Caryl Serbin: What the COVID-19 ASC Shutdown Tells Us About the Value of Outsourcing

The following was written by Caryl Serbin, RN, BSN, LHRM, President and Founder of Serbin Medical Billing.

During this anxious time when ambulatory surgery centers (ASCs) are gradually reopening, there are many uncertainties to face. Industry experts predict that while surgical volume will likely take some time to return to normal as ASCs work to gradually — and safely — resume operations, what will follow is a sharp increase in cases. This brings with it questions concerning volume capabilities, staffing shortages, case backlog, the potential return of the COVID-19 virus, and the associated flexibility to reduce operations if indicated. From a financial viewpoint, ASCs that just experienced a substantial decrease or shutdown of its revenue stream for several months are now facing additional expenses associated with the reopening phase.

With the expected need for higher caseload capacity, surgery centers that decide to meet this demand and take their facilities to the next level will need to address many challenges. These include increased hours of operation (perhaps longer weekday hours or scheduling cases on the weekend), the need for additional experienced staff (clinical and business office), more space for patient care, and the additional cost of safety precautions necessary to meet guidelines dictated by the health crisis. All of this requires upfront financial investment.

Identifying and adding the additional experienced clinical and business office employees may prove difficult. In an optimal scenario, hiring experienced, ready-to-go employees would be a preferred approach as you may have limited time for training, but are such individuals seeking work in your community? Your caseload may grow faster than you can hire staff. Even if you are fortunate enough to find the appropriate personnel, salary and benefits can be cost-prohibitive.

Then comes the matter of the availability of existing staff. How do you reduce their fears of contracting the virus? What if they don't want to return to work yet? Are they willing to return with reduced hours during the ramp-up phase of reopening? What if your employee(s) contract COVID-19 after they return to work? Where do you acquire immediate replacement staff? What about staff who do not want to return at all?

Outsourcing as a Solution

More ASCs are turning to outsourcing different aspects of their operations as they focus on opening the patient care areas of their center safely. Outsourcing for many services has increased over the years. ASCs that were outsourcing services before the pandemic are reaping the rewards. ASCs that transition to outsourcing now can greatly benefit as well.

Examples of outsourced services include information technology services (increased caseload may mean increased IT capacity), cleaning services (deeper cleaning may be required by COVID-19 guidelines), payroll or employee leasing, anesthesia services, managed care negotiating/contracting, transcription, and insurance verification (which is proving more difficult now since many patients lost insurance coverage when they lost their jobs, coupled with the dismantling of the Affordable Care Act ). Another outsourced service that was growing in popularity before the health crisis and is experiencing a surge in interest is outsourcing revenue cycle management (RCM).

As the owner of an ASC-specific revenue cycle management company, I can report that our clients have told us they are even happier with their decision to outsource their ASC's revenue cycle management now that they are confronting this difficult transitional period. RCM outsourcing provides an important benefit as it can help ASCs meet the newly instituted safety recommendations/regulations by freeing up office space for increased waiting room area to meet recommended increased distancing and to implement other patient care tasks, such as COVID-19 screening and testing.

Due to the profound financial strain imposed by the COVID-19 recess, I suggest that one of your center's areas of focus in the early stages of the phase-in period of resuming operations should be your billing and reimbursement backlog. To achieve the ramp up required to take advantage of a rapid growth opportunity, ASCs will need cash flow that exceeds what the center's capacity can generate due to a reduced surgical schedule. Outsourcing your ASC revenue cycle management can jumpstart your revenue stream.

While there are many reasons to outsource revenue cycle management to an independent contracted company, the main benefit in the current COVID-19 climate is an ASC's need to take advantage of proven experience quickly to stimulate rapid cash flow. Qualified ASC RCM companies provide a team of experienced personnel whose only responsibility is to seamlessly deliver timely and compliant coding, billing, and collection services and keep your accounts receivable at or below industry standards.

Two of the least recognized but most significant benefits of outsourcing revenue cycle management during the pandemic is that 1) ASCs gain the ability to grow their outsourced revenue cycle management services as their caseload grows without needing to increase staff, equipment, and business office square footage, and 2) ASCs gain the flexibility to scale back if necessary due to new COVID-19 breakouts and a possible surge of the virus in the fall and winter.

The future of this health crisis is an unknown. ASCs need the ability to adjust their clinical and financial operations effectively and efficiently in response to developments in the coming months. Decisions made now that can help with achieving such flexibility will be critical to dictating whether ASCs remain solvent and achieve long-term success.