Same-Day Surgery Manager: Use peer comparisons to lower operating cost
Same-Day Surgery Manager
Use peer comparisons to lower operating cost
By Stephen W. Earnhart, MS
President and CEO
Earnhart and Associates, Dallas
It’s human nature to compare ourselves to others. There are all manner of comparisons, done rapidly and almost subliminally. We compare our clothes, body type, education, etc.
That comparison is how the fashion industry thrives. We all want to wear Calvin Klein underwear, designer sunglasses, and Armani fragrances. Why? What is this obsession with standardization and lack of originality in our culture? It is based on the fact that the majority of us don’t want to stand out from the "accepted" standard. Let’s take that same assumption and make it work for us in the operating room!
I have never been much of an advocate for across-the-board standardization in anything. I believe that it brings with it the risk of losing originality and stifling new ideas from not trying different methods. However, when it comes to cost control, there are standards that have been proven effective and efficient that we need to consider in the operating room. We need them to help decrease costs and increase efficiency.
A good example of peer comparisons is not having our cataract patients change their clothes for surgery. Many facilities subject this patient to this unnecessary process because that is the way they have always done it. The operating room staff, or the surgeon for that matter, don’t realize that others have been able to effectively and safely eliminate this time-consuming and often embarrassing process for the patient. But rare is the facility or surgeon that would begin this procedure. Chances are, surgeons were exposed to it by someone else and chose to adopt it as their new standard. (For more on letting patients wear their street clothes for minor procedures, see Same-Day Surgery, October 1998.)
Standardize supplies and save money
We need more standardization in the OR to reduce costs and increase efficiency when it comes to light sources, microscopes, intraocular lenses (IOLs), routines, shavers, etc. Because most of our cost per case comes from supplies and equipment, the need for educating our surgeons and staff becomes increasingly important. With the changing reimbursement, it also takes on a new sense of urgency.
Here are some ideas to help standardize cost and equipment. First, pick a procedure to compare. Use a common procedure that is performed by several surgeons at your facility.
For example, consider that you have three cataract surgeons. Label them Dr. A, B, and C. Using their preference cards, price their supply cost. A program such as Microsoft Excel or other spreadsheet program will help you calculate your results easier. Ideally you want to audit a minimum of 10 cases per surgeon. List each item used in the procedure under the surgeon’s name, and price the procedure.
You might have to call your purchasing department to obtain the unit price for each item, but it will be worth the effort. (You probably have several IOLs by different companies, which makes you lose the ability to leverage that collective volume into lower cost per case. How wonderful if they would all use the same lens and vendor!)
Don’t forget to include anesthesia supplies and pharmacy items. Add those columns, and come up with the supply cost per case.
Using the operative note, add the length of the procedure for each surgeon. Then find out the resources used per surgeon: how many staff members were in the room, what was the setup time, etc.? Tally the cost per staff member (take their hourly rate and apply it to the minutes in the OR), and do the same for recovery staff. You are trying to quantify the cost per procedure. Clearly the staffing cost will be lower for the surgeon who doesn’t require the patient to change clothes.
Make your data meaningful
Total the cost for each physician. Chances are, for most of you, the variance between them will be significant. What does this information do for you? Nothing. Now you have to make it meaningful. Present your findings to your OR committee or your administrator or department head. (You will get points for this effort!)
The ideal situation is to subsequently present it to each of the three physicians. Let them figure out who is who. You don’t need to tell them. If they are like most surgeons today, they will want to know why Dr. A is so much higher (or lower) in cost (and/or time) than the others. Many physicians stay with the same format they have always used because they don’t know they can do it differently.
When we first started not requiring our cataract patients to change their clothing (10 years ago), many of the surgeons thought that was a terrible thing and refused to allow it on their patients. They wanted to know who was doing that. Once they found out their peers were doing it, that made it easier for them to try it. Peer comparisons, and knowledge that others are doing it as well, are typically going to be required to change standards. Make your life easier, and let the psychology of it work for you.
(Editor’s note: Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com.)
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