Hospitals across the country are continuing to work on properly allocating their outpatient services to ambulatory care centers. Freestanding Digestive Health Centers for GI endoscopy are an example of the type of centers that are siphoning off many of the ambulatory procedures traditionally done in hospital departments. However, regardless of the attractiveness of these centers, hospital-based endoscopy services need to be maintained for inpatient/emergency GI and pulmonary procedures. This has created unique challenges as total GI patient volume shrinks, creating gaps in the daily schedule for the GI suite. Ensuring a scheduling plan that balances the need for the inpatient procedures with some outpatients is key to success in better management of utilization and productivity on the hospital unit.
The need for an endoscopy procedure is typically identified during the inpatient stay or from an emergency department admission. Some of the referrals are emergencies and need immediate treatment, while others may be urgent or elective but need to be performed in 24 hours or before the patient is discharged. In addition, there is a growing trend of more complex endoscopy interventions (i.e. ERCPs) requiring increased competency of staff and specialized equipment that may not be available in a freestanding center.
When writing the rules for your hospital-based endoscopy program, you can start by following these three steps to be successful:
1. Understand your Demand
The goal is to first understand your resources and the factors influencing your program. Start with understanding your market dynamics of available facilities and physician ownership. Are you facing: (a) an employed model, where all facilities are owned by the hospital and the volume is done where it makes the most sense for physician convenience; (b) freestanding digestive health centers owned by physicians who are not employed by hospitals that want to attract business or find a place to do low reimbursement procedures; or (c) a mix of both? Then assess the types of procedure and referral patterns.
2. Develop a Scheduling Plan
Once you determine your demand, you must develop a scheduling plan for that demand. Start with your urgent/emergent classification system and drill down to further categorize the acuity and complexity of these cases. The way that the data unfolds should give you an initial understanding of the natural breakpoint to begin to classify which cases should be done in the hospital versus the ASC/ HOPD.
3. Plan your Resources
At this point, it’s time to map out your plan. There are many factors to consider during this step. What is your nursing competency level for complex GI cases? Will services be planned as an additional Non-OR Anesthesia (“NORA”) site or will this be a full-time anesthesia service line? What are the scopes needed to meet scheduling?
The bottom line is that better management of hospital-based endoscopy services will yield improved contribution margins for these services and improved patient and provider satisfaction. If you’re struggling with allocation of your cases, Sullivan Healthcare Consulting can help. Reach out to our team today to have a Sullivan expert review your perioperative staffing and resources.
Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.