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Amy Ishmael – Maximizing OR Utilization Through Block Time Optimization
79 Plays6 months ago
Amy Ishmael is currently a senior product manager at HST Pathways, but prior to joining HST, Amy was a GI lab tech for years and a surgery scheduler at an ASC that saw 450 cases/month. She is no stranger to the topic we’re covering today, which is how you can maximize OR utilization through block time optimization. In HST’s State of the Industry report, we shared that, on average, 42% of block time ends up going unused, which is such a waste of revenue opportunity. Amy will walk us through best practices of allocating block time, release policies, and how to incentivize physicians.
In our news recap, we’ll cover Florida’s new price transparency laws, how National Nurses United is fighting back against AI, recent efforts to address the minority physician shortage, and, of course, end the news segment with a positive story about a woman who just received her sixth nursing degree.
Articles Mentioned:
Florida Enacts New Price Transparency Requirements
National Nurses United survey finds A.I. technology degrades and undermines patient safety
Doctors of color call on Congress to help address minority physician shortage
Arizona Nurse Discovers Dual Passions in Nursing and Earns Sixth Degree
HST’s State of the Industry Report
Brought to you by HST Pathways.
Recommended
Transcript
Introduction and Podcast Format
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Maximizing OR Utilization with Amy Ishmael
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode. Amy Ishmael is currently a senior product manager at HST Pathways. But prior to joining HST, Amy was a GI lab tech for years and a surgery scheduler at an ASC that saw about 450 cases per month. So she is no stranger to the topic we're covering today, which is how you can maximize OR utilization through block time optimization.
00:00:57
Speaker
In HSC State of the Industry report, we shared that on average, 42% of block time ends up going unused, which is such a waste of revenue opportunity. So Amy will walk us through best practices for allocating block time, release policies, and how to incentivize physicians.
News Recap: Healthcare Policies and Feel-Good Stories
00:01:18
Speaker
In our news recap, we'll cover Florida's new price transparency laws, how National Nurses United is fighting back against AI, recent efforts to address minority physician shortages, and of course, end the new segment with a positive story about a woman who just received her sixth nursing degree. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
Challenges in Block Time Management
00:01:49
Speaker
So I'm really excited to have you on today because last week we published an episode sharing six tips for improving OR utilization, but we didn't really dive into the role of block time during that conversation. And then I was thinking about it because in our state of the industry report last year, we had shared that actually 42% of block time goes unused. So obviously that's a huge waste of potential revenue opportunity. So I thought,
00:02:11
Speaker
Hi, Amy. Welcome to the podcast.
00:02:17
Speaker
You would be the perfect person to help us dive into this. So can you tell us how does effective block time management impact overall, OR utilization? Yeah, definitely. I can dive into that and I hope that I am helpful today. I'm really excited to be here with you. So starting with that question, I would actually turn it around initially to focus on the impacts of not effectively managing recurring block times.
00:02:45
Speaker
I say this because without a software to do this for you, it is very easy to not pay attention to the unused block time until it is too late to fill the unused time. This can lead to several wasted OR hours, as you mentioned every week, which we can easily be, it can easily be converted at a minimum to thousands of missed revenue dollars. This can also lead to paying staff to wait around for the next procedure while an OR sits empty because they're
00:03:15
Speaker
was unused block time sitting on the schedule. So the schedule wasn't effectively managed and moved around to close those gaps as well.
Best Practices in Block Time Allocation
00:03:23
Speaker
But to focus on the original question that you asked, effective block time management can proactively maximize OR utilization by ensuring that ORs are used efficiently and consistently. Us reducing downtime and allowing for more procedures to be performed within the same timeframe, this leads to higher productivity.
00:03:43
Speaker
better patient throughput and increased revenue for surgery centers. And obviously all of that is incredibly important. So what are some best practices for allocating block time to surgeons? A few best practices that I have followed in the past can include analyzing historical utilization
00:04:06
Speaker
So for providers where historical data is available, it's not always available if you're bringing on a new provider, but if it is available, allocating block times based on past usage patterns and performance metrics is very important. Another best practice would include flexibility. Adjust your block times based on seasonal and demand fluctuations. Don't keep a hundred percent of a rigid schedule. An example that could be heading into Q4, the busy season.
00:04:34
Speaker
proactively review the recurring block schedule and using your historical utilization analysis that we just talked about. And to determine which providers had a significant volume increase in past years, then identify days, times, rooms that you have available on the schedule to offer to these providers to reserve extra time so they can be sure that they get their patients in before the end of the year. So that's just one area where you want to keep that schedule flexible.
Establishing Block Time Policies
00:05:02
Speaker
And then the last best practice I have to share here is outlining clear policies with regular reviews of your block time management. I think this is probably the most important and probably the most underutilized best practice. For this, you want to establish transparent criteria for a block time allocation and communicate them to all your providers. It's one thing to create a policy as everybody knows. It's another thing to make sure that everybody's informed of that policy and adhering to it.
00:05:31
Speaker
An example of that policy, I just want to provide just because I think it's important if you're talking about creating a policy, what could be a good example is set the average utilization of the recurrent block time to be 70% or higher. You can change that based on what works best for your surgery center, but I found 70% is a pretty good average to get a really good usage out of your ORs. And with that,
00:05:57
Speaker
the block time released 48 hours prior to the data service shouldn't count against that utilization percentage. I say within a head prior to 48 hours, just because if you get within that 48 hour window, you don't have a lot of time to get that filled. And then also if utilization is under 70% for two consecutive quarters for a provider, recurring block time should be altered to be in line with the physician's average utilization. So that would just be following up on that policy too.
00:06:26
Speaker
And then a recommendation for maintaining that policy, because again, that can be hard, is a review of block time utilization by provider on a quarterly basis. Take that analysis, share it directly with your provider that you did the analysis on and share it at a meeting like your governing board meeting with recommendations for adjustments. So that way you can follow up on that and
Technological Solutions in OR Management
00:06:48
Speaker
then.
00:06:48
Speaker
To really fully maximize on adjusting recurring block times, be sure to always be building relationships with providers that have high utilization and their staff. Their staff is very important to work on increasing their recurring block time commitment. So take it full circle there where you're analyzing, making adjustments, and then replacing the block time that you potentially removed.
00:07:10
Speaker
I think that's all really great advice. And I think this is an interesting conversation because the providers are your.
00:07:19
Speaker
they're in charge, right? And they're the producers, so we want to keep them happy. So going back to them and saying, hey, you're underutilizing and are underperforming, for lack of a better word, it could be a really tough conversation to have. But if you have policies that everybody has already signed off on and agreed to, then that should hopefully make things a little bit more comfortable and easier to have those confos.
00:07:44
Speaker
Yes. And you had mentioned flexibility before, so I just want to dive into that a little bit further. Aside from kind of that Q4 example, let's say, how else can surgery centers create a flexible block time schedule so that they can adapt to changing needs? Yeah, definitely. So a few ways that I would suggest that this can be done includes dynamic scheduling.
00:08:07
Speaker
So implementing a system that allows for real time adjustments to block times, which most practice management system should have. However, a system that also allows for physician practices to submit adjustments to their block schedule is even better. Another way is block, your block release policy that we just went over previously, but implement a system that automatically sends out reminders to your providers and their staff to release unused block time.
00:08:34
Speaker
It's easy for everybody to be busy and forget. So having that automation really helps. And then also sharing open availability, another item that is really easy to overlook because it's a pretty manual process sharing that open availability with your providers. Unless again, you implement a system that automatically shares open availability and allows providers or their staff to electronically reserve time with on the fly block time. So.
00:09:01
Speaker
So you can see that flexible scheduling is really backed up by having a system to help out your team. Yep. That makes sense. And you've mentioned kind of the block time release a few times now. What other, like what policy should you have in place for that block time release and reallocation, anything you could expand on that you haven't shared already? At a high level, some items to focus on could include
00:09:30
Speaker
advance notice, so require surgeons to release unused block times, at least 48 hours in advance, as we talked about already. Penalty for late release. And I don't love the word penalty, but there's always got to be a stick somewhere sometimes. So implementing some sort of penalty for late release or no show to discourage inefficient use. And everybody knows their providers the best and they are your customers. So that's more in your court to decide where could we figure that out. Aside from
00:09:58
Speaker
potentially taking away block time. And so then the last one is that reallocation process that we've talked about a little bit earlier, having that clear, fair process for reallocating released block times to other providers. So if you are going to put in some sort of penalty or conceptually some sort of penalty, how can you do that? Or what maybe are the potential consequences of underutilized block time?
00:10:25
Speaker
As far as incentivizing, it would be more probably, and from my perspective, recognition and getting in the habit of publicly recognizing providers. Everybody likes that positive reinforcement who do efficiently use their allocated time. So whether it's through your monthly meetings, through regular communication with the providers, through there's, you probably have many modes that you could do, but that public recognition of even just sharing a report of
00:10:54
Speaker
where each physician stands. It depends on how your providers could handle that, but that public recognition is probably the best way to positively reinforce. And then as far as the consequence for under-utilizing, again, sharing reports, so it could tackle two stones.
00:11:11
Speaker
But sharing reports that correlate unused block time with impacts on budget and revenue, that could really help. So that way they can see the value of releasing their block time. It's not necessarily just a consequence. It's turning it around to be like, Hey, we just want to keep you informed of what this has not only on our budget and revenue, but also potentially on your revenue too. So here's where we stand and why and what we could do to make it better, which is.
00:11:39
Speaker
making sure we're optimizing our block time utilization. Sure. So what role does scheduling software play in this whole conversation? I think it plays a large role. Scheduling software, it streamlines the process for allocating and managing block time by providing those real-time updates, predictive analytics, and automated alerts. It helps to automize
00:12:08
Speaker
scheduling by integrating with EMR and practice management systems, ensuring accurate and efficient block time utilization. And additionally, it can generate reports and dashboards for continuous monitoring and improvement. And data is your best friend with block time utilization. So having that assistance of a system is crucial, but you're only going to get great data if you're using the software to its fullest too.
00:12:35
Speaker
Yeah.
Data-Driven OR Efficiency
00:12:36
Speaker
And what, so what kind of data should surgery centers be collecting? So the primary metrics that I would say you should focus on include a few types of utilization rates. Uh, so tracking how often and fully allocated block times are used by breaking your analysis down by these few reports that I'm going to share. So overall facility block utilization metrics.
00:13:05
Speaker
you want to focus on that overall utilization metrics in general, block time utilization variance reports, and then also a deep dive into block utilization by day of the week. If you're used to block time, you know that some physicians have block time the first and third Wednesday of the month where, or they have it the first and third Wednesday of the month and the second and fourth Friday of the month. And so they're
00:13:31
Speaker
block time utilization might vary by the day of the week too. So really phoning in on where they have the highest utilization. And these kinds of reports will really help with that. A few other metrics I would mention aside from the utilization rates is procedure durations, turnover times, provider performance time, patient flow data. All of this is going to help you really fully understand the impacts on your OR utilization. So if you compare your block time utilization reports that I just mentioned with these additional reports,
00:14:01
Speaker
You're going to have a really comprehensive picture of where you can improve efficiency and improve your block utilizations and your OR utilizations at the same time. Perfect. Yeah. Data could just be so incredibly helpful in navigating these conversations and also just knowing where you stand, where you can improve and identifying all sorts of areas for increased revenue.
00:14:29
Speaker
Yeah. And if you're doing all of this reporting and looking at all this data, then that makes the conversations with your providers about their block utilization. Very
Florida's ASC Price Transparency Law
00:14:38
Speaker
easy. If you've got data, you've got everything to back it up. And I honestly think physicians probably really like the data because they just want the hard facts of why, why are you having this conversation with me? Why are we talking about this? So you've got all of it right there. Perfect.
00:14:54
Speaker
All right, Amy, we do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers? What I would say is if you don't already do it, very simple, but it takes a little bit of time. Start sending out a friendly communication to your providers and or their staff to confirm the schedule that you have for them. Make sure it's correct. That's the simple part.
00:15:20
Speaker
and remind them to release their unused block time three days prior to the day to service. That can have a huge impact on your schedule pretty quick. Thank you for all of your great advice and for coming on today. Yeah, definitely. Thanks for having me. As always, it has been a busy week in healthcare, so let's jump right in. A few weeks ago on May 10th, Florida Governor Ron DeSantis
00:15:49
Speaker
signed House Bill 7 0 8 9 into law, which enacts new price transparency requirements for ASCs and hospitals and makes changes to the state's existing good faith estimate requirements.
00:16:02
Speaker
So the new house bill states that beginning January 1, 2026, ASCs must post on their website either a consumer-friendly list of standard charges for at least 300 shoppable services or use an internet-based price estimator tool that meets federal standards. Now, if your ASC offers less than 300 shoppable services, then you'll just post all the ones that you do provide.
00:16:30
Speaker
The new law also changes the timeframes that apply for providing patients and insurers with a good faith estimate, though those changes will not take effect until the federal government makes public and finalizes its own rules pertaining to good faith estimates. Now, if you've been following along with the No Surprises Act, that reference to 300 shoppable services will sound very familiar. Plus, if you are already in Florida,
00:16:58
Speaker
you already have a price transparency requirement in terms of content that is required on your ASC's website. So the rule I'm alluding to that is already in place requires all Florida Surgery Centers to make price transparency and patient billing information available on its website regarding the following, the availability of estimates of costs that may be incurred by the patient, the financial assistance that your Surgery Center offers,
00:17:27
Speaker
any billing practices, and then a hyperlink to the Florida Agency Healthcare Administration pricing website. It also requires the content on the center's website to be reviewed at least every 90 days and updated as needed to maintain timely and accurate information. So it's not super surprising that Florida is actually enacting additional rules here. And in fact, we can likely assume more rules are to come in Florida and neighboring states.
00:17:54
Speaker
So I highly suggest reaching out to your current software vendors to see if a price estimator tool is something that they offer. I know HSC has an excellent one that we provide to our clients. So no need to reinvent the wheel or stress about this as there are current options that already exist to help you out.
AI in Nursing: Controversies and Concerns
00:18:13
Speaker
All right, in our second story, a survey by National Nurses United, the nation's largest union of registered nurses, found that artificial intelligence technology often contradicts and undermines nurses' own clinical judgment and threatens patient safety.
00:18:32
Speaker
The findings, coupled with reports from nurses at hospitals nationwide, underscore the urgent need for stricter regulation and greater input from nurses and healthcare staff on whether and how AI is deployed.
00:18:48
Speaker
So Deborah Berger is the president of the NNU and she shared, and I quote, the survey and reports from nurses across the country demonstrate that we need an immediate pause on implementing AI in healthcare settings. As patient advocates, it is our duty to assess the evidence in front of us and question the unfounded marketing claims that AI will compliment our bedside skills or improve the quality of care for our patients.
00:19:15
Speaker
As always, I will provide a link in the episode notes to the story. And I share that because the article has photos from a protest that took place on April 22nd in San Francisco. The protest was at Kaiser Permanente's International Integrated Care Experience Conference that featured the system's use of advanced analytics in AI. And the signs the protesters are carrying say things like patients are not algorithms and trust nurses, not AI.
00:19:44
Speaker
So if you are a regular listener, you know I'm always sharing stories about the new advances in AI and new studies and research being done. And after reading this article a few times, I think the issue and difference here is that these nurses feel like or have experienced situations where AI is overriding their decision-making skills instead of just complimenting them.
00:20:09
Speaker
They also feel like these new tools are untested and unregulated. And I think another underlying issue is that after COVID, nurses have lost trust in their employers to do what is in the nurse's best interest. So I feel like it's digging up a lot of those kind of similar emotions of we are the ones in the trenches here. Why are you not listening to us? And I do think all of those points are fair. We share stories all the time about how
00:20:39
Speaker
AI can help increase the accuracy of imaging readings or help with clinical documentation or reduce some of the administrative burden. And I do think all of those are still very true, but I think the difference is that the AI solutions need to complement the nurse's skill set and help
00:20:59
Speaker
the healthcare provider, whoever the provider is, not override them and not be making decisions on their behalf that hasn't had that human review or hasn't had that nurse's review.
00:21:12
Speaker
And again, I think looking at the pictures from the protests and things like that, I just feel like nurses and healthcare staff are so extremely burnt out. And they're seeing AI as this shiny new object that people are obsessed with. And at the end of the day, they're the ones standing next to the patient, helping them heal, answering their family's questions and making sure they're comfortable and safe. So I understand their concerns. I truly do.
00:21:39
Speaker
And as AI becomes more popular and more solutions come out, I think we can expect pushback and concerns to match. And while I do believe that with the right leaders in place, these tools will do more good than harm, but we absolutely need to have that balance. It'll be extremely important and the more checks and balances along the way, the better so that patient safety is never impacted. Okay. Switching gears.
Addressing Minority Physician Shortages
00:22:06
Speaker
Doctors of color are calling on Congress to help address minority physician shortages. So currently only about 15% of doctors nationwide are black or Latino. This disparity has far reaching implications for both minority communities and the healthcare system as a whole. So Dr. Samuel Cook is working to change this narrative. He shared, and I quote,
00:22:31
Speaker
The doctors I saw as a child never looked like me, so I made it my life's mission to be the change I saw in medicine. Today, Dr. Cook is a resident at the Morehouse School of Medicine, but his path was not easy. Despite having an above average GPA from one of the nation's top 10 universities, he was told by a medical school admissions counselor that his academic achievements weren't strong enough to make medicine a reality.
00:22:59
Speaker
So recently, Dr. Koch joined other minority doctors on Capitol Hill to share their experiences and urge lawmakers to address the shortage of physicians. The most recent federal data shows that only 8% of doctors are black and 7% are Latino.
00:23:16
Speaker
One major barrier for aspiring minority medical students is debt and money. So while many medical students face significant financial burdens, this burden is even greater for minorities. They are less likely to have family wealth to support them or cover them, and they are less likely to be approved for loans. And even if they do get through med school, they are
00:23:42
Speaker
likely to be paid less afterwards, which of course makes it harder to pay back the loans. So while everyone has a financial, there are financial implications for everybody who goes through med school, the burden looks a lot different for doctors of color. So if you're wondering why this matters or the impact making changes will have,
00:24:04
Speaker
It's no secret that patients often feel more understood or comfortable with doctors who share their cultural and racial backgrounds, which ultimately leads to better patient outcomes. Plus, a diverse medical workforce brings a variety of perspectives to the table, which always will lead to innovation and just a deeper understanding of one another. So addressing the shortage of minority doctors is not just a matter of equity, but it's a necessity for patient outcomes.
00:24:32
Speaker
So how do we do it? A few ideas Dr. Cook and others brought to the table are to increase funding for HBCUs, create more loan repayment programs for med students, and establish a more inclusive and accessible pathway to medical education. And it once again, the link will be in the episode notes if you do want to help out or get more involved.
Inspiring Educational Pursuits in Healthcare
00:24:54
Speaker
And to end our new segment on a positive note, Dr. Ohio has committed herself to lifelong learning and she just obtained her sixth degree, which was a bachelor's in psychology. Dr. Ohio is a mother of seven, a nursing professor at Southern New Hampshire University, and she now has two associate's degrees, a bachelor's, a master's, and a doctorate. Her career in nursing began after the birth of her third son,
00:25:21
Speaker
after she was inspired by a midlife who left a lasting impression on her.
00:25:27
Speaker
So despite the challenges of raising young children, working full-time and attending school full-time, she persevered and found a second passion in nursing education. Her latest pursuit of her psych degree is not just for personal growth, she said, but to better support young adults with mental health challenges. She inspires to contribute to a mental health practitioner program and help address the national nursing shortage through teaching. So congrats to Dr. Ohio on all your success.
00:25:58
Speaker
And that officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we will see you again next week.