Blue Chip: Business Best Practices
12 Steps to Accreditation
Managing Anxiety
Few things in our business produce more anxiety than accreditation, the process by which ambulatory surgery centers (ASCs) meet specific clinical and operational standards and thus become certified to receive reimbursement from Medicare or other payers. But, based on my experience of achieving accreditation for scores of ASCs, it doesn’t have to be this way.
Yes, accreditation is a lot of work, and costs a few thousand dollars. Yes, the application process is paperwork-intensive and the day when surveyors tour your facility can be stress-inducing. However, I’ve found that those ASCs that adopt a few best practices and embrace the process are more likely to achieve the highest levels of accreditation. More importantly, at such ASCs, the accreditation process serves as a strong platform for clinical excellence and long-term profitability. Meanwhile, those who resist or resent the process or take the view that it’s simply a big regulatory hassle have more anxiety and a greater likelihood of having accreditation denied.
The following recommendations have been the key to our success in achieving a perfect score with accreditation and building profitable ASC businesses based on clinical excellence and physician leadership.
- Choose the right agency.
- Start early and do your homework.
- Think strategically.
- Don’t reinvent the wheel
- Select a leader, but get everyone involved.
- Conduct a mock survey.
- Think like a patient.
- Cleanliness is next to accreditation.
- Embrace automation and technology.
- Surveyors are not the enemy.
- Smile on survey day.
- It ain’t over when it’s over.
There are three primary accrediting agencies – AAAHC, AAAASF and JCAHO. Each has its particular strengths and specialty, and slightly different criteria. ASCs seeking accreditation should look closely at the specific standards for each group and determine, based on their size and mix of cases, which is the most relevant type of accreditation. AAAHC usually offers the best fit with Blue Chip-developed businesses.
ASCs have all the answers before they undergo the test of accreditation, but this doesn’t mean you can wait until the last minute to prepare. Each agency provides highly detailed guidelines for meeting the standards. This information offers a playbook for success – so by all means take advantage of it. If you know the requirements, you’ll understand the need to start early and work steadily and consistently in the few months between the date your application is accepted and the day the surveyor turns up to inspect your facility. In other words, time is of the essence.
The real value of accreditation – besides the obvious benefit of opening up the flow of reimbursement – is that it promotes patient safety and clinical excellence, as well as effective management of the business. Blue Chip believes the accreditation process underscores many things most ASCs should do anyway. That’s why surgeons and administrators should reject the notion that accreditation is a “one-time’ or “once every few years” event. The standards – from clinical QI to governance to facilities management – should be baked into everyday operations. In this way, the accreditation process can help you build a better business for patients, payers and the physicians themselves.
The agencies provide a wealth of information, including various checklists and forms, designed to help you meet the standards. Use them. Many ASCs hire consultants to help them through the process. Depending on how well your business is organized in the first place, this may be a worthwhile idea. Blue Chip offers a full range of services to help our ASC partnerships achieve accreditation quickly. See sidebar below
To a large degree, accreditation is about the people at ASCs, not the facility itself. That – along with the survey’s comprehensive examination of operations – is why it’s important to make this a team effort. One person, probably an experienced administrator, should lead the effort, but the entire team must understand what the standards stipulate and why they’re important. In this way, accreditation helps build a culture of excellence. Likely, this will require training and cross-training. The team approach is key in that surveyors may show up unannounced on a day when the administrator isn’t in the office. Further, there is a clear trend of surveyors interviewing staff, not just administrators or managers. The point is, no one person can handle accreditation alone and surveyors will verify that everybody is with the program.
This may be the single most important step you can take to prepare. Set aside one day – and better not to tell everyone when it will be – and have a person experienced with the process turn up and go through the full survey process. This may sound disruptive, but it’s invaluable to getting staff ready.
Because patient care is at the heart of the survey, you should adopt the patient view as you prepare. Do some role-playing so staff can see the facility and operations through the eyes of a patient. Here again, accreditation emphasizes something you should be doing anyway – operating a customer-centric facility and regularly communicating with patients. Remember, it’s possible that surveyors will interview patients.
Beyond the need for sterile operating environments, a clean, well-organized and clutter-free facility reflects well on the overall quality of the operation. It shows that staff cares for and takes pride in the facility – an important intangible in the eyes of surveyors. Cleanliness takes ongoing dedication, as you can’t schedule a major cleaning if you don’t know when the surveyor will turn up. The bottom line is that surveyors will be favorably impressed if the information they request is readily available in clearly labeled and organized file cabinets or folders on a computer network. It also means their work will be easier, which certainly they appreciate.
Accreditation is largely a matter of keeping documentation and records up to date and complete. There are software tools that can proactively notify you when physicians’ licenses or privileges need to be updated or maintenance is required for equipment or the building. Workflow or practice management software may help ensure that QI committee recommendations are forwarded to the Board meetings and all decisions are carefully captured in minutes. The same holds true for financial management and accounting. Surveyors will pore over some or all of these records, so best to automate the potentially overwhelming tasks of keeping them current and organized.
Recognize that, however stressful the surveyor’s appearance may feel, you really are on the same team. Like you ASC, surveyors are dedicated healthcare professionals. Thus, they love to suggest improvements for higher quality care. It’s appropriate to ask questions and, if necessary, dispute the surveyor’s findings, though of course you’ll want to do so civilly and professionally. Just as importantly, if you don’t know the answer to a question, just say “I don’t know” and then go seek the answer. You don’t have to score 100% on every standard and I’ve always found the vast majority of surveyors to be very fair-minded. They also like a good lunch, so plan on that, too.
When the big day finally arrives, do your best to relax. Avoid fire drill mode. Make the surveyor feel welcome and provide a comfortable working space (which you’ll of course have designated well in advance). After an opening conference and introductory facility tour, the surveyor will request to see specific areas or records. The key for interacting with surveyors is to be both professional and personable. Courtesy, warmth and friendliness go a long way, and tell surveyors a lot about how you treat patients and their families.
Even when the survey is complete and you’ve achieved accreditation, you must remember that the process never really ends. Beyond supporting clinical quality and sound financial health of the business, you must stay on top of changes to accreditation standards and ensure ongoing procedures for documentation, maintenance and governance function properly. Blue Chip recommends ongoing training and regular clinical, financial and operational audits to keep your ASC in a permanent state of compliance. If you see the link between these standards and management best practices, you’ll no longer view surveys as anxiety-producing events, but rather as a means to keep your ASC performing at the highest levels.
The Bottom Line
When people ask me what’s the secret to accreditation, I tell there are actually three secrets – preparation, preparation, preparation. The suggestions above really add up to that simple idea. And because surveyors can show up at any time (both initially and for follow-up), preparation is never complete. Through operational discipline, constant attention to detail and steady focus on the patient, ASCs can use the lessons learned through accreditation as a springboard to long-term clinical excellence and financial success.
