ASD Management’s Randy Todorovich Receives Award

The California Association of Ambulatory Surgery Associations (CASA) has awarded The Richard LeBlanc Award to Randy Todorovich, ASD Management Senior Vice President of Managed Care. Originally called “The President’s Award,” the honor is given to a CASA member who has given tirelessly to the volunteer organization, above the call of duty. The award has been given only 11 times in CASA’s 30-year history.

CASA President Deborah Miller made the award to Todorovich on September 5 at the 2018 CASA Conference in Huntington Beach, CA. President Miller acknowledged Todorovich’s active leadership role and committed volunteerism in the development of relationships between the ambulatory surgery center (ASC) association and managed care industries throughout California.

“The ASC industry owes many of the strides it’s made forward to (Randy’s) efforts,” stated President Miller. “He has been instrumental in developing payer relationships, and is now working toward engaging the large employer community to discuss (health premium) benefit design and the advantage of utilizing the ASC model. At times these conversations have been difficult, but Randy remains the consummate gentleman, and his character and mild demeanor are a credit to this success.”

CASA is a leading and pro-active volunteer organization in the ambulatory surgery industry, with a mission of advancing communications and education, appropriate legislative and regulatory actions, and continuous enhancement of excellence in the ASC industry as it embraces the challenges of the 21st century.

“We believe strongly in forging relationship with health plans, payers and other health related entities so they understand the value of surgery centers,” said Todorovich. “Over the years, they have come to understand not only the value of surgery centers, but also the resources that CASA offers in advancing quality and cost-effective health care delivery.”

Through Todorvich’s leadership, CASA has staged executive level conferences bringing together health plans, large surgery center companies and business groups on health, where they can meet face-to-face about key issues on all sides. “This really helped educate us all,” he said, “and now, after 10 years, the health plans find ASCs a viable part of the health delivery chain.”

Todorovich, along with other CASA Board members, is now focusing on developing relationships between surgery centers and large employers with self-funded health plans. CASA is developing objective data to demonstrate that ASCs are not only a lower cost alternative to hospitals, but are also the highest quality provider for non-urgent, outpatient procedures. “The quality piece of the puzzle,” Todorovich said, “is critically important to employers.”

Todorovich’s volunteerism on behalf of the industry dovetails his role at ASD Management, where he promotes and maintains relationships between the firm’s surgery centers and the managed care providers with which they contract. “Through CASA, I have had the good fortune to work with executive level professionals of the health plans, and these connections and resources broaden what I can bring to our surgery centers.”

Download This Article

6 key focus areas regarding ASC materials management

Written by Charles Dailey

In regards to ambulatory surgery centers, the materials management program begets responsibility for procuring products with the expectations of cost control, distribution mediums and inventory management.

The ASC’s supply and drug expense as a percent of the facility’s net revenue should be approximately 25% to 28% for a typical ASC. If this is not what presents, six key focus areas could influence materials management outcomes. As a contributing author in the groundbreaking book, Developing & Managing Ambulatory Surgery Centers, published by ASCA and available on Amazon, listed below are the key areas excerpted from the book highlighted to improve your materials management program.

View Article

ASDManagement publishes first comprehensive book on ASC development and management

After 30+ years in the business, and 1 year in word processing, ASD Management has published the first book taking a systematic approach to the strategies and details of developing and managing an ASC. In the words of co-author Joseph Zasa of ASD Management, “Many articles are published every year, but few describe a proven, systematic approach written by people who are successful developers and operators of surgery centers.”

“There are now over 5,000 ASCs in the U.S.,” writes co-author Robert Zasa of ASD Management. “The low cost of ASCs with very high quality of care have fostered the creation of these centers in almost every area of the country.” Yet, not every surgery center is successful in meeting the prime directives of high quality patient care and safety within a profitable center.

Developing & Managing Ambulatory Surgery Centers is the first book dedicated to the cornerstones of ASC operations: patient care, business office processes, risk management programs, payer contracting and revenue management. The cornerstones are detailed in the four book components: ASC predevelopment, development, management and lessons learned from the field.

Contents is enriched by contributions from the ASD Management team, and experts revered in the ASC industry: Scott Becker JD and Amber Walsh JD of McGuire Woods, Ken Seip of Siemens Financial, Aaron Murski of VMG Health, Joe Baugh of CG/Medvest, Randy Bishop of Surgical Notes, Durr Boyles, Steven Dobias of Somerset CPA and Steve Sorey. And ASC physician leaders: Dr. T K Miller, Dr. John Fitz, Dr. Michael Latham and Dr. Alan Valadie.

Informative, current and entertaining, a must for seasoned professionals as well as industry newcomers, instructors and students. First edition published in March 2016.


Are ASCs in for another rough Q1?

By Carrie Pallardy
This article is reprinted from Becker’s ASC Review

Harsh winter weather and underwhelming financial results were the hallmarks of the first quarter of 2014 in the ambulatory surgery center industry. Winter is threatening to bring another round of record low temperatures in 2015, and the challenges of 2014, if anything, have intensified. How can ASCs prepare for the new year?

2014 retrospective

The opening quarter of 2014 was undeniably difficult for the ASC industry, but if nothing else it can serve as a lesson for the times ahead. Here are key points from the first quarter results of eight public ASC companies.

  • AmSurg. AmSurg’s revenue increased marginally, 2 percent from $258.2 million in the first quarter of 2013 to $263.1 million. Same-center revenues declined 2 percent.
  • Foundation Healthcare. Foundation Healthcare’s revenue was up 18 percent to $22.1 million for the first quarter of 2014.
  • Hospital Corporation of America. HCA’s net income inched upwards 0.9 percent to a total of $347 million. The company’s net revenue had a larger bump of 4.6 percent to $8.83 billion.
  • Medical Facilities Corporation. MFC reported $72.9 million in revenue, consistent with the amount reported in the first quarter of 2013.
  • Northstar Healthcare. Northstar reported a 194.1 percent growth spurt in net patient service revenue, from $4.1 million in the first quarter of 2013 to $12.1 million.
  • Surgical Care Affiliates. SCA’s total net operating revenues, excluding centers the company does not own a controlling interest in, increased 2.1 percent to $196 million. System-wide net operating revenues rose 8.7 percent.
  • Symbion. Symbion’s revenue rose slightly from $130.38 million in the first quarter of 2013 to $133.97 million in the opening quarter of 2014.
  • United Surgical Partners International. USPI reported consolidated net revenues of $145.3 million, compared to $145.1 million during the same period in 2013.

The majority of these companies reported flat financial results or slight increases in revenue and income. AmSurg, SCA and USPI all made reference to the impact severe winter weather had on patient volume and financial performance in the news releases announcing the quarter’s results. Aside from winter woes, ASC companies had to contend with the onset of high deductible insurance plans and expanding effects of healthcare reform.

What to expect in 2015

Though predicting the future of healthcare is an uncertain exercise, the new year is just around the corner. Many forces that will shape the upcoming first quarter are already at play. High deductible plans, just beginning to roll out in 2014, will have an even greater impact in 2015 as more patients become insured and select these types of plans. “We will see a state of flux as high deductible plans gain traction,” says Joe Zasa, managing partner of ASD Management. Patient volumes may suffer another dip in the opening of 2015.

While ASC leaders may not have control over when patients with high deductible plans decide to schedule elective procedures, they can compensate. For example, ASC physicians can schedule heavy Medicare case loads for early in the year, as Medicare deductibles are not nearly as high as the $5,000 or more deductible plans that are rapidly becoming commonplace.

If another brutal winter is in store, ASCs can steel themselves for an onslaught of cold and possible closures. For example, Charlotte (N.C.) Surgery Center closed in winter of this year due to weather, but was able to reopen and perform 44 scheduled surgeries without missing a beat with the help of an online pre-admission solution.

Healthcare reform is not only affecting providers, but is also reshaping the payer landscape. Payers are facing the same fierce pressures to cut costs and produce quality results. “Many centers were lulled by their ‘success’ when reimbursement for out-of-network claims was very high,” says Mr. Zasa. OON volume, while still leveraged in some markets, is drastically dwindling. More and more ASCs are making the move to in-network.

Armed with the knowledge, in part, of what lies ahead for the beginning of 2015, ASC leaders can prepare their centers. “Each ASC is different and must find its niche. It must find ways to grow, recruit and be more efficient,” says Mr. Zasa. The best positioned ASCs and companies will be those that shoulder a certain amount of risk. Whether that risk is a gamble like AmSurg’s acquisition of Sheridan and Surgery Partner’s acquisition of Symbion, a new joint venture or narrow network participation, diversification can pave the way to a stronger first quarter and overall 2015.

© 2014 Becker’s ASC Review.

Reprinted with permission from Becker’s ASC Review.

The Making of Great ASC Board Members & Administrators

12 Key Concepts

By Laura Dyrda
This article is reprinted from Becker’s ASC Review

Leadership can make or break a surgery center. The best centers have strong administrators and board members who motivate and guide the entire organization toward success in the future.

1. Vision. A clear vision will help the leader guide others effectively. “Leaders see the solution or goal and clearly define it,” says Joe Zasa, managing partner of ASD Management. “Vision keeps you focused, fueled and helps you finish.”

These three “F’s” — focus, fuel and finish — embody the best leadership qualities:

  • Focus — When vision is so compelling you cannot become distracted. But self awareness is also important. “Focus on the task but keep a third eye on yourself,” says Mr. Zasa. “Be spatially aware.”
  • Fueled — Communicate vision effectively to set the tone and provide positive reinforcement. Leaders can say, “I’ve watched you, and I like what I see. If you follow our plan and work hard, you will succeed and achieve results.”
  • Finish — Don’t quit, even when the going gets tough. “There are peaks and valleys in life. Hanging in there despite setbacks and interference and finishing strong is the solution,” says Mr. Zasa. “If your vision is so compelling, it will drive you and force you to hang in there and not quit. If you persevere by finishing, you will generally be rewarded.”

2. Perseverance. Perseverance is especially important because even when efforts don’t succeed, the ability to avoid quitting and finishing strong projects an important message to staff. “Since we become what we think of ourselves, it is imperative that you don’t quit because finishing builds confidence in yourself and gives you the best chance to succeed the next time,” says Mr. Zasa.

3. Communication. Communication becomes a second key concept to relay your vision to others and bring them onboard to work toward a common goal. “It is essentially that you get people to buy into your vision,” says Mr. Zasa. “The more you communicate and the more they understand, then the more they care, and if they care, there is no stopping them. Roll with the tide, not against.”

Key tenets for effective communication:

  • Set clear and concise expectations
  • Project genuine and realistic optimism
  • Infuse confidence into the vision
  • Be a storyteller

“People retain stories,” says Mr. Zasa. “The best speakers are those who tell stories and paint pictures with words, not PowerPoint presentations.”

4. Encouragement. When carrying out your vision, encourage others and do for them, not for you. Treat everyone fairly, but not necessarily equally because people are all different. This shows leaders care about their team and could limit conflict and bad feelings.

“Make people feel special, but do this genuinely,” says Mr. Zasa. “They must genuinely know you care about them. When they don’t want to disappoint you, you are succeeding. Additionally, don’t contradict people. They will take it emotionally and you can’t ever reason with them. It’s okay to disagree; it’s not okay to be disagreeable.”

5. Loyalty. Leadership is influencing people toward a common goal, and leaders who take the time to understand their team and express loyalty will reap the benefits. “Take up for your people. If they’re on your team, have their back and be their advocate,” says Mr. Zasa. “You must care about your people, create that connection, be accessible and constantly let them know you care about them.”

6. Respect. Emotional bonds can motivate team members toward the common vision and produce outstanding results. Respect each other by paying attention to new ideas, thoughts and life events to strengthen this bond going forward.

“The highest complement that you can pay someone is to give him or her your undivided and uninterrupted attention,” says Mr. Zasa. “Respect each others’ opinions and get input before making decisions. Your people are part of your team and a part of the process.”

7. Recruitment. Since team members play such an integral part in a strong organization, it’s important to recruit well. “Recruiting, vision and execution wins championships,” says Mr. Zasa. “Be a fisherman for the right people.”

Don’t tolerate complacency. Figure out whether employees are content or committed to the organization. “We need those who are committed and demand it,” says Mr. Zasa.

8. Empowerment. Once the right people are in place, empower them so they can build confidence and assert themselves to help the organization grow. Teach them to identify leadership and motivate others around them.

“Motivation is for a particular moment and is important, but empowerment can last a lifetime,” says Mr. Zasa. “Recruit well, give them a clear vision that they understand, and then let them do their job. Delegation is the ultimate in levering.”

9. Lead by example. If leaders set good examples for their employees and team members, they can demand others do things write and work hard as well. Additional key qualities for strong leaders include:

  • Transparency — Show vulnerability and transparency to build trust.
  • Love — “You can’t coach them if you don’t love them,” Eddie Robinson once said.
  • Kindness — It doesn’t cost anything to be nice, but it costs a lot to break your word or be malignant.
  • Honesty — Tell people the truth to show integrity
  • Accountability — Recognize your mistakes and take responsibility to endear team members

“Hard work builds confidence and hones competence,” says Mr. Zasa. “Additionally, show class and humility. You are who you are, not what you do. Go about your business with class. Show your class all the time and demand it from those who rely on you.”

10. Competence. Those who rely on you should also respect you and come to you with their problems. Colin Powell once said “When people stop bringing you their problems, you are done as a leader.” Show you are competent with proficient preparation and work. Have a plan and vision and then focus on execution on the micro as well as macro level.

“Keep selling your vision but also be sure to focus on the small tasks; the daily things you need to do to win,” says Mr. Zasa. “Doing the small things right adds up to big wins and fulfillment of your vision.”

11. Focus. Mr. Zasa employs the W.I.N technique, which stands for “What’s Important Now.” Keep an open mind to change with time and strive toward success. You can barrow ideas from the best in the industry — as well as thought leaders in other industries — to guide your team as a successful whole.

12. Put the team first. When leaders realize lifting up the team becomes most important, they’ll be able to accomplish work much more effectively. “When you realize that power or influence begets responsibility for others and not personal gain, you separate yourself from other leaders and move into a select group,” says Mr. Zasa. “Do for others and enjoy watching others succeed and grow — it is so much more rewarding and enriching.”

© 2014 Becker’s ASC Review.

Reprinted with permission from Becker’s ASC Review.

What Can Football Teach Us about Surgery Center Management?

3 Essentials for ASC Improvement From Joe Zasa

By Rachel Fields
This article is reprinted from Becker’s ASC Review

“As I watched Alabama win this year’s national championship in college football as well as the national championship in 2009, it struck me how similar running a surgery center is to coaching a football team,” says Joe Zasa, co-founder of ASD Management. Mr. Zasa grew up in Birmingham and attended the University of Alabama, an institution with an abiding love of football and a storied past in the sport.

“I have had a particularly unique window with respect to the football program, and particularly the head football coaches, from Bear Bryant to the current coach, Nick Saban,” he says. “Over this time, Alabama had three very good coaches and several mediocre coaches. There are similarities between the coaches who succeeded.”

According to Mr. Zasa, the “rule of three” applies to both sports programs and to business. The most successful programs have:

1. A system. Establishing a system of operations is the core of a surgery center and a sports program, Mr. Zasa says. “The next time you watch Monday Night Football, listen to the starting lineup,” he says. “You will find that most of the players did not play on championship teams, or even the historic great college football programs. They were excellent players in mediocre systems.”

He says the system for a surgery center has three components: 1) clinical systems, 2) business office and 3) risk management. Each area of the surgery center must have a strict adherence to center culture and strategic direction in order to succeed. Mr. Zasa says when his company approaches a surgery center in need of a turnaround, the problems often lie with systematic failures. For example, the surgery center may not load their contracts into a computer system to track their accounts receivable. The supply area may look like a McKesson warehouse — full of supplies that will never be used but have already been purchased, effectively throwing money away. Employees don’t have a defined process for doing their jobs, so they end up dropping claims and forgetting to follow up on collections.

The surgery center should have a pervasive culture that touches every area of the facility, Mr. Zasa says. This doesn’t just mean purchasing and printing out generic policies and procedures for a small business; it means truly understanding how each role in the ASC contributes to profitability and advising staff members on how their tasks should be performed. Staff members should know how to answer the phone, how to drop claims and how to audit processes to track progress. Mr. Zasa says the surgery center should also have an employee bonus program in place that provides tangible financial rewards for good work. The bonus program should not be a “guessing game”: Employees should understand they will reap exactly what they sow.

2. Recruitment. According to Mr. Zasa, the Alabama football program has had a top five recruiting class for the last five years — and they have won two national championships. “This is not a coincidence, but it is a mistake to believe that recruiting players is the solution,” Mr. Zasa says. “You must have a superior system and superior execution.”

This doesn’t necessarily mean recruiting “stars” if they won’t work with the other members of the surgery center, Mr. Zasa says. “We spend a lot of time with staff members, and we have pre-screening tests to make sure they’re a good fit for the center,” he says. While a small surgery center can’t necessarily implement full-time training for each employee, Mr. Zasa says it helps to have regular on-site training and presentations about the center’s culture.

Physicians and anesthesia providers should be similarly recruited to work within the “system” of the center, he says. Anesthesia groups should be able to turn rooms quickly, choose appropriate drugs for the surgery center and have a strong interest in the quality aspects of the ASC. “You want anesthesiologists and CRNAs who have an interest in outpatient surgery,” he says. The same is true for physicians: Every physician recruited to the center should fit within the center’s strategic plan, bringing a needed specialty and an eye towards quality improvement. The physician should also get along well with the other providers at the center.

3. Execution. Execution is about completing a series of small tasks that create success in the long run, Mr. Zasa says. A football team can’t win a championship just by thinking about it; the team has to run drills during every practice and concentrate on every individual play in order to succeed. Your surgery center might have a good system and great players but fail because of poor execution, Mr. Zasa says.

He says execution comes down to what your staff does on a daily basis. The big picture is useful to keep in mind, but every staff member should primarily be focused on his or her daily tasks. If a team member is distracted by thinking about their upcoming vacation or a fight with their spouse, they will jeopardize the success of the ASC just as a football player would jeopardize the potential to win. “Every day, your staff should be thinking, ‘This is the job I need to do today,'” he says. “It’s about focusing on what’s important now.” Over time, completing those small daily tasks will add up into long-term success.

© 2012 Becker’s ASC Review.

Reprinted with permission from Becker’s ASC Review.