The Value of Operating Room Utilization Data to Anesthesia Practices

Summary: Anesthesia practices should have more and better data about what actually happens in the operating rooms and delivery suite than most other departments in the facility. Do they use this information effectively? That is the question of the day. 

Effective business managers have learned that one cannot manage what one cannot measure. Anesthesia providers have long since learned how valuable timely and reliable data is in the management of their practices. Why does this not apply to their role in operating room management? Anesthesia practices should pride themselves on having more and better data about what happens in the operating room suites they work in. Why does this not translate into an invaluable role as operating room managers? Sadly, the fact is that too many providers see themselves as captive to a system over which they have no control. Operating room utilization and staffing requirements may have more to do with compensation and benefits levels than any other factor, including managed care contracting and the effectiveness of billing and collections. 

The typical anesthesia practice gets a comprehensive packet of management information monthly. It includes lots of data about production performance and payer mix trends but nothing about operating room utilization or provider productivity. The reason for this is obvious: most practices do not see the value of data and metrics for an aspect of their practice over which they have no control. This is a curious oversight and is based on a lack of practical experience. If the goal of management information is to identify actionable opportunities and ways to enhance the anesthesia value proposition then too many are failing to develop a potentially invaluable management tool. 

Metrics That Matter

What is the potential value of relevant utilization metrics? It is surprisingly significant and includes the following facets:

*Intensity. Nothing is more useful in the refinement of staffing plans than a careful tracking of the intensity of care. This may include the average units billed per hour of care. As practices expand to a variety of venues and lines of business it is useful to assess the specific staffing requirements of each.

*Consistency. It is one thing to have good average utilization and a positive payer mix for a given venue, but often it is the consistency of utilization that is critical. How many days a week can the practice count on a full schedule versus days where only a single case or two makes for a very unprofitable day. Most facilities do not really need the same level of staffing five days a week.

*Capacity. Knowing when the operating room schedule winds down each day determines a window of opportunity. How often is there capacity in the afternoon and how might staff be put to better use?

*Comparability. Having reliable benchmark data allows practices to see their situation in perspective. To be useful and effective, however the metrics must be carefully normalized. Defining utilization metrics per anesthetizing location day has proved the most relevant way to view operating room data. Medac has developed an extensive database of comparable utilization metrics by type of venue: inpatient, outpatient endoscopy and out of operating room.

*Profitability. Ultimately, each line of business must be profitable; in other words, the revenue potential must justify the cost of staffing. It is usually those few unprofitable venues that compromise the overall profitability of the practice. Having the ability to identify the loss leaders as they develop is the key to ongoing profitability.

In many ways the relationship between an anesthesia practice and the administrations it must serve is educational. As in any aspect of customer service the key to success is setting realistic customer expectations. This can be a huge challenge when the relationship is defined by scope creep, i.e., expectations and clinical requirements keep evolving. When negotiating a hospital stipend, it has been said that anyone can get the number right today, but it will likely be wrong tomorrow. 

Data That Drives 

Reliable data is the key to identifying the need for change. Too often anesthesia practices find themselves in the service of factors that determine their income and lifestyle rather than being in control of them. This is an inevitable consequence of poor management data. Well-managed practices rely on a three-tier process that is data-driven. They use their metrics to identify outliers: underutilized venues, inconsistently used venues and those where there is not a consistent flow of revenue to justify the cost of coverage. The data then helps them develop a game plan. There is not always a way to make unprofitable venues profitable, but there may be other ways to address problem situations. Oftentimes, having the data is key to helping the administration understand the anesthesia challenges. Reliable data, then, is indispensable to assessing whether the strategy is effective. As with so many things in life, process improvement requires an ongoing commitment.

Graphs That Guide 

What does it take to development an OR utilization dashboard? Clearly, the first step is to develop a reasonable labeling convention for all anesthetizing locations. Typically, each operating room will be numbered, but then the question is how to handle other venues such as ASCs, Endo centers and out of OR locations. Capturing these labels is the key to everything. Those with electronic anesthesia records will find this is easy to accomplish, but those with paper records may find it challenging to get providers to consistently identify the location.

None of this matters if the billing system cannot capture these data elements. Compiling, validating and calculating metrics can be the rate-limiting step. Knowing how to present the data can make a big difference. As an example, most practices find it more effective to present utilization metrics for weekdays from 7 AM to 3 PM. This has proven the best way to compare inpatient and outpatient venues. It should go without saying that such data and metrics only really have value if they are put to good use. The point of the whole exercise is to make better management decisions. Data and metrics that are not actionable are of little or no value to the practice or its customers. This all sounds so logical and simple, but it is amazing how rarely these basic concepts are applied to the management of practices. It has often been said that focus and discipline are the keys to success. That is what OR utilization metrics are all about.

For more information about improving and utilizing your data, please reach out to your account executive, or you can contact us at info@anesthesiallc.com.