Study compares business practices, technology use

Cataracts and colonoscopy are focus

[Editor's note: This is the first part of a two-part series that looks at results of a nonclinical benchmarking study conducted by the Institute for Quality Improvement (IQI). This month, we look at patient scheduling practices, staff costs, use of electronic medical records, and patient satisfaction results. Next month, we look at effective billing and collections practices.]

Billing data, supply costs, staff costs, and patient satisfaction are top issues for all outpatient surgery managers, but benchmark studies that address these areas don't always focus on similar procedures so that comparisons can be made easily. This specific comparison of information is now available to facilities that perform cataract extractions with lens implantation and colonoscopy.

Detailed nonclinical info provided

For more than five years, the IQI, a subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC), has collected clinical benchmarking data that focus on specific procedures, including cataract extraction with lens insertion and colonoscopy.

"We've always included some nonclinical information in our studies, but not the level of detail that this study, which focuses on cataract extraction with lens insertion and colonoscopy, includes," says Naomi Kuznets, PhD, director of the institute. "The difference between this study and other studies that address these issues is that it reflects real-time, rather than retrospective, data, and it focuses on a specific CPT code so that we know we are comparing apples to apples."

These two procedures were chosen because, with approximately 2.5 million cataract extractions and more than 1.1 million colonoscopies each year, they are the two most frequently scheduled procedures in an outpatient setting, explains Kuznets. While the procedures and the facilities at which they are performed differ, a report that compares results from the two groups is available as well as individual reports on each of the two procedures.

Cataract patients tended to wait less time for their procedure than colonoscopy patients, with 29% of cataract patients not having to wait past their appointment time compared to 40% of colonoscopy patients who had to wait. "Outpatient programs that handle cataract surgeries have this procedure down to a science," Kuznets points out. This procedure has been in a competitive market for many years, she says. "Colonoscopy is a newer procedure in the outpatient center arena, so these staffs are still learning some of the tactics that ophthalmology programs learned in past years," Kuznets says.

Schedule carefully to cut wait times

Cataract patients spend less time in the facility for a variety of reasons, says Linda Pavletich, RN, BSN, CASC, LHRM, administrator of St. John's Surgery Center in Fort Myers, FL. Her patients spend about 90 minutes in the facility, well below the median facility time of 128 minutes reported by all cataract study participants.

"We have two operating rooms and 10 surgeons on staff, so we offer block times for the surgeons," she says. Because each surgeon gets one day each week for his or her operating time, the center has the same two surgeons all day, she says. This setup makes it easy to move quickly from case to case because you don't have to prepare a case differently for a different surgeon in the room, she adds.

In addition to the block scheduling, most of the pre-admission information is handled well before the patient arrives, and pre-op calls by nurses are made the day before the procedure, explains Pavletich.

EMRs used by colonoscopy facilities

One advantage that colonoscopy study participants have over cataract study participants is the use of electronic medical records (EMRs), says Kuznets. While almost all participants report the use of an information technology system with an electronic billing component, 40% of colonoscopy study participants report an electronic medical record component. Only 12% of cataract organizations report that feature, Kuznets says.

In addition to the electronic medical record, 47% of the colonoscopy study organizations reported that their scheduling systems decreased the time required when the procedure was scheduled and when it occurred, she adds. These technological features enable colonoscopy organizations to continue to streamline their activities and improve waiting and facility times, she says.

The biggest surprise in the comparison of the two studies came in the patient satisfaction area, says Kuznets. "The assumption is that colonoscopy patients would be less satisfied with the overall experience because of the nature of the procedure, but we found that 98% of both groups of patients were satisfied with their overall experience," she says.

"Because patient satisfaction levels do depend on patient expectations prior to the procedure, we assume that patient expectations of the colonoscopy experience are so negative that they are pleasantly surprised and very satisfied to find that it isn't as bad as they thought it would be!" Kuznets adds.

Sources/Resource

For more information about the Ambulatory Surgery Non-Clinical Study Report, contact:

  • Naomi Kuznets, PhD, Director, AAAHC Institute for Quality Improvement, 5200 Old Orchard Road, Suite 200, Skokie, IL 60076. E-mail: nkuznets@aaahc.org.
  • Linda Pavletich, RN, BSN, CASC, LHRM, Administrator, St. John's Surgery Center, 8901 Conference Drive, Fort Myers, FL 33919. Telephone: (239) 481-8833. Fax: (239) 481-7898. E-mail: stjohnsurgery@earthlink.net.

To order a copy of this study, contact the Institute for Quality Improvement by phone at (847) 853-6060 or fax at (847) 853-9028. Copies of the study also can be purchased by going to aaahciqi.org and clicking on "publications." The cost of the study for organizations that did not participate is $100 for a CD-ROM ($125 for a hard copy) for each of the reports on colonoscopy and cataract extraction, or $150 for a CD-ROM ($175 for a hard copy) for the combined report. Shipping and handling charges start at $12.