Archive February 2018 XIX, No. 2

Business Advisor: Add-On Cases: Friend or Foe?

You should always make room for one more case.

Bruce Kupper

Bruce Kupper, MHA, FACHE

BIO

MORE THE MERRIER
MORE THE MERRIER You might not see it this way, but it's clearly to your advantage to accommodate non-urgent cases when they arise.

If you get annoyed every time a surgeon wants to add a case to his already overbooked block, you're not alone. Add-ons can be incredibly inconvenient and disruptive, especially when they're cases that the surgeon's scheduler forgot to tell you about — not truly emergent ones like ruptured globes, detached retinas, testicular torsions and kidney stones.

But rather than abhor them, we adore add-ons at our 2 independent surgery centers in Richmond, Va. On the one hand, we get paid for performing surgeries, not for standing around. On the other, you can't put a price on the goodwill you'll bank with your surgeons — and your patients — when you accommodate them by gladly accepting add-ons (urgent and non-emergent). Maybe you'll view add-ons in a different light after reading our perspective.

Our duty and obligation

First and foremost, we see add-on cases as part of our commitment to surgeons and patients to provide surgical care when the need is critical, not just when it's convenient.

Many of our surgeons have left the hospitals and only operate at our centers. For example, our 4 retina surgeons operate at our ASC exclusively: 4 days a week — sometimes 5 if there's an add-on. Hospitals found it too expensive to maintain the equipment and the staff's competency in retina surgery. We feel obligated to accept their urgent cases whenever they arise — even on long weekends. A detached retina, ruptured globe or fractured orbit needs to be managed quickly, and the surgeons require OR staff who are comfortable with the procedure.

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