GI ASCs suffer from low reimbursement, so keeping costs down is a priority. If surgery centers can keep turnover times and case times short and target the right patient populations, they can make a significant profit from GI. Lindsay Allen, special services coordinator at the Borland-Groover Clinic, discusses eight statistics every GI-driven center should track.
1. Population growth. Ms. Allen says the Borland-Grover Clinic's executive team routinely reviews regional economic data on population growth that is prepared by a local economist. She says it's helpful for ASCs to understand how the population of the region is changing. For example, if the population is growing, the ASC might focus heavily on physician recruitment; if the population is staying stagnant or shrinking, it may be wiser to focus on direct-to-patient marketing in order to capture valuable market share.
2. Median age. Ms. Allen says GI-driven centers should pay particular attention to population demographics because the patient base is generally age-specific. Patients coming to the surgery centers for colonoscopies are likely to be 45-50 years old, so the center should know whether the average age of the community is increasing or decreasing. As the population ages, it is likely that there will be a significant increase in the number of patients requiring colonoscopies. Benchmarking age demographics can help the center understand which procedures to highlight in direct-to-patient marketing.
3. Wait times. Ms. Allen says it's important for GI-driven centers to benchmark wait times to determine how long patients have to wait for a surgery appointment at the surgery center. John Gol, executive director of finance for the Borland-Groover Clinic, says, "Historically, if a patient has to wait more than three weeks for a procedure, they will go elsewhere."
Borland-Groover Clinic uses its practice management system to produce a report on patient wait times, and then each center tries to stay below an established benchmark. "If our wait times are growing past a certain point, the center looks at the possibility of hiring another physician," Ms. Allen says.
4. Costs per case. Ms. Allen says her centers benchmark costs per case to determine where cost-cutting opportunities might exist. She says physician preference is the biggest cause of outliers when it comes to case costs in a GI center.
"A physician will request [a certain supply], which can cause our costs per case to increase," she says. "Usually by showing them the difference in costs, the physician is agreeable to using a more cost-effective item." She says tracking case costs has enabled the ASCs to notice opportunities to cut costs by identifying both the peaks and valleys in the case costing trends.
5. Staff hours per case. Benchmark staff hours for GI cases separately from OR cases, Ms. Allen recommends. "We keep the calculations separate because it does seem like supplies and staffing for GI are pretty standard, so we keep them separate to monitor the difference in our OR staff hours," she says. She says Borland-Groover tries to keep staff hours per case at an internal benchmark of five hours per case for its GI cases.
"Sometimes it can be as high as seven or eight, in which case we look at the difference and try to determine what happened," she says. "For example, maybe we had more people in the PACU than we needed."
She says benchmarking staff hours per case is useful because it makes staff aware of their time on the clock. "Charge nurses are a little bit more aware of getting people out of there," she says.
6. Polyp detection rates. Ms. Allen says Borland-Groover's quality development department benchmarks physicians' polyp detection rates — that is, the number of polyps found during a colonoscopy compared to the withdrawal time of the scope. She says they compare their physician's rates to national benchmarks, which suggest that 15 percent of women and 25 percent of men will have one or more polyps detected during a colonoscopy.
Jack Groover, MD, CEO for Borland-Groover Clinic, says, "There is a direct correlation between rapid withdrawal times and lower polyp detection rates." Borland-Groover researches and tracks these rates for each of their physicians and counsels physicians who fall below the national benchmarks.
7. Patient transfer rate. Ms. Allen says Borland-Groover's GI centers also track patient transfer rates to determine how many patients are sent to the hospital because of a surgical complication. She says benchmarking these rates has led the centers to implement a pre-admission testing process for GI patients as well as surgical patients.
"Our surgery center used to do PAT for OR cases only, and we will be doing PAT for our GI patients now, to hopefully improve our patient transfer rate," she says. Tracking the number of patient transfers is important for surgery centers to understand whether they are admitting patients who are inappropriate for outpatient surgery.
8. Block time utilization. GI-driven centers should track physician block time utilization to make sure surgeons are using their time effectively. Because GI centers thrive on efficiency, patients should be seen in a timely manner. "We use our practice management system to run a report, accounting for any vacation and on-call days," Ms. Allen says. "The report helps us determine who might need more block time and who maybe needs a little less, to make sure that patients are being seen in a timely manner."
She says every patient should be able to schedule an appointment within three weeks. Borland-Groover leaders look at block time reports monthly and adjust schedules if they see an issue.
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1. Population growth. Ms. Allen says the Borland-Grover Clinic's executive team routinely reviews regional economic data on population growth that is prepared by a local economist. She says it's helpful for ASCs to understand how the population of the region is changing. For example, if the population is growing, the ASC might focus heavily on physician recruitment; if the population is staying stagnant or shrinking, it may be wiser to focus on direct-to-patient marketing in order to capture valuable market share.
2. Median age. Ms. Allen says GI-driven centers should pay particular attention to population demographics because the patient base is generally age-specific. Patients coming to the surgery centers for colonoscopies are likely to be 45-50 years old, so the center should know whether the average age of the community is increasing or decreasing. As the population ages, it is likely that there will be a significant increase in the number of patients requiring colonoscopies. Benchmarking age demographics can help the center understand which procedures to highlight in direct-to-patient marketing.
3. Wait times. Ms. Allen says it's important for GI-driven centers to benchmark wait times to determine how long patients have to wait for a surgery appointment at the surgery center. John Gol, executive director of finance for the Borland-Groover Clinic, says, "Historically, if a patient has to wait more than three weeks for a procedure, they will go elsewhere."
Borland-Groover Clinic uses its practice management system to produce a report on patient wait times, and then each center tries to stay below an established benchmark. "If our wait times are growing past a certain point, the center looks at the possibility of hiring another physician," Ms. Allen says.
4. Costs per case. Ms. Allen says her centers benchmark costs per case to determine where cost-cutting opportunities might exist. She says physician preference is the biggest cause of outliers when it comes to case costs in a GI center.
"A physician will request [a certain supply], which can cause our costs per case to increase," she says. "Usually by showing them the difference in costs, the physician is agreeable to using a more cost-effective item." She says tracking case costs has enabled the ASCs to notice opportunities to cut costs by identifying both the peaks and valleys in the case costing trends.
5. Staff hours per case. Benchmark staff hours for GI cases separately from OR cases, Ms. Allen recommends. "We keep the calculations separate because it does seem like supplies and staffing for GI are pretty standard, so we keep them separate to monitor the difference in our OR staff hours," she says. She says Borland-Groover tries to keep staff hours per case at an internal benchmark of five hours per case for its GI cases.
"Sometimes it can be as high as seven or eight, in which case we look at the difference and try to determine what happened," she says. "For example, maybe we had more people in the PACU than we needed."
She says benchmarking staff hours per case is useful because it makes staff aware of their time on the clock. "Charge nurses are a little bit more aware of getting people out of there," she says.
6. Polyp detection rates. Ms. Allen says Borland-Groover's quality development department benchmarks physicians' polyp detection rates — that is, the number of polyps found during a colonoscopy compared to the withdrawal time of the scope. She says they compare their physician's rates to national benchmarks, which suggest that 15 percent of women and 25 percent of men will have one or more polyps detected during a colonoscopy.
Jack Groover, MD, CEO for Borland-Groover Clinic, says, "There is a direct correlation between rapid withdrawal times and lower polyp detection rates." Borland-Groover researches and tracks these rates for each of their physicians and counsels physicians who fall below the national benchmarks.
7. Patient transfer rate. Ms. Allen says Borland-Groover's GI centers also track patient transfer rates to determine how many patients are sent to the hospital because of a surgical complication. She says benchmarking these rates has led the centers to implement a pre-admission testing process for GI patients as well as surgical patients.
"Our surgery center used to do PAT for OR cases only, and we will be doing PAT for our GI patients now, to hopefully improve our patient transfer rate," she says. Tracking the number of patient transfers is important for surgery centers to understand whether they are admitting patients who are inappropriate for outpatient surgery.
8. Block time utilization. GI-driven centers should track physician block time utilization to make sure surgeons are using their time effectively. Because GI centers thrive on efficiency, patients should be seen in a timely manner. "We use our practice management system to run a report, accounting for any vacation and on-call days," Ms. Allen says. "The report helps us determine who might need more block time and who maybe needs a little less, to make sure that patients are being seen in a timely manner."
She says every patient should be able to schedule an appointment within three weeks. Borland-Groover leaders look at block time reports monthly and adjust schedules if they see an issue.
Related Articles on Gastroenterology and Endoscopy:
Esophageal Cancer Risk Lower for Those With Barrett's Esophagus Than Thought
Study: Metformin Therapy May Reduce Risk of Colon Cancer in Diabetics
Study: Gastric Bypass Patients Eat Healthier Than Gastric Banding Patients