She says this data can be acquired from national surveys that break down data into regions, but the best source may be the candidates themselves. “You get general information about what various categories in your community are getting paid just from the candidates in front of you,” she says. “You will find out what they’re requiring and demanding.” Set your salaries at a competitive rate to ensure employee attraction and retention. During the interview process, you will probably find out quickly if your proposed salary rate is too low.

2. Don’t be afraid to send people home. Unlike the average hospital, ASCs can set clear expectations with staff that if case volume drops, the center will close early or compress more cases onto fewer days. Sandy Berreth, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., says surgery centers should take full advantage of part-time staff members who are generally paid less and can come in at the last minute to cover an unexpected schedule change. Surgery center employees should be told up-front that if case volume drops, the center may need to close one day a week, which means they cannot expect a regular 40-hour work week.

3. Manage the total life cycle of equipment. Mike Kintner, service contracts manager at TriMedx, says the costs related to supporting a piece of equipment over its entire life cycle, from the point of acquisition to disposal, may actually equal or exceed what it cost to just purchase it. To minimize life cycle service costs as much as possible, he suggests ASCs strategically analyze whether a piece of equipment requires lifetime support that is cost-effective.

“What organizations don’t look at is how much it costs over a piece of equipment’s life span to support it, and they usually only look at the capital acquisition,” he says. “They have to actively manage service costs to understand that maybe an investment in equipment with higher capital would be better because its service costs over its life span will be lower than cheaper equipment.”

4. Meet with physicians to receive individual buy-in for reducing supply costs. An ASC’s efforts to reduce medical supply costs are heavily dependent upon physicians’ involvement, as physicians control 70-80 percent of the cost of medical care. Tom Wilson, managing partner of Monterey Peninsula Surgery Centers and board member of the California Ambulatory Surgery Association, says ASCs must first show physicians and physician-owners that reductions in medical supply costs are necessary to remain financially viable in the future. “We’ll meet with our 13 orthopedic surgeons on staff and break down eight to ten very common orthopedic procedures, such as total and partial joint replacements, shoulder repairs, ACL and other knee repairs, and [assign] each physician a letter A through M,” he explains. “Then we will list by letter how much it costs each physician to perform a procedure. One physician might discover his supply costs are higher because he is the sole surgeon utilizing a $300 disposable wand. By doing peer reviews, we can discuss how to deliver quality care at a lower price.”

5. Using cost data in negotiations. Having accurate data about costs makes you a more persuasive negotiator. Demonstrating that you would lose money on the proposed rate may not impress the payor, but it could stiffen your resolve to propose a higher rate or walk away from negotiations. “A payor in one of our Symbion facilities was going to cut our rates dramatically,” Ron Brank, a group vice president for Symbion in Nashville, Tenn., recalls. “From our data, we knew that they were proposing rates that would not even cover our variable costs. We determined the proposal was financially unacceptable and informed the payor we could not continue with the contract.” The ASC team also pointed out that the payor’s cases would go to the local hospital, where payments would likely be considerably more than the ASC asked for, assuming the hospital was getting at least HOPD rates. “While you won’t always be successful in these situations, accurate data does often help us to gain fair and acceptable rates for our ASCs,” he says.

2. Focus on enhancing your orthopedic ASC’s managed care contracts. Even with decreasing Medicare reimbursements and its struggle with the local Workers’ Compensation Commission, Midlands Orthopaedics is keeping a focus goal on achieving improved implant coverage by negotiating managed care contracts with its payors, says Ann Margaret McCraw, CEO of Midlands Orthopaedics Surgery Center in Columbia, S.C. With implants being one of an orthopedic ASC’s largest supply costs, it is critical orthopedic-driven ASCs work diligently and closely with payors to carve those costs out so they can continue to keep those cases in the ASC and generate more revenue.

“We are having success obtaining implant carve outs with our private payers because they recognize the cost savings ASCs offer them,” Ms. McCraw says. “Even securing cost only for implants increases our volume by allowing us to retain cases that would otherwise be sent to the hospital.”

3. Manage the schedule aggressively. Make sure to receive regular and timely updates on when your surgeons will not be using their block times. When future block time becomes available, contact other surgeons’ schedulers at least a month in advance to provide adequate time to arrange the appointment. “Unused OR time is like two-week old cheese rotting on the supermarket shelf,” says Rajiv Chopra and Tom Faith of The C/N Group in Merrillville, Ind.. “You have to find alternative surgeons to absorb unused time.”

4. Admit to mistakes. An important aspect of maintaining respect from physicians is earning their trust, which means admitting to failures. If, after extensive consideration, the administrator’s decision produces negative results, the administrator must identify these failures and collaborate with the physicians to work through them. “If the administrator makes a mistake, he or she should go to the physicians and tell them and then figure out what needs to be done,” says Patrick Hinton, executive director of the Jacksonville (Fla.) Orthopaedic Institute. This will earn the physician’s trust, he says.

Bone fractures require special care to heal properly. In some cases a cast and precautions are sufficient, but in serious injury treatment becomes more delicate.

Now a team of Swiss researchers is investigating the use of metallic glass, a biodegradable material that can be dissolved in the body after fulfilling its restorative function.

Many fractures require orthopedic place and set screws, pins or plates fixed to keep the bone while it heals. These implants are made of stainless steel or titanium, and its implementation involves two surgeries: one for them and another to remove them. The news is that the new material that is developing this procedure could reduce by half, meaning that only need an operation.

Achieving this feat is not easy. The biodegradable material should permit the manufacture of nails or plates strong, rigid and durable, and well-should “dissolve” over time, causing no damage to the body. Faced with this challenge, scientists are testing a material that they believe will work.

The investigations focused on alloys made from magnesium, but the problem of this compound is that, when dissolved, it produces hydrogen atom “liberated” is harmful to the body. In addition, magnesium is formed around the gas bubbles that affect healing and increase the chances of developing an infection.

Given these findings, scientists from ETH Zurich have developed a new alloy in the form of metallic glass combining magnesium with zinc and calcium atoms. They found that this material is completely biocompatible and degrades in a way that it does not affect human metabolism.

The key to making this product is in the rapid cooling of the liquid material, which allows adding more zinc than that generally can be used in conventional magnesium alloys. The new metallic glass has developed a 35% zinc, 5% calcium and magnesium is the rest.

Early animal studies showed no bubbles of hydrogen, so that researchers are hopeful the use of this repair material.