The migration of surgical case volume from inpatient hospitals to outpatient facilities is accelerating. In response, most health systems are stepping up their investment in hospital-owned ambulatory surgery centers (ASCs).
This is a sound strategy, but it carries a major risk. Abrupt volume declines in the main OR will cut productivity, increase costs and create a negative work environment for both physicians and staff.
Hospital leaders that are expanding their ASC strategy need to create a parallel strategy for managing OR outmigration. Here are five ways to protect the main OR as procedures shift to ambulatory care:
1. Establish a realistic outmigration timeline
A detailed forecast of case outmigration by month or quarter will allow OR leaders to plan proactively for volume shifts. Monitor information from the Centers for Medicare & Medicaid Services (CMS) for changes to the Inpatient Only List and the ASC Covered Procedures List. In addition, have conversations with surgeons to gauge their plans for moving cases out of the main OR and into an ASC.
2. Use analytics to fine-tune the block schedule
The outmigration of surgical cases will create large gaps in the OR schedule, leading to low productivity. High-performing ORs are now using predictive analytics to identify emerging utilization patterns. This technique allows OR leaders to conform the block schedule to actual demand, reducing waste and improving the work environment for surgeons and anesthesia providers.
3. Take a fresh approach to the staffing schedule
Case outmigration also creates problems for OR nurses and technicians. First, declining volumes lead to reduced work hours and unpredictable schedules. In addition, the exit of elective surgery means that add-on cases now make up a much bigger portion of the OR schedule. For nurses and staff, this translates into more time on call. To retain experienced OR professionals, department leaders should explore new staffing models. The aim is to do a better job of matching work hours with utilization. One strategy is to replace late-afternoon call coverage with regular paid shifts.
4. Rework OR strategy for the emerging environment
As uncomplicated elective procedures migrate to ASC settings, hospital ORs will increasingly become the setting for complex surgical care. Hospital leaders should make this fact the foundation of OR strategy. Work with surgeons to identify high-acuity procedures likely to remain in the OR and build specialty programs that support this volume. Many advanced opportunities exist in specialties such as neurosurgery, gastrointestinal surgery and women’s surgical care.
5. To maintain a strong OR, build a strong ASC
When a hospital-owned ASC begins to lose money, it absorbs attention from C-suite executives and prevents them from giving the main OR the attention it needs. The key to avoiding cost overruns in an ASC launch is to take a conservative approach to both financial projections and facility design. Hospital leadership teams that approach ASC expansion carefully will be better able to help the main OR thrive in the years ahead.