Doomsday preppers and Chicken Little—two extreme responses to a crisis. The preppers are ready and will own the crisis. Chicken Little gets hit by a raindrop, isn’t ready for the sky to fall, and spreads panic and chaos as she runs madly to get help from the king. When a surgeon leaves your practice, you want to be more like the preppers, obviously, than like Chicken Little. You want—no, must—be ready to thrive.
“Whether it’s our choice, their choice, or no one’s choice, we all have to deal with a physician leaving,” Daren Smith, director for ASC Solutions for Surgical Information Systems, said in his 2018 ASCA webinar, “When a Physician Leaves: Strategies for Surviving and Thriving.”
You’ve Lost Your Volume Leader—Now What?
You can be proactive, says Smith, who has served as director of clinical services for Surgical Management Professionals, an ASC and surgical hospital management and development company, “and that means you’ve planned for a particular surgeon’s exit. They’ve announced their retirement or they’ve put in their notice that they’re leaving town or leaving the surgery center. There is an anticipated event.”
Or you can be reactive. And that means you don’t have a plan in place to guide you through the sudden exit of one of your volume leaders.
Clearly, it’s better to be ready. Smith recommends these preemptive strategies:
Consider purchasing “key person” insurance.
This isn’t pertinent to every ASC, says Smith, but it may make sense to have this insurance if the majority of your volume is coming from one specific surgeon or you have a very important director of anesthesia or a medical director at the surgery center who is key to all of the volume at the surgery center.
“Basically, it acts like a life insurance policy where the business is the beneficiary,” says Smith. It won’t solve your problems but it may help soften the blow and help you keep the business open and running until you can hire and get that volume and revenue replaced, he adds.
Use your partnership resources to recruit.
Don’t reinvent the wheel or go solo. “Independent recruitment of physicians is difficult for a surgery center,” says Smith. “I can’t stress enough how important that collaboration with those outside sources is.”
Work with your physician offices, since they’re adept at managing turnover and recruiting doctors to bolster the practice or replace a retiring physician. A referral from one of your surgery staff can lead to a successful hire—quickly solving your volume and revenue worries. One of your surgeons may have a colleague who’s looking to move practices, says Smith, and will share that with a peer, whereas they may not be interested in talking with a recruiter who’s cold-calling on behalf of your surgery center.
It might be an inside job.
And you never know. Your surgeon replacement could already be working on site, right in your own center or affiliated hospital.
When you’re using analytics to measure volume and revenue levels generated by individual surgeons in your center, you’ll have a clear view of whether or not there’s a surgeon on staff who’s underutilized, Smith says. Your data will show who has the highest block utilization and who has requested additional block time.
Emergency Responder: How to React Without Losing It
Things happen and a doctor can suddenly fly the coop without warning: a sudden illness or an accident may happen and you’ve lost a physician. Having an emergency plan in place for these possibilities will prevent panic and lessen the interruption to your revenue cycle. Smith recommends the following:
Take care of your remaining staff.
This is by far the most important first step, says Smith. The surgeon who suddenly left was likely very integral to the surgery center and very well known to the staff, so it can be hard for them to deal with the loss. “It’s not always just about the volume and the cash flow.”
Insure you understand the immediate impact of the loss of volume and cash flow.
When a physician leaves, making the necessary adjustments and looking at what’s urgent for the next two weeks, at a minimum, is vital, says Smith. Priorities should be:
- Coordinating with the departing physician’s office to make sure all the patients have been notified;
- Making the appropriate changes as far as blocks time, scheduling, and staffing at the surgery center goes. Key: You may find that staffing down is necessary.
Start adjusting for the long-term.
Activate your succession plan and move into the recruitment cycle.
The bottom line: You must take steps—whether you’ve taken preemptive action or not—to address your loss of volume or revenue.
Pump Up the Volume
To understand the overall, long-term effect of the loss on your volume when a physician leaves, you need to turn to data. Relying mostly on guesswork can tank you.
“I can’t emphasize enough how much this needs to be a data-driven process,” says Smith. You need analytics to show how much of a volume leader the physician was, how much revenue he or she was bringing in and how much you’re losing. You have to know the long-term impact on the ASC both financially and operationally, he emphasizes.
Smith recommends these benchmarks for analyzing the volume-related effects of the departure:
The types of cases treated by the surgeon and the time that was spent:
If the departing surgeon primarily performs quick cases that don’t require a lot of pre-op, OR, or recovery time—like cataracts—the situation is going to be different than if your oculoplastic surgeon is leaving, notes Smith.
How volume affects scheduling:
If the surgeon was the primary Thursday person and he was “bringing 30 or 40 cases every Thursday, it might be time to close rooms on that day” and shift staffing around, says Smith. That may mean “calling off the PRNs that you have coming in or closing certain rooms.”
You must keep an eye on your overall gross revenue and your net revenue—which means taking swift action to get all claims processed for the departing physician’s services. If you hesitate or let operational challenges distract you, you’ll risk losing that income.
If, for instance, a physician dies in an accident, hesitation might mean the insurance company has already taken him or her off the books and those claims are rejected, Smith warns.
It may seem like an intangible when you’re focused on data and balance sheets, but a surgeon’s departure can mean have a dramatic effect on leadership in your ASC, which can leave you without a strategic director. Was the surgeon on the boards or your medical advisory committee? Was she a shareholder? Consider what that means for your future and how to fill in the leadership gap.
Once you’ve hooked a new surgeon for the center, it’s easy to forget a vital component of bringing the new doctor on—getting him or her credentialed. Don’t let this be an afterthought, says Smith. The process can take time—there are records to collect, the medical advisory committee has to meet to get everything signed off so that the credentialing can go through, so it’s best to make this a priority.