For most surgical practices, scheduling is the revenue engine and often the least understood process in the building. As clinics absorb more responsibility for authorization, clearance and patient preparation, the cases that quietly fall out of the pipeline rarely show up in any report, even as they drain operating room time and revenue.
During an executive roundtable at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Conference, two leaders examined how a nearly century-old orthopedic group turned a scheduling crisis into recovered capacity and revenue.
The speakers were:
- Ashvin Dewan, MD, a board-certified orthopedic surgeon in the Houston area specializing in sports medicine and minimally invasive knee, shoulder and elbow procedures and advisor to LeanTaaS
- Ken Takenaka, director of operations at Orthopedic + Fracture Specialists in Portland, Ore.
Below are four takeaways from their conversation.
Note: Quotes have been edited for length and clarity.
1. The most expensive scheduling problems are the ones no one can see
Dr. Dewan opened with the story of a practice navigating staffing shortages, nursing strikes and shrinking operating room access — disruptions that exposed a deeper, invisible problem. When the group finally looked closely, it found more than $500,000 in potentially recoverable revenue that had slipped out of the surgical pipeline. These weren’t denied claims or reimbursement issues; the failure points practices tend to fixate on. They were patients who had been recommended for surgery and simply never made it to the operating room.
“The opportunity was there, the patients were there, the revenue was there, but it was invisible,” Dr. Dewan said. He argued that while the electronic medical record is built to store medical records, it falls short as a tool for managing the surgical scheduling workflow.
2. A crisis forced visibility that volume had masked
For Mr. Takenaka, the “protagonist” in Dr. Dewan’s story, the breaking point came when external shocks broke a system the practice had long taken for granted. Orthopedic + Fracture Specialists — founded in 1933, with 20 physicians, 15 of them surgeons and a jointly owned ambulatory surgery center — had relied on volume always being there. Then the hospital system the group works with hit nursing strikes, supply chain problems and an anesthesia shortage following a contract transition.
“It got to the point where the hospital would be calling our practice to tell us what our OR time was two weeks from then,” Mr. Takenaka said. Without a centralized view of where patients stood in the process — authorizations, medical clearance, primary care sign-off — the group couldn’t pivot fast enough to fill the time it did have and lost operating room slots as a result.
3. Standardizing the workflow mattered more than changing the surgeons
The fix Mr. Takenaka’s group landed on was iQueue for Surgical Clinics, LeanTaaS’ platform for managing the surgical pipeline. He set two priorities in selecting it: structured, on-demand data he could analyze himself, and enough flexibility that he wouldn’t have to tell surgeons to change how they practiced to fit the tool. In practice, that meant letting surgeons keep their varied intake habits — sticky notes, chat messages, EMR orders — while routing everything into a single source of truth on the back end.
The harder part was adoption, and the resistance came not from the surgeons but from veteran scheduling staff confident in their own efficiency. Mr. Takenaka recalled a longtime supervisor who, two weeks before go-live, told him she didn’t see how the system would help. Two weeks after go-live, her assessment had flipped.
“She said, ‘We’ve never been this efficient. We’re completely caught up,'” Mr. Takenaka recalled. “It had to show up in their hands. They had to see the result for themselves.”
4. Visibility converts into velocity and recoverable revenue
Once the pipeline produced reliable data, the gains compounded. Mean time to schedule a case fell from 40 days to 10. The same scheduling team, with no added staff, went from handling 123 cases per scheduler per month to 181 — roughly the work of four and a half schedulers done by three. Surgical volume rose about 12% against a comparable prior-year period, and average patient wait time dropped from 29 to 20 days as the group grew nimbler at backfilling canceled slots.
The data also surfaced what had been invisible: of 164 stalled cases across one review period, the group identified about half as recoverable, representing more than $447,000 in potential revenue. With that visibility, Mr. Takenaka’s team began meeting with its ASC to review cancellations and tighten the quality of information reaching anesthesiologists, so patients who never should have reached the schedule stopped doing so.
Where leaders go from here
Dr. Dewan closed with a challenge he framed as a “chart biopsy”: ask someone to review the last three months of clinic visits, flag every time surgery was recommended, and calculate how many of those patients actually reached the operating table. The resulting booking rate, he argued, is where most practices will find opportunities hiding in plain sight — particularly those with an ASC, where integrating the workflow end to end pays off on both sides.
The throughline was that none of it required reinventing the practice. Orthopedic + Fracture Specialists started with skeptics and a crisis, stopped flying blind, and turned a fragile, reactive process into a durable and proactive one.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.