THE WEEK OF NOVEMBER 7, 2022

CONTRIBUTE CONTENT TO THE PULSE

Your response to THE PULSE has been overwhelmingly favorable. To continue providing membership with a quality product, we need your help. Member centers and vendors are urged to contribute content. This is your newsletter, be a part of it!

For it to reach its full potential, your contributions to content are needed.

Please send your questions and comments to the Editor, specific to these recurring columns: 

• SURVEY SNIPPETS
• WHAT’S ON YOUR MIND
• WE HEAR YOU

Please send your questions and comments to

Jeff: jshanton@jssurgctr.com

IT’S TIME TO RENEW YOUR NJAASC MEMBERSHIP!

Please be aware that 2023 NJAASC dues renewal letters have gone out to the membership.

NJAASC would like to thank all of you for your support this past year. We have even bigger plans for 2023, and we need your continued help to make it happen.

If you have any questions about your membership renewal or have not received a letter, please contact Kelly Biddle: kbiddle@njpsi.com

We also have a membership renewal giveaway!

One ASC and one Vendor member that renew prior to Thanksgiving will be randomly selected and treated to a lunch (up to $400) by NJAASC. In addition to lunch, a donation will be made in those member center and vendor names to the 30 Days of Giving charity drive that is underway.

PRESENTATIONS AND POWERPOINTS

ARE UP ON THE WEBSITE

Speaker presentations from the 10/19 Quarterly Membership Meeting are up on the website.

Blogging Made Easy



There is a lot of great content out there, and ASCs may want to consider blogging to:

• inform and educate their patients
• further build their center’s reputation as a trusted provider, and
• share a bit about your center’s workplace culture

Here are some tips for getting people to find yours and look forward to reading it:

• Determine the blog’s main categories and stay focused.
• Blog regularly on a manageable schedule to build your following and keep readers engaged. Whether it is once a week or once a month, the goal is to be consistent.
• Regularly incorporate images, charts, infographics, pull quotes, etc. Mix up the use of visuals. But make sure you provide the proper attribution or credit for the photo or graphic. Otherwise, source your images from a free site or through a paid monthly subscription.
• Show the human behind the blog. Add personality to your blog posts. 
• Offer a regular feature (on say, the first Monday of the month) that you can build a following around and that people come to expect. This could be answering routine patient questions, insight into some new technology at your center, or a Q&A with one of your physicians.
• Make posts search engine friendly. For example, headlines should be 8 – 14 words long, and posts should be at least 300 words but can be as long as a few thousand.
• Add your blog url to your email signature and other communiqués utilized by your ASC such as alerts, emails and presentations.
• Post details about new blog posts to your social networks. For added mileage, turn each entry into a series of social media posts. Don’t forget to add the link to the blog post in your social media post.

Nina Dietrich

Nina Dietrich LLC

nina@ninadietrich.com

Standing out in a crowded world by being markedly different is very difficult, yet it’s possible to emphasize key differences between you and the rest of the pack by developing a ‘master narrative’- your own story, in your own unique tone of voice. This effectively creates a central communications framework to express the purpose, mission, vision, culture, values and goals of your ASC. When investing in and compiling this infrastructure for ideas, please use the following ‘Six C’s’ to monitor its relevance and resonance.

1. Context- Be honest as to where you and your ASC sit in the minds of your market and your competition, and how you want that to change.
2. Content-Compelling content is the fuel that drives the relationships all ASCs need to build success.
3. Clarity-This is the most potent weapon you have in communications. Who are you? What do you do? Why should people care?
4. Creativity-Many ASC messages are clear, yet boring. Let your intelligence, wit and where appropriate, emotion show.
5. Consistency- Say what you need to say, the way you want to say it, and repeat as necessary. Then become known for it.
6. Channel- Evolve your view and use media to match your messages to your constituents.

Ron Capello

INFINIA Group

rcapello@infiniagroup.com

The terms "Life Safety Branch," "Critical Branch," and "Equipment Branch" are something you may have heard in recent years. What are they? Keeping it simple, they are 3 separate and distinct circuit panels connected to the center's generator and transfer switch. Each branch is equipped with specific circuits defined in Chapter 6 of NFPA 99-2012, one of the CMS referenced

publications. An expensive fix if not installed correctly at the time of ASC construction, the absence or incorrect configuration of these panels have come under scrutiny in recent years. The only way to know if your center’s panels are correct is to speak with a healthcare electrician, electrical engineer, a life safety expert, or reading up on the code and comparing.

Anthony Riehl, CFI, CESI

Healthcare Safety Consultants

anthony@hlsconsultantsllc.com

Financial Review

Ch. 3.B: Fiscal controls are in place to protect the assets of the organization (v41 of AAAHC’s Accreditation Handbook and Medicare Deemed Status (MDS) Handbook). What does this mean, and how do the surveyors verify that these are in place?

The reason that accreditation organizations want to see this information is that they want to ensure the financial viability of the center. They should ask to see financial reports, i.e., the Profit and Loss Statement, at a minimum. Is the center making a profit? If they review 6 months of a P&L, and the center has lost money every month, the center may be in trouble.

The Standards require these written policies:

1. 3.B.1  Policies to provide accounting controls over assets, liabilities, revenues, and expenses. They may ask for additional reports to verify this information
2. 3.B.2   Policies for controlling accounts receivable and accounts payable
3. 3.B.3   Policies to control cash payments and credit arrangements. Don’t forget petty cash.
4. 3.B.4   Policies to manage unpaid accounts and those being considered for transfer to collection agencies. I suggest that these accounts be reviewed by the patient’s physician and that he/she approves of the transfer.
5. 3.B.5   Policies that relate to materials management

These can be in a Business Office Manual, but they need to be in writing.

You’d be surprised at how many centers don’t have any of these policies in place. They also cannot readily provide reports that the surveyors want to see. A big red flag is when the administrator has no access to any of these reports. I surveyed a center in the South where the physician brought me the financial reports in a sealed envelope which he wanted to hide from his administrator. How can you, as administrator, run a center if you don’t know anything about the financials? You can’t. This is not a rare situation. It raises a lot of concerns for the survey team, and it will be mentioned in the survey report.

Remember, everything that the surveyors see is considered confidential. They are not going to share it with others.



Ann Geier

Ambulatory Healthcare Strategies

ageier@ah-strategies.com

From a Center:

Newly-credentialed physicians need to provide at least 2-3 references, and they must be checked and confirmed before approval by the Governing Body.

A common error occurring in surgery centers is the dating of Rocuronium and Succinylcholine. After Rocuronium or Succinylcholine is removed from the refrigerator, they should be dated with a new/shortened expiration date. This is regardless whether the vials are opened or not.  

Rocuronium would be good for only 60 days when removed from the refrigerator. Succinylcholine would be good for only 14 days when removed from the refrigerator. To avoid potential mistakes, date the individual vials with the EXPIRATION DATE. This avoids confusion between the two products. Both products beyond the aforementioned dates may experiences a significant loss in potency.

Please feel free to reach out to us for a printable reminder PDF which can be hung on refrigerators as a reminder to anesthesiologists.

References:

1.  https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f1933332-1ae0-4dc1-be4c-694849e6c9f9

2.  https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=53e064bb-f71c-485f-b466-58a0739e7753



Amit Gupta RPh, Pharm. D, CCP

Consultant Pharmacist

amit@amitguptaconsulting.com

www.amitguptaconsulting.com

Q: We responded to a commercial carrier negotiation request and were told that the carrier determined that the claim was a surprise bill and this is all they are paying.  What do we do?



A: I would appeal it and say it is not a surprise claim under NSA and should be processed as an elective procedure. Make your attorney aware. 

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/CAAQualifying-Payment-Amount-Calculation-Methodology.pdf

Q: Can workers with exemptions do a Rapid test or do they need to have a PCR test?

A: Either is fine. Go back to EO 252, #3 which outlines what an acceptable test is: ‘antigen or molecular, that have EUA from the FDA.

Q: Are there any NJDOH regulations about the number of nurses needed to care for pediatric patients in PACU?

A: There is no regulation for PACU staffing in New Jersey.

Q: Is it mandatory that each stretcher have a portable oxygen tank with a regulator beneath it?

A: No. Unless, of course, you are transferring the patient somewhere on a stretcher or patient is on oxygen to begin with.

Q: Are centers starting to run into problems with COVID testing? We are hearing that insurance carriers are starting to not cover pre-surgical COVID tests, only paying ‘if exposed.’



A: There is no mandate that carriers have to pay for COVID testing on asymptomatic patients, pre-surgery.  That is why patients should be fully vaccinated; then, there is no worry about testing (per ED-20-016 revised).  If fully-vaccinated, no test is required. 

The pandemic has caused many changes in the healthcare industry. Hospitals and clinics have started to use AI in various aspects of patient care, from diagnosis to treatment. This trend is expected to continue in the future as AI becomes more sophisticated and cheaper to implement.

This could have a major impact on

healthcare careers, as more tasks are automated and carried out by machines. For example, jobs that involve data entry or simple analysis may be replaced by AI. However, jobs that require human interaction and empathy are unlikely to be replaced by machines anytime soon. So, while some healthcare careers may be adversely affected by the rise of AI, others will remain largely unchanged. It’s more likely that jobs will become AI-centric, as more people are hired to monitor and apply AI software.

Keith McConomy

MITCHELL MARTIN HEALTHCARE

kmcconomy@hcmmi.com

If you think it’s important to have a business plan and strategic vision, you need a human resources (HR) plan, too. It’s just as critical, and especially so in a post-pandemic workplace, where having a people strategy can make all the difference in building an engaged, successful workforce.

A solid HR strategy:

1. Gets your employees ready to execute on your business strategy and goals.
2. Helps prepare your current staff and anticipates your future HR needs.
3. Prevents employee turnover and prepares your business leaders to make strategic hiring decisions in the future.
4. Includes a succession plan to limit disruptions to your business should there be a change in management or structure.

So, what’s your company’s HR strategy? 

If your HR department works only on tactical processes like payroll and time and attendance, you’re missing out on strategic HR benefits!

Jeanne Roman

INSPERITY

Jeanne.roman@insperity.com

Whenever you revise your ASC’s point-of-service collections processes, allocate adequate time to effectively train staff on what’s changed, why the change was made, and what staff should do going forward. If a change to the process does not need to occur immediately, build in time for roleplaying as part of your training. This will give staff the opportunity to run through the revised processes and ask questions before the processes are brought over to patient interactions.

Kathryn Boylan

SIS FIRST

kboylan@sisfirst.com

Implementing procure-to-pay software solutions is the most efficient approach for organizations to improve efficiency in buying needed services. When assessing your alternatives, it is critical to examine your company’s major procurement and accounting payment difficulties. Here are some tips to help you identify the best procure-to-pay solution for your center.

1. Is it possible to fully automate the processing of all invoice formats?
2. Can line-item requisitioning be done in the system?
3. Is there real-time budget visibility in the procure-to-pay system?
4. Is the system set up as a multi-tenant environment?
5. Will I be able to design sophisticated workflows?
6. Is it simple to utilize the sourcing tool?
7. Is it true that the invoice automation solution can handle all invoice formats?
8. Is the analytics solution customizable and offers out-of-the box reporting?
9. What is the procedure for upgrading?
10. When custom fields are upgraded, what happens to them?

Jilliam Dickerson

HYBRENT

hello@hybrent.com

Did you Know This?



The Joint Commission reports that the area of Infection Control is commonly cited for “failure to implement IC activities or required evidence-based guidance such as Standard Precautions

(IC.02.01.01)”

This includes failure to follow state or federal regulations, manufacturer’s instructions for use (IFUs,) and/or processes and organizational policies and procedures.

It is essential that all facilities have updated IFUs for all items being processed. In addition, the facility needs to ensure they have the recommended equipment and implements (e.g., sonic cleaners, brushes, etc.) that are recommended in the IFUs, the staffing to perform all the steps in the IFU, and that training has been provided for any complicated IFUs. Furthermore, the IFUs need to be conveniently located for staff reference. This means readily available in the Decontamination area, as well as the sterilization area. 

It is also important that staff is able to interpret the IFUs and bring to the attention of management when an IFU is confusing or in non-compliance with standards. The facility should have a policy on Manufacturer’s Instructions for Use listing how they are updated, obtained, tracked, and what to do if an IFU needs further investigation, which should include not processing the device in question until the issue is resolved. 

Compliance with IFUs in a patient safety initiative. Non-compliance could result in an “immediate threat to life” citation from the JC or other surveying agency. 

Sterile Processing University offers on-line training for SPD technicians, which is compliance with the most current AAMI standards. Contact us if we can assist with your training or continuing education needs.

Nancy Chobin, RN, CSPM, CFER

President

Sterile Processing University, LLC

Nancy@SPDCEUS.com

414 River View Plaza Trenton, N.J. 08611 •  (609) 503-7696  • info@njaasc.org

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