Stephanie J . Zvolenski, MBA
Financial Manager, ABC
News broke recently of the United States Congress decision to freeze Medicare payments for 2011 and not move to enforce a previously proposed approximately twenty-six percent (26%) cut in the national anesthesia conversion factor. Although this makes for a little brighter turn of the New Year, practices across the country are still faced with daily challenges of maintaining a healthy bottom line with more and more Americans still uninsured and/or under- insured. The costs of providing quality care still exist, yet the payments continue to decrease. Expenses in medical practices seem sometimes to be best represented by a freshly filled helium balloon at a child’s birthday party, “Up, Up, and Away....until they are out of sight”....unless the party host finds creative ways to stabilize them.
Specifically, many anesthesia practices across the country are struggling with rising costs of personnel management, scheduling to meet the demands of the surgical and facility requirements without breaking the practice’s bank with overtime expenses and lack of appropriate utilization. Some practices have found that it is not only cost beneficial but it many cases absolutely necessary to move away from the traditional 7:00 a.m. to 3:00 p.m. shifts for their anesthetists. Practices are becoming more and more creative in scheduling management to partner with their surgeons and facility administration yet keeping their finances stabilized. Some ideas and examples that may be helpful for your practice are outlined below.
Offer daily shift flexibility to the anesthetists in order to achieve coverage for late afternoon add-on cases without paying overtime rates. For example, a number of the practices’ anesthetists are working a combination of twelve (12) hour shifts and eight hour shifts on rotation. This actually is attractive to the anesthetists as they achieve an extra day off each week. This modification in schedule provides coverage for the late day cases without creating any expensive overtime for the practice and also eliminates the anesthetist expectation of leaving every day at 3:00 p.m.
In conjunction with an analysis of case start times in your operating room, there may be an opportunity to stagger daily start times of the anesthetists depending upon the surgeon and case load that day, so even reaching eight hours of work on a particular day may be the result of a 7:30 a.m. to 4:00 p.m. schedule rather than 7:00 am start time. Also, practices should schedule a one-half hour unpaid lunch break into the daily shift, so that the schedule is actually 7:00 a.m. to 3:30 p.m. rather than 3:00 p.m. with the lunch break included.
Another idea is to analyze your anesthetist compensation package in total. It is beneficial to the practice and the facility to compensate anesthetists with a base pay and incentive bonus for anesthetists’ contributions and alignments to practice, department and facility objectives and goals. For example, OR efficiency, minimal case delays and day of surgery cancellations and patient and surgeon satisfaction are all metrics to consider when building a comprehensive evaluation and incentive-based compensation structure for your anesthetists. By incentivizing the anesthetists to work on efficiency and productivity goals, they have some control over managing their schedule as well as additional compensation opportunity.
Remember that the federal labor laws define overtime as hours worked greater than forty (40) in a given week. Some practices have mistakenly been paying an overtime rate for hours worked greater than eight in a day. Frequently there is at least one day each week that is lighter in the operating room schedule and personnel can take some of their time back from other days that week in which they may have worked later.
You may want to be careful with shift differential compensation as well. It can be beneficial if the practice offers increased compensation in an effort to entice personnel to volunteer for later shifts on a consistent basis or as a regular schedule; however, you may find anesthetists working the day shift becoming slightly less motivated to gain efficiencies if there are greater dollars to be earned by working later in the day.
Finally, in all cases it is necessary to evaluate your entire staffing plan and perform a comparative analysis of the cost associated with the hiring of additional part-time or full-time anesthetists, per diem labor as well as overtime to your current staff. Not every practice is the same and no one method will work for all. As we learned in seventh grade algebra, the optimal point is where the x crosses the y axis...this point will be different for every practice.
The ultimate goal is an appropriate balance between practice vitality, recruitment and retention of quality providers, surgeon and facility satisfaction and above all the highest quality of patient care.
Stephanie J. Zvolenski, MBA, is a Financial Manager for ABC. Stephanie is responsible for the financial, strategic and operational management of our financial management clients and also serves as an industry consultant and business advisor. Some of her responsibilities in this role include: provider compensation assessment and comparison to market, shareholder/employment agreements, hospital subsidy negotiation/agreements, feasibility studies for new and existing practice opportunities, governance support review and restructuring and design and administration of benefit programs. Stephanie has been with ABC for 4 years and has 15 years of experience in physician practice management including serving as an Administrative Director for a multi-specialty physician practice network within a three hospital system and as a system service line Director. She holds a BA from Washington and Jefferson College and a MBA from Waynesburg University. Stephanie can be reached at 724-952-1361or at Stephanie.Zvolenski@AnesthesiaLLC.com.