When someone requires surgery, most of the time they want to get it over and done with as soon as possible. And it’s not just the patient who doesn’t want to wait around. Surgeons are also keen to get each case taken care of as quickly as possible. So, why is there often a hold up of weeks and even months?
Why surgery can’t happen overnight
While short wait times are a gold standard of the health care system, there’s a very good reason that surgery can’t be scheduled from today to tomorrow. Enter the insurance companies.
Whether we like it or not, the insurance companies have a 14-day window to authorize each surgical procedure. Sometimes that authorization arrives much faster, but sometimes it takes the entire two weeks to get the go-ahead.
It’s clear, then, that scheduling a procedure within a week (or even two) is not practical and likely to frustrate patients and cause unnecessary stress chasing up authorizations. And who wants to do that?
That being said, 14 days is a long time to have to wait for permission for surgery and it’s incredibly frustrating that the process can get held up over paperwork.
At the other end of the spectrum is the patient who can’t get a surgery date for months – because the surgeon is booked out. While it is true that patients often choose their surgeon based on rapport, one other essential factor guiding that choice is when they’ll be able to go under the knife. If it’s as hard for would-be patients to get a firm date for surgery as it is to get a table at the hottest restaurant in town, it’s likely they’ll go to another surgeon who can fix what ails them sometime this century.
To prevent the waitlist from getting too backed up, here are our top tips on how to achieve the sweet spot of the “good things come to those who wait” type of waitlist time that everyone – surgeons, patients, schedulers and even insurance companies – can agree is acceptable.
1. Centralize your scheduling setup
It’s almost 2020, but there are still so many practices operating like it’s 1999. Setting up a centralized scheduling setup gets rid of so much of the minutiae involved in scheduling surgery. And it also hits it out of the ballpark in terms of efficiency.
It’s difficult to keep on top of everything needed for each procedure (clearances, H&Ps, PATs and EKGs and so on), not to mention all the endless calls to the insurance company. A centralized scheduling setup minimizes the time involved in each of these steps, including getting multiple patients precerted at once, which is a huge time saver and also a surgery saver given the insurance companies and their strict procedures and requirements, which can so easily nix a procedure at the last minute.
Which brings us on to tip numero duo.
2. Keep a move-em-on-up list
No one wants to be a B-list invite, but for surgery, there’s nothing better than getting a firm surgical date because someone else canceled. How the list gets set up and who gets the upgrade depends on the individual practice, but having a defined system in place can avoid canceled surgical slots going to waste, prevent lost income and wait lines that never seem to get any shorter.
3. Give high volume surgeons more block time
Block time has been described as being like a reservation at a restaurant – a surgeon turns up and knows they have a space at the exact time they ordered. For busier surgeons, it’s not always enough to show up at a restaurant, they want to know the restaurant has received rave reviews. That might be stretching the metaphor a bit far, but the busier a surgeon, the more block time they need because they have more patients and do more surgery (natch).
On the other hand, a surgeon who doesn’t fill their block time is losing money for themselves and the facility in which they are operating. This also causes other surgeon’s waitlists to be longer than they should be.
Practices should be able to analyze the data of their block time usage in order to make informed decisions and move things around within the block time allocation.
4. Maximize block time
Once a surgeon has the block time they want, they need to get the most out of it. One way of maximizing block time is using the “flip room strategy.” What this means is running two OR rooms side-by-side so the surgeon can jump from one room to the next without having to hang about while the room gets cleaned and set up or patients get wheeled in or out.
Surgeons like this strategy because it allows them to work seamlessly. However, it has its detractors because it leaves the ORs unused for periods of time (how long depends on the surgery taking place). This is why this strategy is most suited to short-duration procedures like carpal tunnels.
5. Urgent cases come first
The problem with efficiency – like maximizing block time and keeping the cancellation list moving – could mean that all surgical spots are taken. Yay for efficiency, but nay for anyone who needs an urgent procedure (hello poor lady who just fell and needs a hip replacement, ASAP!).
Practices need to ensure there is some space available for these urgent cases – without compromising other patients.
The best way to do it is to take a longer view of things and instead of scheduling elective surgery within a few weeks or even a month, to schedule it further out. This way, everyone’s happy – the patient has a firm date, the surgeon’s all booked up and there’s room for last-minute emergencies that have a habit of cropping up.
The perfect combination for patient satisfaction
Scheduling surgery is a deft art. Too soon and authorization might not come through, too long and another surgery spot might open up because the patient got fed up with waiting and shifted allegiances to another surgeon. At the end of the day, a combination of strategic scheduling, keeping on top of things and ensuring surgical time never goes to waste can help keep wait times down and help keep patients satisfied.