Most surgical practices know their surgical scheduling and coordination processes are messy, and the workflows are leaving money on the table. However, they find it difficult to pinpoint the problems or how to address them effectively without precise surgical data tracking. Additionally, most EHR systems don't track this information out of the box.
Working with surgical practices across the U.S., we have learned the key performance indicators (KPIs) that surgical practices should look at and the targets to accelerate business performance.
We've helped hundreds of surgical practices reduce cancellations, improve block time utilization, and reduce the time spent coordinating surgeries. So, let's look at which KPIs are the most important for your surgical practice.
Your Surgical Practice’s Key Performance Indicators
Key performance indicators for surgical coordination efficiency include:
- Surgery order conversion rate
- Avoidable cancellation rate
- Block time utilization
- Reschedule rate
- Full-time employee costs
We’ll review each KPI, why it's essential, and how to calculate them with or without your ASC or hospital’s help. After a few equations, you can reflect on each and determine how to improve your practice.
Find Your Surgery Order Conversion Rate
Surgery order conversion rate is the percentage of surgeries performed out of the total surgeries ordered. This KPI shows how much business you may be missing out on. You’ve invested so much effort in building loyal patients, attracting them to your clinic, and caring for them, so every eligible surgery candidate is a real economic opportunity. If faced with delays in surgery or lack of clear communication, patients may receive a lower quality of care or feel pushed to seek care with another practice.
You should be able to find the info you need in most modern EHR systems. If you don’t have an electronic ordering system in your EHR, you can do a sample study of your physicians to get a solid estimate.
For example, ask your teams to collect all the orders created over the previous three months and then cross-reference these against your practice management system to see which patients had a procedure. This process will give you a relatively accurate surgery order conversion rate.
A lot can happen between submitting a surgery order and performing the surgery, and many patients make very well-informed decisions to not proceed with surgery. Factors like avoidable cancellations and unavoidable cancellations can also influence this KPI. The world isn't perfect, so no practice will see a 100% conversion rate for surgery orders.
However, some of the most advanced practices we work with regularly monitor this KPI and design process improvements to create efficiencies over time. That’s because they know unlocking even a 1-2% higher surgery order conversion rate can mean big dollars by adding surgery volume that otherwise would be missed.
Find Your Avoidable Cancellation Rate
Avoidable cancellation rate is the percentage of cancelled surgeries that could have happened but did not due to factors within your practice’s control. Reducing avoidable cancellations will help your practice save time and money, treat more patients, and maintain a good reputation for future patients.
Here are just a few examples of what can cause an avoidable cancellation:
- Mistakes in the coordination process or communication
- Prior authorization not secured in time
- Scheduling errors with the facility
- The surgeon arrived at the wrong location
It’s also important to note what an unavoidable cancellation is and remove those from this calculation. Unavoidable cancellations include factors outside your practice’s control, like patient-side cancellations, natural disasters, or family emergencies.
In most modern practices, pulling up a report of all surgery appointments, cancellations, and rescheduled appointments is possible. While typically not 100% reliable, these systems often capture cancellation reasons at the point of cancellation, offering insight into some typical causes.
From there, it may be possible to parse out which cancellation reasons are unavoidable or avoidable. You can do all this by:
- Looking at your practice management system reports, which usually require documentation of cancellation reasons.
- Organizing the cancellations into “avoidable” and “unavoidable” categories.
- Dividing the avoidable cancellations by the total number of cancellations.
That’s your avoidable cancellation rate.
If you work with an ambulatory surgery center (ASC), another option is to work with your ASC manager to evaluate cancellation rates and reasons with a digestible sample. For example, a standard ASC with four operating rooms may have a couple hundred cancellations over three months.
You can work with your ASC to manually review these to determine the causes, what percent were avoidable, and if those surgeries got rescheduled. Even if your practice works well with your ASC, the findings can be eye-opening.
We’ve found that about 30% of cancellations are tied to avoidable factors that can be reduced with better processes. But how can that be when so much of the business is dedicated to performing surgery? If a tiny piece of surgery coordination is out of place, the surgery cannot be performed. Surgeons and management often agree avoidable cancellation rates can be improved – and they’re correct.
Find Your Block Time Utilization Rate
The block time utilization rate tells you how efficiently your practice uses operating room time, making it a crucial KPI. A low block time utilization rate indicates inefficient usage and costly, idle ORs for your practice — each minute of OR time can cost between $30 and $100.
Surgery cancellations – both avoidable and unavoidable – can cause ORs to go unused. A practice can mitigate this issue with an efficient workflow that “bumps up” or reschedules patients who have everything they need to head into the OR earlier than they were previously scheduled.
With a digital system and automation, bumping patients to fill a cancelled OR slot is quick and efficient. With a good workflow, these idle OR times often remain full.
If you work with an ASC that uses a modern practice management system, you can find block time utilization rate as a metric in a dashboard or report. Without an ASC, find this KPI by:
- Finding a surgeon’s total scheduled block time over a month’s period and removing any days off (vacation days, for example).
- Dividing the difference by the scheduled block time.
That’s your block time utilization rate.
Many practices don't know they have a block time utilization issue until they look at their report. Without their practice data, they rely on their hospital or ASC to periodically provide this information. Having a system for the practice to capture this information independently can be very valuable.
Find Your Reschedule Rate
Your reschedule rate is the percentage of surgeries completed on a date later than the originally planned date. Knowing your reschedule rate helps identify how many surgery cancellations get rescheduled and completed. Many practices are surprised that their reschedule rate is 50% or lower.
If you've found your avoidable cancellation rate, you may already have some data for this calculation. You can calculate this number on a per-patient basis by:
- Adding up all cancellations over a period of time.
- Identifying the total number of those cancelled cases that were scheduled for a later date (we recommend removing same-day reschedules for your analysis).
- Dividing the total number of rescheduled cases by the total number of cancellations.
Remember to consider multiple cancellations per surgery since each cancellation impacts your surgical coordinators’ workload.
Generally, if a practice has a high avoidable cancellation rate, it will see a low reschedule rate. While different, coordinating a surgery and rescheduling the surgery have some overlap. But moved cases inevitably cause a lot of rework for your team.
Small steps toward efficiency can make a difference in your bottom line, but only if you know where to look, for example, creating follow-up plans for cancelled cases to make sure they get rebooked.
Find Full-Time Employee Costs Around Surgical Coordination
Full-time employee (FTE) cost is the cost spent on employees to coordinate surgeries. FTE costs are essential for budgeting. Identifying how much time a dedicated coordination platform could save helps you decide what to invest in.
There may be some overlap. For example, each week a Medical Assistant who spends three hours on pre-cert activities adds three hours to your weekly surgical coordination FTE cost; a full-time surgical coordinator adds 40 hours to your weekly FTE cost.
Ask supervisors for a close estimate of their direct reports’ hours to help with this calculation. Include hours dedicated to the surgical coordination workflow for roles like:
- Surgical schedulers and coordinators
- Pre-cert employees
- Those who work with patient financials
- Your billing team that is gathering surgical payments from patients or insurance companies
Then, calculate FTE cost by:
- Adding up the hours dedicated to surgical coordination.
- Multiplying those hours by the hourly employee cost.
That's your FTE cost for surgical coordination.
Depending on the number of employees, the amount of duplicate data entry they perform, and how efficient your coordination workflow is, this can be a significant dollar amount, which makes sense. Surgical coordination is a large part of your business, and it’s worth investing in for your practice.
Rounding Out the Numbers
After you've made your calculations, take some time to reflect on your KPIs. Ask yourself and other leadership members:
- What is the impact of marginal change on these KPIs? If the impact is significant, is it worth additional research and investment?
- Are we getting enough out of what we spend?
- Are there workflow improvements that would help?
- Would more employees help?
- Can we turn to specialized software?
To some smaller practices, the information these KPIs provide is worth discussing over lunch. As for other large practices, it's the main topic at the next board meeting. But one thing is certain, most practices should look at these numbers and can use them to improve the way they run their surgery business.