsibility.


Mentor to director of nursing (DON). The medical director should be willing to serve as a resource for the DON and be prepared to offer guidance and direction concerning clinical issues. This can include matters such as how to effectively run an operating room to decisions about clinical staff promotions. A medical director who is approachable and embraces the role of mentor will elevate the performance of the DON. Considering how closely a medical director and DON should work together, I recommend involving the medical director in the hiring of a DON.


Clinical resource to non-clinical administrators. Some, but not all, ASC administrators possess a clinical background. For those who do not, the medical director should serve as a clinical resource. I’ve worked in health care for more than 30 years, but there are clinical intricacies that I will never grasp particularly well because I am not a clinician. The medical director who served as my clinical resource when I was an administrator was of tremendous help when I was making decisions that would impact our ASC’s clinical operations.


Separation and balance. As noted earlier, a good medical director is approachable. A good medical director can also help serve as a mediator, addressing any barriers to success and building consensus around important clinical issues.


But a medical director must also walk a fine line, avoiding any appearance of favoritism. A medical director must be careful not to accept the responsibility of representing the interests of an individual physician, physician group, specialty, staff member or department. The medical director’s responsibility is to champion the greater interests of the ASC as a whole and the center’s mission of delivering safe, high-quality care.


John D. Brock is the principal of Healthcare Solutions Consulting in Lubbock, Texas. Write him at jbrock@hcaresolutionsconsulting.com.


The advice and opinions expressed in this column are those of the author(s) and do not represent official Ambulatory Surgery Center Association policy or opinion.


ASCs Win Big with Medicare’s Final 2019 ASC Payment Rule


In November, the Centers for Medicare & Medicaid Services (CMS) released its final 2019 payment rule for ASCs and hospital outpatient departments. It included significant changes, many of which benefit ASCs.


Most notable is the decision to update ASC payments using the hospital market basket inflation factor. This represents a much more realistic indicator of rising costs in the ASC space than what CMS used before, the Consumer Price Index for All Urban Consumers (CPI-U), which focuses on prices for a broad range of consumer goods. ASCA has fought for this change over the past decade.


This rule also reduces the threshold definition of device- intensive procedures in ASCs from 40% to 30%—another policy change ASCA supported. This rule change effectively grows the list of device-intensive procedures ASCs can provide to Medicare patients from 153 to 277 in 2019.


Other policies in the rule allow for several new cardiac procedures in ASCs and introduce positive changes to the ASC Quality Reporting Program. The credit for achieving these goals goes to all ASC supporters who have supported ASCA’s advocacy efforts for so many years.


Access ASCA’s final rule summary. ASC PHYSICIAN FOCUS 3


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