By Stephen W. Earnhart, MS
CEO, Earnhart & Associates, Austin, TX
Mr. Earnhart discloses that he is a stockholder and on the board for One Medical Passport.
As promised in the April issue, here is the second part of my column about reader feedback to the March article, “Things I Notice.”
I have replied to all who emailed me, so if I missed you and didn’t get your message, please send again. In all, there have been more than 100 emails and 375 comments. I appreciate all the feedback.
11. Requiring patients to come to your facility two hours before surgery is ridiculous and just highlights your inefficiency. This hit a nerve with many people. Several responders offered excuses for why patients must be in the facility two or more hours before surgery and were “offended” that I would label this inefficient.
This is a service industry we all work in, which means we provide a service to our customers. I’ll use Starbucks as another example of a service industry. Imagine that every time you went in for a cup, they told you that you must wait while they clean the machines and brew the coffee. You would say, “Why don’t you do that before I come in?”
Many of you said you must allow for patients getting lost or showing up late or missing insurance papers, etc. However, those are excuses, not reasons.
Most people agreed that most of the time that is not the case. So, why are patients who comply punished for the actions of the minority? If a patient arrives late, then there should be better communications from staff.
If your surgeon wants to “stack” patients for high-volume cases, such as cataracts, gastrointestinal, or pain management cases, then you must increase your timing and communications for patients to make sure the surgeon has his or her next patient ready.
Bottom line: If it takes longer than 45 minutes to process a patient through registration and into the operating room, you are inefficient and must conduct a step-by-step review of why you cannot handle your patients in a respectful-of-their-time manner. Take the time to learn your bottlenecks and fix them.
12. Only 30% of facilities have instituted updated policies and procedures because the odds are you will get away with it. Sadly, there were only a couple of comments on this observation. There always is something more important to be done. Often, time doesn’t allow for this function, which we all need to do. So, here is my best response when I am sitting with the medical director of a facility or the administrator of a facility that is out of date on their P&Ps: “Pretend that I am sitting in the jury box, and you are going to explain to me why you didn’t have the time to update your procedures for the safety of your patients.” It is effective.
13. Eighty percent do not capture all patient charges. I received more than 40 responses to this statement. Almost all agreed that many charges escape staff and cost the facility money. Review your process and hold a staff meeting to find a better way of capturing this money left on the table.
14. Ninety percent don’t even know it. Most of the commenters didn’t understand how they would know. Perform an “operational and process audit” on yourself. Ask a staff member or hire an outside company to conduct it for you. Audit your cases and make a note of everything used during those patient encounters. Compare the audit with what your staff submitted. Most of you will find a large discrepancy.
15. Most medical directors of ASCs have no idea what is required of them. Guess who sent me the most emails? Medical directors. There were a few management staffers who responded for their medical directors, which should tell you something. Most will be surprised to know that Medicare requires that the medical director has a job description and a contract that spells out exactly what is expected of them.
16. Elimination of the Affordable Care Act will have virtually no effect on your job. Not a single response.
17. About 99% of facilities are not equipped with enough supply or equipment storage space. This problem results in cluttered hallways and sterile corridors that make facilities look “trashy” to patients wheeled into the operating or recovery room. Almost everyone who responded agreed with this statement and wish they had more equipment storage space.
18. Most surgeons don’t care about your personal issues. Save them for Facebook. I guess I must have been wrong about this, based on comments like, “My surgeons do care about my boyfriend issues,” “Our docs want to see pictures of my child’s birthday party,” “I think it is important to share political feelings with the surgeons — they always seem interested in my opinions,” “I can share my feelings with the surgeons that I cannot with my wife,” and “I think it is important that the surgeons understand that if my child support payments were on time then I could fix my car and not be late so often.” Interesting, but compare these responses with the next observation.
19. All staff resent surgeons talking about their new homes, cars, or boats while they struggle with day care costs and day-to-day expenses. A good surgeon is a quiet surgeon. That last sentence upset some surgeons; however, I received more than 100 emails supporting this observation from staff.
Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: [email protected]. Web: www.earnhart.com.
This is the second part of a column about reader feedback to the March article, “Things I Notice.”
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