See if this sounds familiar…your organization understands the importance of providing surgical services (65% of hospital revenue as generally reported[1]), and in fact, you cater to your surgeons and their requests. Strategic and IT initiatives that span the operative space head straight to the top of the project grid year after year. But you’re still unsure whether you’re getting any definitive ROI from the work being done. Has the financial health and success of the program been improving or not? You are also keenly aware that the cost of running the surgical program is your hospital’s largest area of expenditure. But are you doing everything you can to contain or reduce it? Are you maximizing the financial success of this key service line, or are you leaving money on the table?

Running a financially viable Perioperative program is crucial to hospital and revenue cycle leaders. Understanding where the revenue opportunities are though, and exacting paths for gain, is not always such an easy feat. Improvement to volume and capacity will certainly provide returns, but in times of value and cost containment the opportunities to expand are rare. Fortunately, there are other high-impact initiatives you can undertake to produce incremental improvements to the bottom line. In last week’s blog, we focused on asking powerful questions, and with that concept still in mind, we turn our attention to some of the items and questions we at The Wilshire Group focus on in the operative space, categorized within two areas of significant opportunity.

Process and Key Metrics

It is no secret that the top-performing surgical units are the ones with programs that operate efficiently.  By seeking to align with the performance standards of those organizations, you too can gain. 

• What is your first case on-time start percentage?  If you aren’t at 90%, are you doing anything to get there? 
• What is your room turnover time?  If you are higher than best practice (30-35 min), have you taken a deep dive into the processes and reasons?  
• What do your utilization figures look like, and how frequently do you review scheduling blocks to determine their efficiency and effectiveness?
• Do you have bottlenecks or inefficiencies within your surgical subprocesses (pre-admission testing, pre-op, scheduling, authorizations) that continue to have impacts downstream?
• How do your patient cancellation and other case delay numbers measure up? Evaluating and reducing them will lead to direct throughput and added revenue.  
• How detailed are your billing processes and coding audits? Do you have revenue sitting in logs that were never posted?  Are you maximizing your Anesthesia charges or are you potentially short-changing yourself at procedure completion?

Optimization, Standardization, and Maintenance

After evaluating the core elements of your program, it is time to turn attention to smaller, but equally important details. 

• How frequently are your surgeon’s preference cards updated? Omissions and inaccuracies result in extra time spent in preparation for procedures and also negatively impact sterile processing. 
• Product purchasing for materials and supplies can bring financial gain when streamlined.  Are you leveraging rebate programs?  Are the prices you are paying in line with manufacturer and distributor contracts, are there contracts that could be re-negotiated? 
• Do your surgeons have preferred items that may be unnecessary?  Standardizing through a request-and-approve process, or otherwise putting limits on high-cost items that don’t impact outcomes are staple opportunities for cost reduction.
• Do you utilize diagnosis-driven order sets that span pre, intra, and post-op care, procedural templates, and real-time information displays? Are your Anesthesia medication fees streamlined and automated?  The configuration available within Epic OpTime and affiliated applications can do wonders.  
• Do you regularly maintain your SUP, ORP, and EAP files, ensuring that prices are accurate and integration opportunities are being leveraged? With value-based care payments and penalties now in place for hospital acquired conditions, leveraging clinical system capabilities is more important than ever. With The Wall Street Journal reporting[2] that 46-65% of adverse hospital events relate to surgery, optimal setup now translates to money in the bank.

Now that we’ve highlighted ways big and small to improve the operational efficiency and financial viability of your surgical program, think about how much attention you may or may not be giving to them.  You may even want to generate your ROI potential based on deviations from operating best practices.  The financial returns you can achieve in the operative space are directly proportional to the programmatic improvements and efficiencies you are able to make.  With some focused effort in the areas above, your program’s financial state will leap forward.  To discuss further or to enlist The Wilshire Group in helping to get you there, reach out to us and our experts will get you on your way.

[1] https://www.beckershospitalreview.com/quality/the-importance-of-perioperative-services-in-the-leap-to-value-based-care.html

[2] https://www.wsj.com/articles/how-to-make-surgery-safer-1424145652