Becker's Hospital Review

66 Executive Briefing Sponsored by: How to Align Surgeons to Increase Productivity and Curtail Outmigration S ince surgical departments typically drive the majority of a hospital's revenue, it's imperative for hospitals to attract the best surgeons and create a robust perioperative services line. The better a hospital's surgical department, the more likely payers and providers alike will be to refer patients to that hospital, according to Alecia Torrance, MBA, MSN(c), BSN, CNOR, senior vice president of clinical operations and chief nursing executive for Surgical Directions. To attract the best surgeons, hospital executives must understand the surgeon mindset. "A surgeon's time is extremely valuable," says Ms. Torrance. "If a surgeon is working in an inefficient operating room where a lot of time is wasted and they can't get on the schedule, you better believe they will want to go somewhere else that has overcome those efficiency obstacles." Ambulatory surgical centers are among hospitals' biggest competitors when it comes to retaining good surgeons, according to Ms. Torrance. ASCs tend to have less bureaucracy and more efficiency, and they also have an advantage with many insurers. Some payers only reimburse certain procedures if they are performed in an outpatient facility, such as an ASC. In response to this trend, some hospitals are acquiring surgeon practices, but this isn't the only way to reduce surgeon outmigration, according to Ms. Torrance. By making the perioperative service line of a hospital as efficient as that of an ASC, the surgical department can boost productivity, improve surgeon satisfaction and curb outmigration. Attracting Top Surgeons Most ORs have block scheduling, not unlike a reservation, for surgeons. The problem with this type of schedule is new surgeons fresh out of a training don't automatically have a block, so they tend to go to multiple facilities to build their case volume. According to Ms. Torrance, making it easier for young surgeons to get on the schedule and build their case volume in one facility is just one way to attract these specialists. Additionally, the minimum threshold to maintain a given surgeon block should be no less than 75 percent and no more than 80 percent. Surgeons without consistent block utilization should lose some or all of their block time based upon historical utilization metrics that are provided to them monthly through surgeon specific scorecards. Hospitals can also tap into surgeons' referral sources to attract great talent and increase case volumes and prevent outmigration. "Typically, a patient must go to a primary care physician, internist or general practitioner to be referred to see a surgeon, and these parties tend to have clear referral patterns," says Ms. Torrance. "Surgeons hold these referral sources in high esteem. If the source is based at a specific hospital, a surgeon may be more willing to work at the same facility to avoid alienating their referral source." In other words, hospitals should not focus exclusively on attracting surgeons, but they should also dedicate energy and resources to working with their primary care physicians, internists and general practitioners, who can then use their own rapport with surgeons to attract and retain talent. Limiting Outmigration Once hospitals have attracted the best surgeons, it's crucial to make efforts to keep them. For this, aligned incentives are absolutely necessary. "There are some new programs in the industry to help align incentives, including bundled payment initiatives," says Ms. Torrance. "With bundled payments, there is one payment for a patient's entire episode of care, and it's split between multiple entities." Bundled payments encourage hospitals and surgeons to limit the amount of care they provide by optimizing the patient prior to the day of an elective surgery. By addressing patients' comorbidities and preparing them for their procedure, hospitals can improve outcomes and reduce the risk of costly readmissions. Gain-sharing programs that allow surgeons to share in the profits of reducing the cost of care also limits outmigration and boosts surgeons income. It's also important that hospitals remember surgeons rarely book their own procedures — that task is frequently left to office personnel. "A trick I learned really early on in my years running a surgery department is that office schedulers want intuitively to schedule their surgeon at whatever hospital is easiest to call and complete the task," says Ms. Torrance. "So if you can make your scheduling system better than your competitor's by creating simplified scheduling pathways and reducing the amount of work and time that an office representative has to take to schedule procedures, or be put on hold, you can win their loyalty." While appealing to a surgeon's office scheduler is a useful tactic to limit outmigration, ultimately, the best way to keep a surgeon satisfied at your hospital is to keep their surgery schedule full. Boosting Productivity Since time is money in the OR, all hospitals want to support their surgeons' productivity. And, when surgeons are measurably productive, their level of engagement and commitment to an organization will rise. According to Ms. Torrance, there are six ways to increase surgeon productivity. 1. Increase access to the surgical schedule. One way to give surgeons, particularly young surgeons, more time on the OR schedule is to designate 80 percent of the OR as blocks and have the remaining 20 percent of the rooms operate on a first-come, first-serve basis. Leaving 20 percent of the rooms open allows younger surgeons who don't yet have a block to grow their volume, expand their referral sources and, eventually, earn a block themselves. It is also important to have a governance structure in place that ensures surgeons' interests are represented, according to Ms. Torrance.

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