Follow these cost-saving tips in same-day surgery

Stephen W. Earnhart, MS

President

Professional Surgery Corp.

Dallas

For those unfortunates who were unable to attend the Same-Day Surgery Conference in December, I wanted to pass onto you excerpts from my talk on "Cost-Saving Tips." Due to the number of items, I will not be able to list all of them in this issue, so this will be the first "to be continued" column for me. I will include the tips the attendee gave at the conference so you can benefit from those as well.

Some of these tips can give you immediate results, others, such as staff training, will take a little longer. You need to decide those tips that will work in your facility. These tips are not listed in order of importance or of dollars saved.

* Space and facilities.

-- Offer beepers to waiting friends and families. With the cost of these inexpensive electronic devices, you can save thousands of dollars on renovations to your waiting area. Give a beeper to family members when the patient is taken back to the OR. Tell them how soon their loved one will be available to see them. (Always extend the time you think it will take. Otherwise, at the end of the time period, they are going to get concerned).

Tell them the distance range of the beepers (depends upon the type you get) and the areas they can go to in that range. Tell them they will be "beeped" about 15 minutes before the patient is ready to see them.

Let them go to the coffee shop or to a local mall or restaurant instead of taking up valuable space in your center that you need for patients and persons just coming in. I started using beepers about 12 years ago for this reason and have never had a problem with them. Also, I've never lost one! Make sure you do your homework and have a staff member test the beeper's range. Just use common sense, and you can save a bundle.

-- Use mobile trailers. This is not my idea. It came from your peer. Rather than add expensive physical renovations to the center for staff support, he rented a mobile trailer and placed it in the parking lot. It can be used for the business office or other staff when you need to expand your clinical area.

* Personnel.

-- Hire volunteers as patient "greeters." Retired individuals often are hungry for something meaningful to do with their free time. They are great with the patients and their families, especially in the waiting area. It is a win-win arrangement that everyone will enjoy.

-- Eliminate one full-time equivalent (FTE) through attrition. You may think you can't get along without one more person, but try it. With the pressures on cost reduction hitting all of us, you should at least try it for a couple of months. You can still interview replacements and have someone "lined up" if you just cannot do without the position. You probably will be surprised.

-- Set a goal for percent of personnel expense vs. net revenue. Your personnel cost should go hand-in-hand with the volume of work performed. Personally, I like to see the percentage as no more than 15-20% of net.

* Energy.

-- Adjust thermostats. With a heavy heating season on top of us, adjust your thermostats in non-clinical areas to save money. Most centers I go to are too warm in the offices. Adjusting even a couple of degrees can make a difference.

-- Dry your linens. Whenever and wherever feasible, allow solution soaked linens to air dry before sending to the laundry. Most laundry services charge by the weight of material cleaned, not number of pieces.

* Communications.

I read an article in one of the trade papers that said that 45% of all company phone calls are abused with personal calls and/or long distance use. Reinforce your phone policy with staff members to ensure compliance. You can have your telephones restricted after hours by the phone company.

* Supplies.

-- Cut back on office supplies. Reduce your office supplies by 10%, and no one will even notice the change but your bottom line. Ask a cognitive member of your staff to approve all office supply requests.

-- Restrict access to supply rooms. Lock them up, especially after hours. Outright theft does occur, or staff may be taking home items that they really don't consider as stealing. Reinforce that it is.

-- Audit supply prices. We recently did this at one of our facilities and discovered that we had been paying full list price on several of our supposed discount items. No one's fault really, but unless you periodically check what you are being invoiced vs. your discounted items, you could be paying much higher prices than you thought.

* Vendors.

Make it a rule to never see vendors without an appointment. Otherwise they may catch you with your guard down or when you're rushed, causing you to make a decision that you would not have made if you were prepared for their high pressure sales. Most vendors know they can get more sales if you're rushed and unprepared.

* Turnaround time.

-- Reduce it. Every minute of down time in your OR's costs big bucks. Reducing that time by even a few minutes can save you many dollars over the year -- to say nothing of the potential new cases you may get from your surgical staff. (For more information on reducing turnaround time, see Same-Day Surgery, July 1995, p. 84.) Set a goal in minutes that you wish to reduce turnaround time by, and post it. Keep a log for each room, and get the staff involved.

Be realistic in your goals, however. If it is taking you 20 minutes to turn it around, look to cut three minutes off by the end of a month. Then another minute or two after that. Post the results in each room so your surgical staff can realize what you're doing. They may help.

-- Remove reading material from the staff lounges and locker rooms. Nothing infuriates a surgeon more than seeing anesthesia or staff sitting down and reading a book or the paper.

* Accounts receivable.

-- Open a cash management account at a local bank. You probably have thousands of dollars sitting in your account that aren't working for you. While interest rates are very low right now, even a few thousand dollars a year in interest could be helpful to your facility.

-- Check out the thickness of the "correspondence pile" in your business office. This is the stack of claims insurance companies need to get information from before they pay. Consider this rule of thumb: If it is greater than a quarter of an inch, someone isn't following up on them, and you are not getting the payment you have earned and deserved in a timely fashion.

Many of you who regularly write or call me about issues we discuss in this column have been given my private-mail number. As a result of playing "phone tag" with so many people due to my heavy travel schedules and never being in the office, each column will now list my e-mail address, which is the best way to reach me. So far, I've been able to respond to every message I receive, and I will continue to do my best to do so. E-mail number: prosurg@onramp.net. *