AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Improving access to care: An operational and financial analysis of service-based interventions to optimize patient throughput in an academic plastic surgery practice
C Scott Hultman, MD, MBA1, Wendell Gilland, PhD2, Jennifer Lord3, Carol Williams, RN3, Mary Lee Baker, RN3, James Pichert, PhD4, Samuel Weir, MD3, Anthony A. Meyer, MD, PhD3.
1University of North Carolina, School of Medicine and Kenan-Flagler Business School, Chapel Hill, NC, USA, 2University of North Carolina, Kenan-Flagler Business School, Chapel Hill, NC, USA, 3University of North Carolina, School of Medicine, Chapel Hill, NC, USA, 4Vanderbilt University School of Medicine, Nashville, TN, USA.

Introduction: Inefficient patient throughput in a surgery practice can result in extended new patient backlogs, excessively long cycle times in the outpatient clinics, poor patient satisfaction, decreased physician productivity, and loss of potential revenue. This project assesses the efficacy of multiple throughput interventions in an academic, plastic surgery practice at a public university.
Methods: During fiscal year 2006-07, our 5-surgeon division implemented a patient access and efficiency (PAcE) initiative, funded and sponsored by our healthcare system, designed to improve patient throughput in the outpatient surgery clinic. Interventions included: 1) creation of a multi-disciplinary team, led by a project redesign manager, that met weekly and included surgeons, nurses, a financial counselor, a coder, a business analyst, and receptionists, 2) definition of desired goals, critical metrics, and targeted outcomes, 3) streamlining and revision of clinic templates to reflect actual demand, 4) working down patient backlog through group visits (breast reduction, body contouring), 5) booking new patients across entire practice, 6) assigning a physician's assistant to the preoperative clinic, and 7) designating a central scheduler to coordinate appointments and flow of information. Main outcome measures included: patient satisfaction using Press-Ganey surveys; number of unsolicited physician complaints reported to patient relations; time to 3rd available appointment; size of patient backlog; monthly clinic volumes with utilization rates and supply/demand curves; "chaos" rate (cancellations plus reschedules, divided by supply, within 48 hours of booked clinic date); patient cycle times with bottleneck analysis; physician productivity measured by RVUs; and downstream financial effects on billing, collection, accounts receivable, and payor mix. We collected, managed, and analyzed the data prospectively, comparing the pre-PAcE period (6 months) with the PAcE period (6 months).
Results: The PAcE initiative resulted in multiple improvements across the entire plastic surgery practice. Patient satisfaction increased only slightly from 87.1% to 89.9%, but the quarterly number of complaints notably declined from 17 to 9. Time to 3rd available new patient appointment dropped from 52 to 38 days, while the same metric for a preoperative appointment plunged from 46 to 16 days. The size of the new patient backlog fell from 169 to 110 patients, and total monthly clinic volume climbed from 574 to 766 patients. Our "chaos" rate dropped from 12.3% to 1.8%. Mean patient cycle time in the clinic decreased dramatically from 127 to 44 minutes. Mean monthly productivity for the practice increased from 2479 to 2702 RVUs. Although our collection rate did not change, days in accounts receivable (A/R) dropped from 66 to 57 days. Mean monthly charges increased from ,213 to ,193, and mean monthly collections improved from ,967 to ,987. Payor mix remained unchanged.
Conclusions: Implementation of a patient access and efficiency (PAcE) initiative, focusing on outpatient clinic throughput, yields significant improvements in access to care, patient satisfaction as measured by complaints, physician productivity, and financial performance. An academic, university-based, plastic surgery practice can utilize throughput interventions to deliver timely care and to enhance financial viability.


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