5 Steps to Maximize Utilization at Surgery CentersT.K. Miller, MD, an orthopedic surgeon with Carilion Clinic Orthopedics and medical director at Roanoke (Va.) Ambulatory Surgery Center, recently went through a utilization analysis and found ways to make the surgery center more efficient and bring in more cases without building onto the original facility.
"We just expanded our efficiency without doing anything to the building," says Dr. Miller. "Now, we'll have to do a new assessment for any new providers who want to use our facility. We have a little wiggle room in pain management, but once those spaces are filled the facility will be truly max out and then expansion becomes a very realistic option."
Dr. Miller discusses five steps to accommodate additional patient volume before spending the time and money it takes to build onto your facility.
1. Bring surgeons in for a full day. If possible, schedule physicians for a full day of block time at the surgery center. Sometimes this will mean scheduling someone every first and third Wednesday or another surgeon one Friday per month, but having surgeons scheduled for one full day is more efficient than multiple half-days.
"From the perspective of getting physicians to use the facility, offering a full day to lock them in is good," says Dr. Miller. "If we can get a physician to come in and stay at the facility for a full day, even if they have one case that we would just break even on or lose money on, having that surgeon there for the full day is beneficial for us. We would rather offer someone one full day per month than two half days because nobody will want an afternoon half day to follow a surgeon who might not run on time."
However, when you assign half days to surgeons you may run into negative utilization patterns unless you allow surgeons to schedule the maximum cases per day. When utilization is based only on the percent of time the surgeon uses, they might be told they can't bring an extra case in at 2:45 pm if the full day ends at 3:30 pm; they are just credited for the full day.
"When surgeons aren't allowed to add on a last case, we look critically at what kind of cases they want to add on and whether that fits in their usual volume," says Dr. Miller. "You have to look at where everyone is and whether you need to be more efficient in order to fit that last case in."
2. Find holes in the schedule based on the provider. Even if all the block times are filled, look at the actual utilization rates to see whether there is an opportunity for consolidation. On average, your surgery center might see a 79 percent utilization rate, but when you break it down there are four days with 115 percent and one day with only 70 percent. Figure out how to fill the gaps on the 70 percent day.
"You have to see if you have consistent gaps and figure out whether somebody only consistently uses a certain number of hours on their block time," says Dr. Miller. "For example, one provider might have a day where he is consistently cutting his schedule at noon so he doesn't see anyone else after 11am. Nobody new will want to fill that afternoon space, but we can offer it to another provider who is already at the center."
Even though half days aren't ideal, this arrangement could work out if the first surgeon ends promptly and the second surgeon is already invested and present at the surgery center. "This way you can improve utilization and you don't need to add anyone to your facility," says Dr. Miller. "If you look at the gaps, you can see where moving one provider around might make a difference and the schedule starts to cascade from there."
3. Fill large gaps with a new provider. If you find there are large gaps in the schedule and consolidation leads to more open space, consider bringing on a new provider. "If you look at utilization and find consistent openings in your schedule, you can add providers without expanding the facility or purchasing more equipment," says Dr. Miller. "This is especially true if you are adding a provider from a specialty that already brings cases to the center."
If you have the opportunity to bring on a new specialty, there are several factors you have to consider. Make sure the operating rooms are the right size for the new specialty and that you have the right equipment. You also want to make sure flipping the operating room between specialties won't cause inefficiencies at the center.
"You might consider this type of expansion if there are new providers coming into the center and bringing in new specialties, or if there are patient losses in other areas and there is a potential to bring cases into the facility that it wouldn't otherwise capture at all," says Dr. Miller. "If there is space available, they will come to your center based on your reputation."
4. Revise block schedule times. Dr. Miller just finished doing an analysis on their schedules and revising block schedule times. As a result, the surgery center was able to add two new groups to the surgery center that will bring in around 60 to 70 more cases per month.
"Physicians might think they are using all of their time and need more, but when you show someone their utilization for one quarter compared to the other, they most likely aren't using all of their time," says Dr. Miller. "Physicians are very protective of their block time and they don't want to give it up. At the hospital, if you give up block time, you might never get it back. We tell them we won't give up their block and if our new schedule doesn't work out they can have the block back."
Dr. Miller has found that surgeons are often open to trying the change if they know their block time will be protected. With better utilization, you can bring in new providers you didn't anticipate having space for in the past.
5. Expand to evening and weekend hours. Before expanding the facility, consider whether you will be able to benefit from evening and weekend hours. There are challenges associated with both evening and weekend hours, but with the right surgeons and staff members it is possible.
"The risk of going to extended hours is the tendency to nudge people to work longer," says Dr. Miller. "We have high staff retention because people know when they can go home. If we are going to extend our hours, we have to define who comes in to the late hours and make sure the change happens smoothly."
Surgery centers also have the option of keeping Saturday hours, opening one or two operating rooms every Saturday.
"There is a subset of staff that only want to work one or two days per week and a patient population that doesn't want to interrupt their school and work weeks to get surgery done," says Dr. Miller. "Consider whether you have the right pool of people who want to work on the weekends — staff members, surgeons and anesthesiologists — and the right patient population. With those in place, Saturday hours will work."
More Articles on Surgery Centers:
Running a Profitable Ophthalmology Surgery Center: Q&A With James Dawes of Center for Sight
5 Common Hiring Mistakes in Ambulatory Surgery Centers
5 Steps to Reduce Supply Cost Per Case in Surgery Centers
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