In physician-owned ASCs, there is often a democratic environment which leads to, at least initially, the equal divvying up of block time. For example, each physician receiving a morning and afternoon block. But what should a center do when some physicians fill up and utilize all of their block time and others do not?
“It’s really incumbent upon the board to carefully monitor, at least quarterly but preferably monthly, the utilization of all of the rooms that are operating and make reasonable adjustments to the physician blocks as the center evolves and grows,” says John Poisson, executive vice president of Physicians Endoscopy.
A board that makes arbitrary decisions about block time allocation can lead to frustration for physicians who do not receive the block times they desire and question the mechanisms for determining block time allocation. One way to avoid this potentially messy situation is to develop a measurable method to determine who can request more block time and who should possibly have their time reduced.
One such method, developed by an administrator at one of the Physicians Endoscopy’s-partnered centers, and endorsed by Mr. Poisson, is the use of a composite score, also described by Mr. Poisson as a “quarterback rating.” The score is determined by the actual volume of procedures that a physician brings to the facility added to the percentage utilization of his or her blocks.
“There’s a composite score threshold that’s been decided upon by the board that determines whether or not a physician is able to get additional block time if they come in above that threshold,” says Mr. Poisson. “Unless you’re above the threshold, any request for more block time won’t be honored. If you are above the threshold and you do request more block time, if it’s available and works into your schedule as a doctor, it will be made available on a first-come, first-serve basis. But if you’re consistently falling below that threshold, an end result may be the board taking away some block time.”
Why is the safe and efficient use of block time so important? Consider, for example, that a morning block can safely handle nine patients each day, but a physician with two morning blocks is only filling each of those blocks with five or six patients, on average. If the physician was cut back to one block — which was then filled entirely with nine patients — and the other block was released to a physician that could also fill it up, instead of seeing 10-12 patients in those two blocks, the center is now seeing 18 patients per week in those two blocks.
“That will have a huge impact on the profitability,” says Mr. Poisson. “Making a change like that would add six more patients each week, times 52 weeks in a year, and that’s 312 patients. On average, figure a conservative $550 per patient and that’s $172,000 in additional collections just by making that change. That’s huge.”
While physicians will not appreciate having their block time taken away, the use of this measurable metric at least offers a concrete reason for change, and can help serve as justification for reallocation of block time as it prioritizes the overall success of the center.
“We try to develop a culture that the center itself really doesn’t have a preference as to which physician users are using that room — the center just wants it filled with doctors performing safe and high-quality patient care in an efficient manner,” says Mr. Poisson. “The board making decisions to reallocate block time is not an easy topic to take on and it tends to be controversial and very emotionally and passionately driven by physicians, but at the end of the day, if you can create a culture that focuses on the center’s second most important priority (the first being safety) of utilization, the attitude may change.”
The use of a composite score can encourage other improvements in physicians’ practices. If physicians know that an unused block will affect their composite score, they may be more inclined to inform the facility when they’re going to be on vacation, allowing the center to give those available blocks to other doctors who are willing to fill them.
Also, if a doctor is struggling to fill blocks on a regular basis, this can give the board an opening and an opportunity to discuss the cause of this inefficiency and potentially fix the issue. For example, if a physician is scheduling the right number of patients to fill the block but seeing regular cancellations, the center can consider taking the approach of airlines and overbook the block, planning for some cancellations, Poisson says.
Note: Before reallocating any block time, make sure that any changes do not impact your quality of care. On paper, it may seem practical to take a block away from a surgeon and ask him or her to cover more cases in a single block, but you must find out if the reason why the surgeon is not filling the block times is related to a process you can change (reporting vacations, slow dictation in between cases, etc.) and not related to how they treat patients and perform procedures. You will definitely not want to put your surgeons in a position where they feel they must rush through and handle more cases just to keep their block time.
You will also want to avoid instantly rewarding more block time to surgeons who have not proven their ability to handle a larger caseload. Giving these go-getters parts of blocks rather than complete blocks initially will allow you to monitor and ensure their quality of care does not suffer as they take on more cases.
