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How Cerner EHR Technology Supports Ambulatory Surgery Center Success

A modern EHR technology is enabling American Surgery Center to identify opportunities for increasing profitability and contend with regulation impacting reimbursement levels.

Ambulatory surgery centers (ASCs) have a vital role to play in reducing costs and improving quality of care. Recent claims analysis by UnitedHealth Group found that payers could reduce surgical costs by upwards of 59 percent by directing members away from hospital settings to ASCs.

But many ASCs struggle with finding health information technology that suits their unique workflows and staffing models, which impact the efficiency and productivity of these facilities. With the healthcare industry pushing care from expensive inpatient to cost-effective outpatient settings, the pressure is on ASCs to focus on improving its people, processes, and technologies to deliver high-quality care at an affordable cost.

For American Surgery Center in Delaware founded in 2015 after purchasing a failing ASC, digitizing the organization’s workflows led its founders to partner with Cerner to tailor and implement a solution that would replace the organization’s inefficient paper-based systems.

“Until a few years ago, there simply were no good options,” says Kemal Erkan, MBA, chairman of the board at American Surgery Center and United Medical ACO and CEO of United Medical.

“An EHR system designed for a physician’s office would not have the functionality ASCs need to support the work they do,” he continues. “ASCs operate more like a hospital than a doctor’s office. But a hospital version of an EHR — designed to process and manage hundreds if not thousands of patients — is too big and cumbersome as well as too expensive of a program for an ASC.”

A unique staff requires a modern approach to technology

ASCs face significant technology challenges due to staffing. First, surgeons frequently operate across multiple institutions.

“Most likely, these surgeons have been using an EHR system for their private practice for years,” Erkan explains. “If an ASC is available for multiple surgical practices, finding the right EHR management system can be time-consuming. Every surgeon will want a platform that fully integrates with their own and will resist learning a new software platform just for use in the ASC. This obstacle can be surmounted by having the same platform across all practices and the ASC, but that might not be feasible.”

Second, ASCs rely on a multitude of nurses which can easily introduce new levels of complexity.

“Rather than employ full-time staff, which is expensive and often problematic given the variety of needs, many ASCs employ contractors and per diem nursing staff,” Erkan notes. “An ASC might need ten nursing roles filled in a week, but these ten roles could be filled by any of thirty part-time per diem nurses that the ASC is currently contracted with. With this staffing model, it is entirely possible to have nurses who work at a given ASC only one day every two weeks and who spend the rest of their time staffing different medical facilities, using completely different processes and systems.”

Value of a system suited to surgical workflows

A surgical procedure comprises seven stages: pre-arrival, check-in, pre-op, intra-op, post-op, discharge, and post-discharge. As a result, ASCs need EHR technology to support a patient’s progression through these stages.

Erkan describes the ASC’s Cerner EHR as a “game-changer” for the organization.

“As a patient moves through each of the six stages, staff completes specialized checklists to manage, record, and monitor the workflow. A patient cannot move from pre-op status to the operating room without the checklist being completed. Each list interface is customized to the user; a nurse’s interface will display different information and checklists than the surgeon’s interface,” says Erkan.

“A patient’s status is monitored through the patient portal module, which is displayed in our waiting room on a tracking board for anyone who might be waiting for the patient,” he adds. “Think of it like displays in airports that monitor the arrival and departure of different flights, only this is showing the patient’s progress through the stages of the procedure. Chart reviews, device interfaces, lab interfaces — the Cerner software correlates and stores all the patient’s data in one easy-to-navigate location.”

Surgeons in the CHRIAS medical group are the sole users at American Surgery Center. As a result of the medical group’s adoption of Cerner, the ASC and the group benefit from complete integration that enables any changes to a patient’s record to be recorded and updated across both systems, enabling provider access to timely and accurate information.

“Not every ASC will be so lucky to have such an integrated system, but the Cerner system has modules that assist with integration with other EHR platforms,” Erkan admits. “But this level of integration increases patient safety and saves countless hours over outdated methods for tracking and recording data.”

Enabling operational excellence moving forward

The success of ASCs moving forward will depend heavily on identifying opportunities for increasing profitability and contending with regulation impacting reimbursement levels in outpatient settings. A modern EHR technology is enabling American Surgery Center to do just that.

According to Erkan, the ASC leverages its Cerner platform to gain insight into the services that are the lifeblood of the organization.

“By increasing the number of surgical procedures that the ASC performs that are more cost-effective (e.g., bariatric surgeries over colonoscopies), the ASC can increase profitability. Through meticulous information tracking, EHR software platforms can help an ASC see which procedures are the lifeblood of the ASC,” he notes.

To compete with hospitals, ASCs as a group need to be able to demonstrate to payers, most especially the Centers for Medicare & Medicaid Services, their ability to bend the cost curve in a way that benefits health outcomes and healthcare expenditures.

“There is a huge gap between what a hospital can charge for a procedure and what an ASC can charge,” Erkan emphasizes. “On top of that discrepancy, Medicare has recently rolled back some of the procedures it would cover if performed at an ASC, removing valuable revenue streams from ASCs and giving them back to the hospitals — where these procedures are even more expensive. This is a problem only with Medicare at the moment, but as we’ve seen in the past, other insurance and payment providers often follow Medicare’s example.”

For Erkan, implementing EHR technology that enables ASCs to be more efficient is essential to their future success.

“ASCs cannot stand against these larger systems if they are technologically out of date, using outdated methods of information management. If too many ASCs lag behind and refuse to upgrade to government-required EHR technology, all non-hospital surgery centers will be viewed as obsolete. This will hurt not only the surgeons who use ASCs but also the healthcare system as a whole because these lower-cost options will no longer be available, and insurance premiums will continue to rise at an astronomical and unsustainable rate.”

For ASCs to provide high-value care in a highly competitive market, they must increasingly embrace modern technology. By partnering with a technology company that understands the nuances and intricacies of surgical procedures, these facilities can continue to provide access to effective and affordable care.


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