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How ASCs Can Ace Patient Satisfaction

Analysis  |  By Debra Shute  
   December 14, 2017

Patient ratings can help make or break an ambulatory surgery center. An orthopedic surgeon shares his top tips for ensuring satisfied consumers.

Ambulatory surgery centers (ASC) can be an appealing option for patients—and a sound revenue stream for systems and physicians. Patient satisfaction scores can play a key role in an ASC's success, but obtaining high patient ratings can be difficult.

Nicholas Frisch, MD, MBA, is an orthopedic surgeon with Ascension Crittenton Hospital in Rochester, MI, and Bald Mountain Surgery Center in Lake Orion, MI. 

The following transcript has been lightly edited.

HealthLeaders Media: What are some key challenges to achieving patient satisfaction in ASCs in particular, as opposed to hospitals or other ambulatory settings?

Nicholas Frisch, MD: In an ambulatory environment, you don't have all of the resources you would have, say, at a large academic medical center. So you have to be prepared for situations that could arise and require additional instrumentation or equipment. The preparation to have that available is a challenge for everybody, and requires a bit more work on the front end for ASCs.

The other issue is managing the patients' expectations in terms of what they want out of the experience. Patients are drawn to ASCs because they want a more personalized experience compared to going to a big hospital.

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But not every patient is a candidate for outpatient surgery. While 60%–70% of my patient population, for instance, might be candidates from a medical standpoint, you have to take into account the social realities of their lives and circumstances. For some patients, it's wiser to operate in a hospital in case problems arise. If all is well, they may still be able to go home the night of surgery. I call all of my patients the night after surgery to make sure everything is OK.

Finally, I can't emphasize enough the importance of creating the right infrastructure. We try to make sure there's an opportunity for people to come to our clinic if there's an issue before their follow-up appointment, which may be three weeks after surgery.

We had to increase our staffing to do this, but we also reach out to patients at critical intervals, such as one week out or when they start outpatient physical therapy to make sure everything is in order. And we have to train staff to answer questions and concerns and identify which people need to be seen in the clinic.

Patients are much more comfortable when they know they can get ahold of you and that you can see them if they need to be seen.

HLM: What ways do you measure patient satisfaction?

Frisch, MD: It can be different everywhere, but for my center it's a bit of a hybrid approach. We have some internal surveys to look at satisfaction and track our patients and their experience. We're actively trying to engage them in that process in terms of ways we can improve their subjective perception of their experience.

We also track functional outcome metrics, which reflect objective information about how patients do after surgery.

HLM: How can ASCs optimize patients' health—and the odds of good outcomes—prior to surgery?

Frisch, MD: An app we use called PeerWell makes my job a lot easier. Unfortunately, we don't have hours and hours to sit down with patients and have multiple discussions to go through all of the material they should understand.

For example, people with poor nutrition may be predisposed to issues with wound healing and infection, so we target nutrition aggressively. For most patients, the content in PeerWell's PreHab program helps patients understand how they should eat. But for patients who need extra assistance, we'll send them to a nutritionist before surgery.

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HLM: What's your advice for meeting patients' expectations specifically when it comes to pain management while practicing more careful prescribing? After all, a study published in JAMA Internal Medicine just last month showed that patient satisfaction declines when clinicians say 'no' to their requests.

Frisch, MD: Ambulatory surgery, when it comes to joint replacement, has really pushed what we call perioperative pain management, which uses multimodal protocols.

It used to be that you could give out narcotics and manage the pain, and patients never really called complaining of pain. But it wasn't addressing the problem. It was a reactive approach.

Now, we're proactively targeting pain—which means for a surgery center we have to be organized—so that when patients leave, they have everything they need available. We give patients their prescriptions in advance so they can have them filled, and we have them bring them on the day of surgery. There, we'll go over the medications and a schedule of when to take them. And we try to target non-opioid medications, such as Tylenol, NSAIDs, and gabapentenoids.

Whereas we used to give medications to take as needed, now we've put together a schedule for the first two weeks, in which many of these medications are scheduled for every six to eight hours, so that the only time they need a narcotic is for breakthrough pain.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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