Here are eight areas surgery center administrators should benchmark monthly to optimize success.
1. Infections, complications and transfers. Clinical benchmarking is important for proving the quality of procedures performed at your center. Some surgery centers, such as Blue Ridge Surgery Center, have a quality coordinator who reports on infection rates, complications, wrong site surgery and unplanned transfers. The categories can be broken down even further to track antibiotic delivery and shaving instances.
"If we feel like we are seeing a negative trend on one of these issues, we bring the leadership team together to discuss what the problem might be and how to achieve the best resolution," says Kathy Leibl, administrator at Blue Ridge Surgery Center in Raleigh, N.C., which is affiliated with Surgical Care Affiliates. "We communicate with our team about the data, which is updated each quarter. If our data is improved, we give kudos to our team. We are always trying to improve."
Additional benchmarks Carolyn R. Hollowood, administrator at City Place Surgery Center in St. Louis which is affiliated with Meridian Surgical Partners, tracks at City Place Surgery Center include:
• When the antibiotic was administered
• Unexpected patient care within 24 hours after surgery
• Patients who remain in the recovery room longer than two hours
• Patient burns
• Patient falls
• Post-surgical wound infections
• Surgical site hair removal
"We use these benchmarks to provide safe and efficient patient care," says Ms. Hollowood. "We also conduct handwashing surveillance to make sure everyone is doing what they should in terms of infection control when as they transfer from patient to patient. In addition, we practice mask surveillance to make sure no one is wearing their mask outside of the sterile quarter."
2. Room utilization. Every month, Ms. Hollowood gathers the data from hours spent delivering care per patient and room utilization to derive the monthly percentage of room use. "I balance what we have available with what we actually used so we can improve for the next month," she says. "Usually it's a pretty easy fix, if you are watching it on a monthly basis. If you let the problem go for six months, it's not as easy to find a solution."
Efficiency is a key element to physician satisfaction, says Diane Lampron, administrator at The Surgery Center at Lutheran in Wheat Ridge, Colo., and Peak One Surgery Center in Frisco, Colo., and quick turnover times are important. "We benchmark how long it takes for us to clean the room and set it up for the next case after the first patient leaves the OR," she says. "We also look at how physicians are using block time in the OR. If they are using the room for surgery 75 percent to 80 percent of the time, that's good. If the physician is only using the room 50 percent of the four hour block schedule, we need to adjust their schedule for a higher utilization rate."
Adjusting the schedule might mean finding a different time or day that works better within the physician's schedule.
3. Physician growth. It's important for surgery centers to grow from year to year, and one of the ways to measure growth is through physician performance. Ms. Leibl's surgery center looks at physician case volume on a monthly basis and compares their numbers to previous year. There are several factors that could impact case volume, including vacation time, seasonality and the economy.
"The economy has periodically affected patient volume over the past few years," says Ms. Leibl. "Deductibles are becoming higher. For instance, ENT physicians may see a lower case volume because co-payments have grown from $25 to $75."
4. Patient and staff revenues. Ms. Hollowood receives critical management reports every month detailing revenue factors. "On the revenue side, review at gross patient revenue — were there refunds? — and then I review net patient revenue and then net patient revenue per patient," she says.
The revenue reports also depict efficiency based on staffing. Ms. Hollowood looks at paid time off hours each month, total hours worked by all staff and how many full time employees worked per month. "With this report, I can look at the hours staff spends per patient and the payroll expense," she says. "I look at the payroll per case and then I look at the total payroll as a percentage of net revenue."
5. Accounts receivable. Each month, Ms. Hollowood is able to see data on the center's accounts receivable and A/R days outstanding. These reports also include the total operating income, operating income per patient and operating margin as a percentage of net revenue.
"I look at all of these numbers every moth to give me a snap shot of activity," she says. If there are still outstanding claims or denied claims the center needs to resubmit, Ms. Hollowood knows the issue and can make sure it's dealt with. She compares her center's revenue cycle management statistics with others in several categories, including:
• Number of claims denied
• Number of claims filed
• Collection goal met
• Dictation delays greater than 48 hours
• Medical records reviewed
"We use these accounts receivable benchmarks to figure out whether there are claims we haven't collected on or accounts we must resubmit for paper or electronic claims," says Ms. Lampron. "Identify the accounts to need to re-examine for reimbursement. If you are getting a lot of denials, figure out what you need to do to lower that number."
For example, if your claims are often denied for incomplete patient information, implement a strategy with your front office staff so they get all the information upfront for submitting to payors. Other problems may occur if the claims aren't sent out quickly enough.
"We look at how quickly we are billing insurance payors, and if we aren't quick enough, we try to find out what is impeding that process," says Ms. Lampron. "Physicians might not have the dictated operative report needed for the coder. If there is a lag time between the operation and dictation, we work with the front office staff and medical records personnel to help facilitate the physicians getting their dictions in more quickly."
6. Case scheduling. Surgery centers can glean helpful information by monitoring the number of cases scheduled per month. Record the number of cases scheduled inappropriately — such as scheduling the wrong procedure or scheduling the procedure on the wrong day — and work toward minimizing mistakes. The statistics Ms. Lampron looks at include:
• Whether the cases are scheduled accurately
• Efficiency of case scheduling
• Whether cases are scheduled 24 hours to 48 hours before an operation
• Whether the staff has enough time to prepare for the case
• Procedure start times
• Amount of time taken for each case
• Cancellations
"To stay efficient, we need to know whether the cases are running on time or going over," says Ms. Lampron. "If a is surgeon often over time we want to know whether they are taking a break or whether their cases are just running 45 minutes longer on a regular basis."
7. Cancellations. Cancellations on the day of surgery can have a big impact on your surgery center. By the morning of surgery, staff members are already scheduled and the OR is already reserved, so when cancellations occur those resources are lost. Ms. Lampron looks at information every month on the cancellation rate for patients after are admitted as well as the reasons behind those cancellations.
"The cancellation is usually based on the patient's health status, meaning there was an issue that wasn't known ahead of time, such as a blood pressure increase on the morning of surgery," says Ms. Lampron. "However, there are some things that could have been caught during a pre-surgical phone call — such as the medications patients didn't stop taking before surgery — and we need to catch those to decrease cancellations."
8. Staffing needs and payroll. Every month Ms. Lampron examines the daily, weekly and monthly statistics about how many full time employees are on payroll and how many hours staff members reported working per case. She also looks at how many cases per work FTE are being done.
"We are continually looking to meet our staffing goals," Ms. Lampron says. "Salaries are one of the highest costs for surgery centers and we want to make sure we are being efficient based on case volume."
More Articles on Surgery Center Benchmarks:
20 Statistics on Physician Compensation for 5 Key Surgery Center Specialties
20 New Statistics on Surgery Center Staffing Costs
16 New Statistics on Surgery Center EBIDTA
1. Infections, complications and transfers. Clinical benchmarking is important for proving the quality of procedures performed at your center. Some surgery centers, such as Blue Ridge Surgery Center, have a quality coordinator who reports on infection rates, complications, wrong site surgery and unplanned transfers. The categories can be broken down even further to track antibiotic delivery and shaving instances.
"If we feel like we are seeing a negative trend on one of these issues, we bring the leadership team together to discuss what the problem might be and how to achieve the best resolution," says Kathy Leibl, administrator at Blue Ridge Surgery Center in Raleigh, N.C., which is affiliated with Surgical Care Affiliates. "We communicate with our team about the data, which is updated each quarter. If our data is improved, we give kudos to our team. We are always trying to improve."
Additional benchmarks Carolyn R. Hollowood, administrator at City Place Surgery Center in St. Louis which is affiliated with Meridian Surgical Partners, tracks at City Place Surgery Center include:
• When the antibiotic was administered
• Unexpected patient care within 24 hours after surgery
• Patients who remain in the recovery room longer than two hours
• Patient burns
• Patient falls
• Post-surgical wound infections
• Surgical site hair removal
"We use these benchmarks to provide safe and efficient patient care," says Ms. Hollowood. "We also conduct handwashing surveillance to make sure everyone is doing what they should in terms of infection control when as they transfer from patient to patient. In addition, we practice mask surveillance to make sure no one is wearing their mask outside of the sterile quarter."
2. Room utilization. Every month, Ms. Hollowood gathers the data from hours spent delivering care per patient and room utilization to derive the monthly percentage of room use. "I balance what we have available with what we actually used so we can improve for the next month," she says. "Usually it's a pretty easy fix, if you are watching it on a monthly basis. If you let the problem go for six months, it's not as easy to find a solution."
Efficiency is a key element to physician satisfaction, says Diane Lampron, administrator at The Surgery Center at Lutheran in Wheat Ridge, Colo., and Peak One Surgery Center in Frisco, Colo., and quick turnover times are important. "We benchmark how long it takes for us to clean the room and set it up for the next case after the first patient leaves the OR," she says. "We also look at how physicians are using block time in the OR. If they are using the room for surgery 75 percent to 80 percent of the time, that's good. If the physician is only using the room 50 percent of the four hour block schedule, we need to adjust their schedule for a higher utilization rate."
Adjusting the schedule might mean finding a different time or day that works better within the physician's schedule.
3. Physician growth. It's important for surgery centers to grow from year to year, and one of the ways to measure growth is through physician performance. Ms. Leibl's surgery center looks at physician case volume on a monthly basis and compares their numbers to previous year. There are several factors that could impact case volume, including vacation time, seasonality and the economy.
"The economy has periodically affected patient volume over the past few years," says Ms. Leibl. "Deductibles are becoming higher. For instance, ENT physicians may see a lower case volume because co-payments have grown from $25 to $75."
4. Patient and staff revenues. Ms. Hollowood receives critical management reports every month detailing revenue factors. "On the revenue side, review at gross patient revenue — were there refunds? — and then I review net patient revenue and then net patient revenue per patient," she says.
The revenue reports also depict efficiency based on staffing. Ms. Hollowood looks at paid time off hours each month, total hours worked by all staff and how many full time employees worked per month. "With this report, I can look at the hours staff spends per patient and the payroll expense," she says. "I look at the payroll per case and then I look at the total payroll as a percentage of net revenue."
5. Accounts receivable. Each month, Ms. Hollowood is able to see data on the center's accounts receivable and A/R days outstanding. These reports also include the total operating income, operating income per patient and operating margin as a percentage of net revenue.
"I look at all of these numbers every moth to give me a snap shot of activity," she says. If there are still outstanding claims or denied claims the center needs to resubmit, Ms. Hollowood knows the issue and can make sure it's dealt with. She compares her center's revenue cycle management statistics with others in several categories, including:
• Number of claims denied
• Number of claims filed
• Collection goal met
• Dictation delays greater than 48 hours
• Medical records reviewed
"We use these accounts receivable benchmarks to figure out whether there are claims we haven't collected on or accounts we must resubmit for paper or electronic claims," says Ms. Lampron. "Identify the accounts to need to re-examine for reimbursement. If you are getting a lot of denials, figure out what you need to do to lower that number."
For example, if your claims are often denied for incomplete patient information, implement a strategy with your front office staff so they get all the information upfront for submitting to payors. Other problems may occur if the claims aren't sent out quickly enough.
"We look at how quickly we are billing insurance payors, and if we aren't quick enough, we try to find out what is impeding that process," says Ms. Lampron. "Physicians might not have the dictated operative report needed for the coder. If there is a lag time between the operation and dictation, we work with the front office staff and medical records personnel to help facilitate the physicians getting their dictions in more quickly."
6. Case scheduling. Surgery centers can glean helpful information by monitoring the number of cases scheduled per month. Record the number of cases scheduled inappropriately — such as scheduling the wrong procedure or scheduling the procedure on the wrong day — and work toward minimizing mistakes. The statistics Ms. Lampron looks at include:
• Whether the cases are scheduled accurately
• Efficiency of case scheduling
• Whether cases are scheduled 24 hours to 48 hours before an operation
• Whether the staff has enough time to prepare for the case
• Procedure start times
• Amount of time taken for each case
• Cancellations
"To stay efficient, we need to know whether the cases are running on time or going over," says Ms. Lampron. "If a is surgeon often over time we want to know whether they are taking a break or whether their cases are just running 45 minutes longer on a regular basis."
7. Cancellations. Cancellations on the day of surgery can have a big impact on your surgery center. By the morning of surgery, staff members are already scheduled and the OR is already reserved, so when cancellations occur those resources are lost. Ms. Lampron looks at information every month on the cancellation rate for patients after are admitted as well as the reasons behind those cancellations.
"The cancellation is usually based on the patient's health status, meaning there was an issue that wasn't known ahead of time, such as a blood pressure increase on the morning of surgery," says Ms. Lampron. "However, there are some things that could have been caught during a pre-surgical phone call — such as the medications patients didn't stop taking before surgery — and we need to catch those to decrease cancellations."
8. Staffing needs and payroll. Every month Ms. Lampron examines the daily, weekly and monthly statistics about how many full time employees are on payroll and how many hours staff members reported working per case. She also looks at how many cases per work FTE are being done.
"We are continually looking to meet our staffing goals," Ms. Lampron says. "Salaries are one of the highest costs for surgery centers and we want to make sure we are being efficient based on case volume."
More Articles on Surgery Center Benchmarks:
20 Statistics on Physician Compensation for 5 Key Surgery Center Specialties
20 New Statistics on Surgery Center Staffing Costs
16 New Statistics on Surgery Center EBIDTA