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When pilots fly into fog, they can lose sight of the horizon. When that
happens, serious problems can result. The horizon is the principal tool
aviators have to tell whether they are flying level or not. Pilots who
soldier on without this visual cue may firmly believe that they are flying
straight and at a consistent altitude. Actually, though, they may be circling
down toward the ground, an event aviators call the "graveyard spiral."
Many experts blame this for the untimely death of John F. Kennedy, Jr.
Flying by the seat of your pants works well when it's bright and sunny
and you can see clearly. But when the way ahead is hazy or dark, it may
be wise to place less trust in your instincts and more trust in objective
instruments. And that brings me to my point.
Most outpatient surgery facilities could do with a little less seat-of-the-pants
flying. More need to develop and use tools designed to help them measure
important aspects of their business and make the right decisions for their
facilities. The ones that do will do better.
After precisely determining its case costs and comparing them with reimbursements,
one multidisciplinary Midwestern ASC stopped doing cataract surgery; it
wasn't making any money on the procedure. That same center also found
that it could use the information to negotiate more favorable contracts
with commercial insurers. "Medicare plus 10 percent just doesn't cut it
on some of the orthopedic procedures," the director told us recently.
After joining a benchmarking service and comparing its results with
those of other centers, an Illinois orthopedic center discovered that
although its surgeons were doing knee arthroscopy more quickly than average,
the PACU time was considerably longer. The same was true with its carpal
tunnel procedures. A closer look revealed that the center's anesthesia
professionals were sedating patients more heavily than other centers were.
After making the anesthesiologists aware of this fact, PACU time declined.
An East Coast hospital-owned ASC we know not only does regular patient
satisfaction surveys, but also does surgeon satisfaction surveys, gauging
doctors' attitudes toward scheduling, instrumentation, staff and other
items. Several centers we know collect case costs by physician and discreetly
divulge the results. Almost invariably, at least some of the inefficient
surgeons become more efficient as a result.
Collecting information that helps with decisionmaking takes lots of time,
although it can be made easier with good computer systems and good benchmarking
services. It's also costly. But what is the cost of making poor decisions?
A lot of things will change over the next decade. But I'm guessing one
thing will remain the same. In 2010, the most successful surgery facilities
out there will continue to be the ones that actively collect information
and use it to help them make their facilities grow larger and run better.
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