How ASCs can turn clinical data into better patient care.
By Pete Mercer
Editor’s note: This is part two of a two-part series
As the demand for high-quality, cost-effective surgical care continues to grow, ambulatory surgery centers (ASCs) are playing a more prominent role in the healthcare landscape. But building a successful ASC isn’t just about bricks and mortar – it requires a strategic approach grounded in culture, compliance and clinical performance.
To better understand how ASCs can use clinical data to not only meet regulatory standards but also drive measurable improvements in patient outcomes, Repertoire Magazine sat down with Lisa Austin, a senior consultant with Avanza Strategies. With more than four decades of healthcare experience – and 35 of those focused specifically on developing and operating ASCs – Austin brings insight into what it takes to launch and sustain a high-performing surgery center. From setting the tone during early planning stages to tracking the right metrics for Medicare certification and accreditation, Austin emphasizes that data isn’t just a requirement – it’s a tool for transformation.
In our conversation, Austin shared how ASCs can build a culture of safety from the ground up, leverage clinical data to make informed decisions, and adapt to a changing healthcare environment where private equity, hospital partnerships, and technology all play key roles.
Launching ambulatory surgery centers
Austin has spent the last 35 years of her career operating and developing surgery centers. She started consulting with Avanza in 2020, bringing her extensive ASC knowledge and expertise to its clients. A lot of them come through hospital systems, and they often engage with Avanza in the early stages of the development process to get a better understanding of what it takes to build and run a successful ASC, and even whether they should or shouldn’t do one at all.
She said, “I like the process of when it’s someone else’s idea: bringing it to fruition for state licensing and Medicare certification, and then accreditation through one of the accrediting organizations.” According to Austin, this is a process that involves a little bit of everything – helping the organization get legal involved to form their LLCs, opening bank accounts, overseeing construction design, procuring the necessary equipment, hiring staff, and implementing any policies and procedures to go through state licensure, certification, and accreditation.
One of the first steps to establishing an ASC is to start conversations about what the culture is going to be. This is especially important in the hiring stages while the leadership team is setting the foundations and expectations for the entire organization. “We want to ensure that, overall, it’s a culture of safety, from every aspect of the experience: from the surgeon on to the patient’s pre-op experience, during the procedure, their recovery, and then their post-op care,” Austin said.
From there, Austin will conduct performance reviews because she knows what accreditation organizations are expecting for demonstration of improved performance, even in the early stages of an ASC’s operations. Quality improvement opportunities can come from anywhere, even something as simple as where the supplies are and should be located in the facility. It’s all about finding the rougher spots of the operation and smoothing those out.
Tracking and leveraging clinical data
Most clinical care quality factors can be measured through quality measures, many of which are standardized (especially for those ASCs certified through Medicare). These measures are designed to ensure the safety of each patient as they come through the facility, as well as measure how well surgeons and staff are performing at their jobs.
Austin said that Medicare-certified surgery centers have to electronically submit all the required information about each measure. This includes things like patient falls, patient burns, hospital transfers, and any admissions (regardless of whether it had to do with surgery or not). Additionally, anything that goes wrong during surgery is measured – wrong site, wrong side, wrong patient, wrong procedure, wrong implant.
The ASC Quality Collaboration (ASCQC) is an organization that exclusively and specifically collects benchmarking data about ASC quality measures and performance.
“They work with organizations like Regent Surgical, SCA, and USPI – the larger ASC management companies that would provide higher amounts of data to track things like patient safety, patient outcomes, and operational efficiencies,” Austin said. While most of what the ASCQC does is similar to what Medicare requires for reporting, Austin said that they help ASCs track the metrics and publish benchmarking data and a range of helpful resources for ASCs to access.
In addition to all the standardized Medicare quality measures, ASC quality control efforts should include tracking and measuring things like operating room turnover, case volumes, staffing levels, financial performance, overall revenue, and cash collections.
Prioritizing the right data
In order to maintain their Medicare certification, ASCs may undergo surveys (i.e., inspections) from accrediting organizations that verify whether ASCs are taking appropriate steps to ensure patient safety and quality of care. ASC accrediting organizations like Accreditation Association for Ambulatory Health Care, Accreditation Commission for Health Care, The Joint Commission, and QUAD A go to great lengths to ensure that their standards meet and build upon those set by the federal and state governments.
Austin said, “When an accrediting organization comes in and they know you’re a Medicare-certified facility, they are going to make sure that you are reporting on all the CMS-required measures. They will look through everything, including things like patient satisfaction, records of patient infections, admissions to the hospital and demonstration of clinical leadership.”
In recent years, Austin has found these organizations have become even more thorough in their surveys, going so far as to ensure the governance of the board is informed and making decisions based on data presented on an ongoing basis.” They’re looking to understand an ASC’s processes and where information gets captured and then reported, and then what is done because of that information.”
How ASCs have changed over the years
With Austin’s 40+ years of experience in healthcare, she has seen how the ASC landscape has changed over the years. From an operational perspective, she’s seen how many more hospitals are including ASCs and joint ventures with physicians in their strategic planning. At one point, hospitals largely viewed ASCs as the competition – they were losing some of their best surgeons to ASCs, which offered physicians the opportunity to become business owners, gain greater control over their surgical environment and experience, and deliver high-quality care at a lower cost.
“What I’m seeing right now is a lot of mergers and acquisitions affecting ASCs, and a lot more private equity getting involved with surgery centers,” Austin said. “The private equity aspect is particularly interesting, because private equity groups tend to have a short game in mind – they want to get in and require all these benchmarks to be made, like adding new surgeon partners and cases, and then they want to flip it and sell it for a profit.”
From a clinical care perspective, not much has changed from how patients are moved from pre-op to surgery to post-op. While that has stayed fairly consistent over time, what Austin has seen change is the ability to capture data to better understand and tell the story of a patient’s journey. This is largely possible because of the assistance of national organizations like the Ambulatory Surgery Center Association (ASCA) and ASCQC and state ASC organizations. For Austin, this has had two primary benefits. “One, the public is more aware of ASCs. Two, we’re able to better negotiate contracts with insurance companies. They rarely want to raise reimbursement rates and pay surgery centers more, so we have to have a good patient outcomes story to tell and we have to have good data to support that story.”
Because of technology available today, like electronic health record and analytics solutions, ASCs are able to collect better data than ever before, which greatly impacts the industry. “What I think that does is allow us to do our jobs better. We can track the number of post-op infections and even hospital admissions 24 hours after the surgeries. From there, we can better understand how to prevent those kinds of incidents. We’re motivated to keep improving not only because adverse events are a burden on the healthcare system, but more importantly, they are a burden on patients.”