Saturday, May 18, 2013

Efficiency in Scheduling Surgery

After the events this past month, I need to vent with a back-to-the-basics post.  Let me start by telling you what happened.

A relative of mine, we’ll call her ‘the patient’, had major elective surgery. About a month ago, the surgeon’s office staff told the patient that they would take care of everything. They said there was no paperwork for the patient, someone from their office would call the patient with a surgery date. Easy enough, right? NO, it inefficient.

When the surgeon’s office called to provide the surgery date, they didn't tell her anything but the date. That left the patient (and me) with multiple questions…pre-op clearance from other doctors involved in her care? What about taking medications prior to surgery? What about post-op care? How long will she be in the hospital? Does she need another pre-op visit with the surgeon? The surgical scheduler had to call her back after asking the doctor. How inefficient!

About two weeks later, the patient receives another call from the surgeon’s office asking why the patient hasn't had pre-op testing.  The patient explains that the hospital has not called her to schedule the testing. Only now, surgeon’s office tells the patient that it is the patient’s responsibility to schedule testing – the hospital will not call her. Unfortunately, the surgeon’s office did not have the correct telephone number for the patient to call and schedule. So, they instruct the patient to look up the phone number on the hospital website. Really? What if the patient didn't have access to a computer?

The patient calls the hospital and testing is scheduled. The hospital representative asks the patient if her insurance requires precertification. Of course, the patient does not know and ultimately calls me to ask what to do. I explained that her insurance, Medicare, does not require precertification and neither does her supplemental with Medicare primary. Since when do patients understand precertification?

From there much of the same confusion continues. But rather than boring with all the details, let’s look at the problems here.

First, the patient was not given anything by the surgeon’s office. No printed materials about the surgery itself, no instructions on what medications to take or discontinue prior to surgery, NOTHING. When questions like this arose, the patient (and family) had to call the doctor’s office to ask one-off questions.

Next, the patient was not given correct pre-op instructions regarding testing, clearance, etc. This resulted in the surgeon’s office having to call and follow about where the test results were and the patient having to call the surgeon to ask more questions. 

To the hospital: Seriously, do you really expect a patient to understand precertification? That’s YOUR job! BTW, you’re welcome for my consultancy on that topic – that’ll be $500 payable by the hospital.  

Ok, I am going to stop ranting now. Basically, everything about this situation was wrong. Now, let’s talk about why it was wrong and how to fix it. Here are the back-to-the-basics every doctor’s office MUST know:

Patients are scared. When a person is sick, they cannot think straight. They don’t know what to ask during their pre-op visit with the doctor; even the common sense questions don’t enter their mind because of fear. All a patient can think is “what if I die.”  As a healthcare worker, your job is 99% compassion and 1% everything else. Compassion is understanding how the patient feels and helping to ease the patient’s mind. Sure, you cannot promise that the surgery will be successful, but you can ease the patient’s mind by showing the patient that the surgeon’s office is in control of the administrative/business part of the situation.

Not only is this important for the patient’s piece of mind, but it is also important to your business. For most surgeons, word-of-mouth is their primary means of advertising.  Do you think that the patient I mentioned above is going to rave about her doctor after such hassle?

Healthcare is confusing. Patients do not understand the health part, let alone the business part. Precertification, billing, coding, etc. It is all outside of their world. Patients depend on healthcare workers to understand the business and help the patient; the same way you depend on your accountant to help you with the tax code. Think about it, if your accountant told you to call the IRS to get your answers, how long would it take you to find another accountant. Why is healthcare any different?

Time is money. Each time someone has to call to follow up or ask questions, something else (likely something profit generating) is not being done. If you do not provide the all the right information the first time, you are wasting time and money.

The solution is one word… Training. Doctors, Office managers, administrators, please teach your staff to recognize these three basic principles. Patients are scared, healthcare is confusing, and time is money.

A simple way to address these problems is to create and distribute patient-friendly surgery packets. The packets should contain information such as:
  1. Patient to-do check list with due dates: For example, the instructions might contain reminders like "Stop taking your Coumadin X days before surgery" or "See your PCP 2 weeks before surgery for pre-op clearance" 
  2. Instructions for complex pre-op to-dos: provide the patient with detailed instructions for things like bowel prep. 
  3. Easily understandable documentation about the surgery: Krames has wonderful, patient friendly booklets that can be purchased and distributed to patients. 
  4. Frequently asked questions: For example, "How are pre-admission tests scheduled?" or "when can I expect a call from the hospital to tell me when to arrive on the day of surgery?" and "what is precertification and what do I (the patient) have to do for precertification"
  5. Important phone numbers: These might be the hospital phone number, like for the pre-admission testing department.
  6. Reliable sources of on-line information: You know many are going to research, so make sure you guide them to good information like the Mayo Clinic or WebMD

These are not complicated to create. You can even create a fill-in-the-blanks template that is generic enough to use for multiple surgery types in Microsoft Word. Even the documents that are surgery specific aren't too hard as most surgeons only perform a handful of surgery types depending on their specialty. You’ll be amazed how such a small step can help to reduce phone calls and set the patient’s mind at ease. 


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