A recent report from the Department of Health and Human Services stated that "per capita spending in the U.S. exceeds the level in the next 3 closest countries by more than 50%", and raised "concerns about the negative impact of health care cost inflation on the U.S. economy"1.
The pressure is mounting to cut healthcare costs, and ASCs are beginning to feel this through reduced facility reimbursements. The ASC industry is seeing payment cuts to common procedures, shifting groupers and bundles, and the trend towards linking quality outcomes with risk of reduced reimbursement for facilities. Despite all of this, the costs of staffing, supplies, pharmaceuticals and implants continue to rise unabated. If reimbursement is less each year with costs increasing, the only solution is to find ways to use the resources at hand more productively. Efficiency is the key.
Peter Anderson, Chief Strategy Officer for Sutter Health states "Today's customers need real value in healthcare services and ambulatory surgery centers have become part of that solution. They provide convenient, high quality and high satisfaction services to patients who qualify clinically to use them, and do so from a lower cost platform than other alternatives". This increased pressure to find more cost-effective solutions can be the ASC industry's greatest advantage, but only if we can continue to run our facilities efficiently.
Efficiency is not only imperative to keep up with the changing financial pressures, but can be a great tool for physician recruitment as well. In the last 2 years, Santa Rosa Surgery and Endoscopy Center has grown case volumes by over 300%. Much of the reason for this success is that during this time period surgery turnover times have been cut by 14%, and pain management turnover times by over 50%. Ultimately this has played a key factor in both recruiting physicians as well as bringing in more cases from existing physicians.
1. Utilize the best ideas of staff and physicians
It turns out staff and physicians have some pretty good ideas. Physicians have usually trained at other locations, and by listening to them you can adopt best practices from a vast network of other facilities. At SRSEC, one physician knew of a hand table which attached to the patient gurney, eliminating the time needed to transfer a patient back and forth to the OR table. Another physician shared different post-operative handoff protocols he had seen elsewhere which cut staff time again. Staff members recommended changes to paperwork based on examples from other facilities. Upon further review, old paperwork fields were found that were duplications or were no longer necessary which helped not only improve efficiency, but reduced some frustrating redundancy for the staff as well.
2. Analyze your processes. Over and over again.
Involving your team in continuous rounds of process improvement can help fine-tune important details. Recurring meetings with key team members and physicians to examine every detailed step in a process, can be used to identify bottlenecks and address each of them individually. Even many small things such as disinfectants with shorter dry times, or analyzing and reassigning staff roles during the turnover can make a huge difference. In a lineup of 60 quick procedural patients, even very small things such as which staff member puts on the bandage or changes the pillowcase add up at the end of the day.
3. Strategic Staffing:
Once bottlenecks in a process have been identified, it is typical to find one area of staffing that has critical actions which hold processes up more than others. In pain management for example, SRSEC found that that sedation nursing had the longest part of the process between cases at that facility. By tripling staffing in this area, the facility was able to see three times the caseload without having to increase all of the other staff associated with the procedure such as circulators, techs or front office staff. Overall, turnover times in this specialty dropped by over 50% as well. On a per-case basis, this greatly cut costs, and was a huge satisfier for the physicians.
4. Room flipping
Room flipping is typically viewed as inefficient because of wait times while another case is going on. Room flipping done without any guidelines can indeed increase downtimes between procedures. Effective utilization of room flipping at certain times when it makes sense though, can greatly increase efficiency and still cut turnover times. In utilizing strategic room flipping for the latest room of the day after the shortest one gets out, SRSEC has been able to decrease the number of Operating Rooms running past 5:00 from 26% down to 9% over the past 2 years, despite packing a far higher volume of cases into the remaining business hours. This meant more cases done quickly for the surgeons, increased block time utilization, and a 50% drop in overtime rates.
Efficiency is what will help us survive on smaller margins and continue to differentiate our industry in the future. As an added bonus, you will find that it can also be a positive factor for improvement in physician recruitment and even staff satisfaction as well.
Dan Peterson is graduate of Brigham Young University, and received his MHSA from the University of Michigan. He has worked with Kaiser Permanente, the United States Veterans Health Administration and the University of California, Los Angeles Health System. Dan is a Fellow in the American College of Healthcare Executives, and has been the Administrator of Sutter Health's Santa Rosa Surgery and Endoscopy Center since 2012.
1 The Effect of Health Care Cost Growth on the U.S. Economy; Final Report for Task Order # HP-06-12; Prepared for the Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services.
https://aspe.hhs.gov/sites/default/files/pdf/75441/report.pdf
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