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(Editor's note: In this first part of a two-part series on the future of same-day surgery, we help you prepare for the challenges you'll face, including reimbursement, staffing, and technology. In next month's issue, we offer you tips on managing change.)
Looking into the future is not easy for same-day surgery managers. No one has a crystal ball that could have predicted the variety and speed of changes that have been seen in the past few years. Most of the people now working in same-day surgery can remember the days of developing long-term, sometime five- or 10-year plans. Now managers find that kind of long-term planning impossible.
"For a lot of reasons, same-day surgery managers are less direction-oriented and less confident about making predictions about same-day surgery because no one expected as much upheaval as we’ve seen in recent years," says Beth Derby, RN, MBA, executive vice president of Health Resources International, a West Hartford, CT-based management and consulting firm for ambulatory surgery centers. "Now, if you produce a three-year plan, you revise it every six months." Even with the unpredictability of the field, strategic planning is important, says Derby. "Strategic planning and consensus building will be an essential part of a manager’s job," she says.
Financial planning is key to a successful future, she says. "We’ve learned how to control costs, but we also need to work on how to spend money and how to negotiate contracts that reflect cost changes," says Kathy Bryant, JD, executive director of the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA.
Shrinking reimbursement will result in more finely tuned decision making, says Derby. "Managers will have to ask themselves if they are niche players offering a special service, or if they compete in a variety of specialties," she explains.
The way a same-day surgery program defines itself drives some of the technology purchase decisions, she says. For example, some programs may decide to specialize in just a few areas such as orthopedics or plastic surgery in order to focus their technology expenditures, she explains. "We can’t afford to buy everyone a little something new each year, because the technology is expensive and we have fewer dollars for capital expenditure," says Derby.
"Compliance with government regulations will become a greater challenge for same-day surgery programs," says Bryant. Regulations that address overall workplace safety, along with specific issues such as privacy, require a staff person who can stay on top of regulatory changes and monitor compliance, she says.
"For a small business such as a same-day surgery program, these requirements present a real challenge. If you are hospital-based, you have other departments that can help you monitor changes and compliance, but if you have a small staff, you have to pull someone away from his or her normal duties," she explains.
Running a same-day surgery program is more complicated than it used to be, Bryant says. The emphasis on cost containment and moving more procedures to an outpatient basis has focused attention on same-day surgery and increased the need for managers and administrators to become adept at handling a myriad of tasks, she adds. "Same-day surgery management is no longer just a subset of health care in general," explains Bryant. "It is its own field requiring a specific expertise."
For this reason, FASA is offering a credentialing program for ASC administrators that will give same-day surgery managers a chance to refine and hone their skills, she says. (For more information, see "FASA offers professional credentialing program," in this issue.)
Although many people look at the movement of many procedures from inpatient to outpatient settings as progressive and amazing, "this is just surgery coming full circle," says J. Lance Lichtor, MD, president of the Society of Ambulatory Anesthesia in Park Ridge, IL, and a professor of anesthesiology at the University of Chicago Hospitals. The first anesthetic used in surgery was administered during an office-based procedure in 1842, he points out.
Although surgery has become more advanced and physicians can perform more complex procedures, the technology also has advanced to the point these complicated procedures can be performed on an outpatient basis, Lichtor says. "Better optics and better anesthetics increase the number of procedures that can be done safely in same-day surgery," he says. (For more on clinical changes, see "Manage costs, contracts to survive reimbursement," in this issue.)
One area in which same-day surgery has usually had less of a challenge than inpatient surgery is staffing, but that is changing and will present more problems for more managers, says Kay Ball, RN, MSA, CNOR, perioperative consultant for K&D Medical, a surgical consulting and education firm in Lewis Center, OH. "It’s always been easier to recruit same-day surgery nurses because the hours are better, there are no weekends, and there is no call, but we are no longer going to be able to rely upon recruiting experienced nurses from inpatient units," she explains.
Partnerships with colleges and high schools and other creative approaches will be needed to address the shortage, Ball adds. (For more about addressing the staffing shortage, see "Staffing challenges require new approaches," in this issue.)
Another challenge for SDS managers will be preparing and managing for change in general, adds Ball. "The first step will be accepting change, then we need to move on to preparing for it," she says. What will be the result of future challenges and changes for same-day surgery program managers? "Programs will look less and less like each other," Bryant predicts. "They will be designed differently and offer a variety of services that reflect their unique situation."
For more information about challenges and changes for same-day surgery, contact:
• J. Lance Lichtor, MD, Professor of Anesthesiology and Critical Care for the University of Chicago Hospitals, 5841 S. Maryland Ave., Chicago, IL 60637. Telephone: (773) 702-6855. E-mail: firstname.lastname@example.org.
• Beth Derby, RN, MBA, Executive Vice President, Health Resources International, 433 S. Main St., Suite 302, West Hartford, CT 06110. Telephone: (860) 521-8811. Fax: (860) 521-8815. E-mail: Hribsd@aol.com.
• Kay Ball, RN, MSA, CNOR, Perioperative Consultant, K&D Medical, 6743 S. Old State Road, Lewis Center, OH 43045-9227. Tele-phone: (740) 548-4972. Fax: (740) 548-6894. E-mail: KayBall@aol.com.