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Kayla Schneeweiss-Keene - Using Technology to Improve Patient Outcomes
99 Plays2 years ago
Kayla Schneeweiss-Keene is the administrator at Mann Cataract Surgery Center, and she's here to talk to us about how to use technology to improve patient outcomes. Kayla and her team recently implemented groundbreaking technology at her ASC, and she'll walk us through what that was like and tips for how you can do the same.
In the news recap, we'll cover more cybersecurity attacks, patients being charged for MyChart messages, the pros and cons of pre-filled syringes, and of course, end the news segment with a positive story about medical drones that are saving lives.
Articles Mentioned:
How to address healthcare’s unique cybersecurity challenges
More health systems charging for MyChart messages
Prefilled Syringes Are the Preeminent Option
Medical drones are saving lives and coming to skies near you
Brought to you by HST Pathways.
Recommended
Transcript
Podcast Introduction and 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.
00:00:27
Speaker
Hi, everyone.
Subscription Reminder
00:00:28
Speaker
Before we jump into what you can expect on today's episode, just a reminder to please take a second to subscribe to the podcast on whichever platform you're listening from. I'd really appreciate it. And that way you'll never miss an episode.
00:00:42
Speaker
So what are we getting into today? Kayla
Technology in Surgery Centers: Zeiss-Artivo Microscope
00:00:45
Speaker
Schneeweiss-Keene is the administrator at Mann Cataract Surgery Center, and she's here to talk to us about how we can use technology to improve patient outcomes. Kayla won the ASC Innovations Award at the Texas ASC Society show this year after implementing groundbreaking tech at her surgery center. So she has a really cool story to share with us and lots of tips.
00:01:07
Speaker
In the news recap, we'll cover more cybersecurity attacks, patients being charged for my chart messages, the pros and cons of pre-filled syringes, and of course, end the news segment with a positive story about medical drones that are saving lives. Hope everyone enjoys the episode and here's what you can expect on this week in Surgery Centers. Kayla, welcome to the show. Thank you. Thanks for having me.
00:01:36
Speaker
Can you tell our listeners just a little bit about your facility at a high level? Yeah, absolutely. We have a few facilities here in Houston. One's up in North and Humboldt. One's here in the museum district. We're building another one in Sugar Land. The one I'm standing in now, we just moved in in April, this past April. We were across the street starting in 2007 and we just built this beautiful brand new building and moved in this past April.
00:02:04
Speaker
Fantastic. And I understand that congratulations are in order because at this year's Texas ASC conference, you actually won the ASC Innovations Award specifically for implementing the Zeiss-Artivo microscope. Did I get that right in terms of pronunciation? Correct.
00:02:26
Speaker
Awesome. Can you tell our listeners a little bit about that microscope, that technology decision and how that came about? Yeah, absolutely.
Benefits of Zeiss-Artivo Microscope
00:02:38
Speaker
The microscope is a 3D technology. It's put up on a 55-inch screen TV and 4K monitor. It has a heads-up display for marking torque lens alignment.
00:02:54
Speaker
It's one of the highest tech ophthalmology microscopes that we've seen. It also hooks up to the IOL master that's done in the practice, which is a piece of testing that's done for the patients over in the practice. So it links that information over to us, which actually helps a lot of communication. And it's really good for ergonomics. Our doctors, I think, initially wanted to purchase it because, I mean,
00:03:24
Speaker
Years and years of microscope use, you have this forward head tilt looking into oculars and it does a number on the back of the neck. So the doctors were really intrigued with being able to sit up ergonomically correct and do cataract surgery.
00:03:40
Speaker
So that's super interesting. And that's what I was curious about is, hey, this is a big expensive piece of technology. What was the major problem or opportunity? And so it did seem like doctor health, doctor ease of use, economics were a piece of it. What about patient outcomes? Did that factor in as part of the decision making process here?
00:04:05
Speaker
Um, it does have a visual field for the doctors. Um, I mean, they, they already had, we had a Zeiss microscope beforehand, but it wasn't their TiVo. They already had a 3d view of it.
00:04:18
Speaker
They were able to get a bigger picture of it because you now have this big 55 inch screen TV and right in front of you but it's also was very intriguing for the nursing staff to now see what the doctor sees and that we'll all put on three my three glasses and It's it's absolutely Phenomenal what you see on that big 55 inch screen TV. It's it's hard to explain. It's really cool to see it
00:04:44
Speaker
Got it. And so who's in charge of a process like this? Maybe in
Deciding on Technology Purchases
00:04:49
Speaker
terms of kind of the idea generation, who surfaced this idea or concept of, hey, we should be looking at upgrading our microscope?
00:04:58
Speaker
Yeah, our doctors, particularly our owners, are very much into staying ahead of the game in technology. They want to be a world-class technology center. And so they saw it and wanted to demo it. We brought it in and we demoed it. We had most of our surgeons demo it and give their opinion. That's one of the things that our owners
00:05:23
Speaker
is successful at, they valued the opinion of the other surgeons, the non-owners as well. So they demoed it, they liked it. And it was also an easier decision because we knew we were building this building and our previous microscope that we were currently using in the old building, it was about 15 years old. So we knew we were having to buy a new microscope anyway. And so that decision was kind of easy to make since we're moving into the new building.
00:05:52
Speaker
So the new facility needing to make a capital investment anyway, it was really kind of a question of
00:06:01
Speaker
Which version? It was just that time was perfect timing. Guys, so you've got physician owners that are staying on top of the technology trends that are advocating for this, which is great. And you mentioned the other stakeholders in the process, you know, as part of the demos and then so forth. What other stakeholders were important to bring on board to make a major purchase like this?
00:06:33
Speaker
I mean, they got all the surgeon's opinions in the collective group to be able to purchase it. So I mean, when you're talking about big stakeholders, that was it. When you're talking about profit margin, it was something that we could market, right? Patients always like to see that you have the top technology. So that was helpful and to be able to market on our website.
00:07:00
Speaker
Got it. So the idea was, hey, this could be helpful for case volume, and this could be helpful for brand reputation as well in the marketplace. Yeah, pretty much brand reputation. Excellent. Good way to put it. Excellent. And so it seems like there's a lot of buy-in around this. Any dissenting opinions, whether from physicians or for a clinical staff or others?
00:07:26
Speaker
Um, the cost was, was pretty pricey. Other, other than that. Um, no, I think all the staff.
00:07:34
Speaker
initially liked it because it was a wow factor at first, certainly, something that we've never seen before and we weren't able to look in the surgeon's microscope because even the assistant microscope is not 3D. And I'm a backup scrub tech, so when I'm looking in there, I don't even see what the surgeons are seeing. So it was a real treat, actually, to see it.
00:07:57
Speaker
Cool. So staff loved it. More bells and whistles. There's a cost factor that came into play, which owners are always going to think about. Was there any revenue justification or new case justification that was required to get over those cost objections? Or was it really just the view and belief of the physicians?
00:08:23
Speaker
the view and belief of the physicians that they knew that they wanted it. They believed it was gonna help them out in the long run for their aspects. So it was really them. Fantastic. And what feedback have you gotten from patients? What have you seen in terms of case volumes? What output has there been around this decision and implementation?
00:08:49
Speaker
From the marketing standpoint, I think patients are intrigued that we have one of the best technologies from the microscript standpoint. Feedback from the staff, again, it was a wow factor. They all like it. They like looking at the screen and seeing what's going on with the case, because when you see what's going on with the case, you can kind of help the surgeon anticipate the next step.
00:09:19
Speaker
Great. And so I know that technology is important and carefully regarded at your facilities. And so I want to kind of zoom out for a second and talk about technology more broadly and kind of break it down across the patient experience.
00:09:37
Speaker
So pre-surgery across the man facilities, have you seen technology that's been helpful before patients even step foot in the facility from a pre-surgery perspective?
00:09:50
Speaker
Yes, absolutely. And just to hit on the other previous question, how do we get everybody's buy-in? It was also a decision that, well, I would suggest that when making a decision to purchase equipment to also not only get your non-owner surgeons input in, but also your scrub tech's opinions and your nurse's opinions, because sometimes they can see it from a different point of view from like a flow perspective. And they can see whether or not
00:10:20
Speaker
This new technology or new way of doing things is going to add on five minutes to a case, right? And so if you if you have 40 cases in a day and each of those add five minutes onto it, that's a big deal. So you want to be able to get opinions with others, not only just your owners.
00:10:37
Speaker
Absolutely. The owners can see a benefit, but you got to operationally work through the users, right? To understand like, Hey, what are the real operational repercussions or benefits going to be? It makes total sense. Absolutely. And from
Enhancing Patient Flow with Technology
00:10:51
Speaker
a pre-op perspective, pre-surgery, one of the biggest implementations that we did a few years ago, that was a big hit, was a pre-screening patient portal for our patients.
00:11:04
Speaker
patients were able to go in and fill out their medical history and their medication list. This was huge because we service the geriatric population and on average, most of our calls took a nurse 20 minutes each. So if you can imagine just one day, you have 40 patients in one day, even 30 patients in one day and each of those calls takes 20 minutes.
00:11:27
Speaker
your staff is all tied up making phone calls, right? So the patient portal that we got also had texting service. And so when we're talking about a pre-screening patient portal, this is very good for high volume centers because of this reason. I mean, so we have on average 70% usage, our patients, 70% of our patients use it.
00:11:52
Speaker
And so it saves us about 18 hours of nurse time per week, which is almost a half of an FTE and around about $2,500 to $3,000 a month. So it adds up and it pays for itself.
00:12:05
Speaker
And that's fantastic. And that's great to see that you guys kind of quantified the time savings and the benefit and half of an FTE in a week. Did that result in you needing to hire less nursing staff or did you repurpose that time allocation? Yes, around about that way. So before the patient portal, we were
00:12:33
Speaker
pretty much bringing a PRN into the facility on a weekly basis, almost daily, just to do the pre-op phone calls. And then after the pre-screening patient portal was brought in, we didn't have to bring that person in. So it actually might have saved us more than a half of an FTE. But looking at our numbers,
00:12:55
Speaker
from a quantitative standpoint, it looked like it was total half T per week. Yeah, that's a great savings. And you mentioned that there was an opt-in rate of around 70%, which sounds pretty good. Did you get 70% right off the bat, or did you have to work up to that?
00:13:10
Speaker
We worked out to that. We were actually really nervous about it because I mean, of course we're working with a geriatric population and they're not technology savvy, right? And you need a computer to be able to fill in all these questions. And so we started out probably with 55, 60% implementation usage rate. And we actually got our
00:13:33
Speaker
practice involved with this. So when the counselors were talking to the patients they were mentioning, they were giving them a sheet of paper or a card saying, hey, go online and pre-register for your surgery. And so that helped a lot and that brought our average up to 65 to 70%. Got it. So it was really the counselors on the front end of the process saying, here's the next step, here's the link.
00:13:58
Speaker
Absolutely. And if we didn't get it in time, that texting service that came with it, we were able to just text the patient and send them our reminders. Hey, just a reminder, go in and fill out your patient portal for us. I love that. And then if patients show up without doing the pre-screening online, would you do it there at the facility?
00:14:17
Speaker
We do, we have a handful of patients per week show up without pre-doing it. So we have really, we bring them into pre-op area. We have a computer right there and they'll sit down there with their family member and fill it out.
00:14:30
Speaker
Love it. So both are options, but over time through best practices and tips and tricks, you're being able to tick up the percentage that fill it out online before they come. Absolutely. I mean, it's better for the patient as well. From the patient standpoint, it's less wait time for them because sometimes they're taking 30 minutes to fill it out, right? And when they've already had it complete, they have a faster flow in the back.
00:14:54
Speaker
Nobody likes to grab the pencil and the clipboard and fill those things out at the day of. Sounds like a win all the way around. So that's the pre-op side. What about day of surgery? We talked about the microscope, which is a big one. Any other technology or software that you found to be helpful from a day of surgery perspective?
Efficiency with New EMR Systems
00:15:15
Speaker
So we have a lot of changes this year. Now I'm just opening a new center, but we also implemented a new EMR this year. So that alone saved our front desk time from chart prepping. It saved them probably six to eight hours of chart prepping per week. From a cost standpoint, that was great. And then from a patient standpoint, they can come in and
00:15:41
Speaker
checking at the front desk quicker than before with paper. We're also implementing prepayments. We haven't started it yet, but the theory behind it is, I mean, if you think about it when patients come in,
00:15:57
Speaker
one of the most stressful things that one of the most stressful, I mean, they're already stressed out from surgery, right? But they're all stressed out for payments. I mean, that's a good chunk of change that they're about to give up. So it's stressful, right? A stressful thing. So if we can take that one
00:16:13
Speaker
stress off the patient and collect prepayments. By the time they get to the surgery center a couple of days later, then that will be one less stress for them. It's helped improving the patient experience, honestly. That's what we're doing with it. Got it. So EHR and prepayments, I want to ask you a follow-up about each of those. On the EHR side, you mentioned it saves six to eight hours per week in terms of chart prep. Did I get that right?
00:16:43
Speaker
Fantastic. And what specific pieces of the chart prep, is it the, hey, we're not having to enter in information twice? Is it make it easier to actually go in and get, you're not having to physically kind of put the charts in different places? What about the chart prep is most helpful? Well, when we were on paper,
00:17:08
Speaker
they would print out packets right out of the whole chart and they would have to flap stickers, patient information stickers on every single one of those paper, pieces of paper. And if you imagine, there's probably about 13 or 14 sheets of paper per chart. And so they're slapping on stickers. I mean, that took like a lot of just busy work time just slapping on stickers to a patient chart. Especially when you have a busy 30, 40 case day.
00:17:37
Speaker
Sure. And so that's six to eight hours. Does that help the nursing staff do more cases, spend more time with patients, spend more time on lunch breaks? How did they repurpose those time savings? It helps our front desk be able to focus more on the patient and be able to do other tasks. Got it.
00:17:59
Speaker
That's great. Okay. And that's the EHR side. And then the prepayment side, you mentioned there's the benefit to patients. There's the benefit probably from a time savings, again, of not spending much time kind of registering a patient on the front end. What percentage do you expect will kind of pay prepay versus time of service?
00:18:24
Speaker
We're hoping 100%. But I think we would be happy with about 70%. Wow, 70% is fantastic. And again, are you planning on using kind of the texting and some of the reminders that you guys have done and part of the pre-screening process there? We're not quite sure yet. And we're kind of in the pre-planning phase of this. Awesome. So we haven't really implemented it yet.
00:18:50
Speaker
We'll have to check back in with you and see how it goes on the prepayment side, but definitely see the benefits there. What about post-surgery, Kayla?
Improving Precision with Laser Cataract Surgery
00:19:01
Speaker
What technology have you seen from a post-surgery perspective that benefits the center or that benefits patients? I'll go back just real quick and hit on one other technology that we have during surgery.
00:19:17
Speaker
Here at Mann Eye Center, we have laser cataract surgery. And this is a huge benefit not only for the patients, but for the surgeons as well. So laser cataract surgery, what it does, it makes a perfect 360 degree circle in the capsulotomy of the patient's eye, which is the bag that the patient's cataract or lens sits in.
00:19:41
Speaker
And the doctor has to get into the bag to be able to remove the lens. Well, once you create a perfect 360 degree circle, it helps the lens once you
00:19:56
Speaker
insert the artificial lens, it helps it center it, which gives the patient a better outcome. Not only that, it also fragments the lens. So for cataracts, we grade them from difficulty. A one plus is kind of a soft cataract and a four plus is kind of a hard cataract. We can turn a four plus cataract into a two plus cataract with this laser. And what that does, it makes it easier for the surgeon to extract the cataract. And it also makes it the recovery time better for the patient because when the cataract is softer,
00:20:25
Speaker
It's less vibration in the eye from the phacomachine that we're taking out the cataract with, which means less inflammation for the patient's eye, better recovery so the patient sees better, faster. Wow. Fantastic. Sounds like a great, great clinical benefit there. Huge. Cool.
00:20:48
Speaker
Yeah, if we move on to the post-surgery side, anything there that's been implemented or you guys have seen success with it, man.
00:20:57
Speaker
I would say, again, the patient portal. So the patient portal also provides post-op reminders for the patients. It also allows them to stay in touch with the surgeon's office in case they have questions, which we've found has been a benefit. Instead of having the patient call a call center and be hung up on the line or waiting in line to get in touch with somebody, it's been helpful.
00:21:27
Speaker
Fantastic. And do you guys have to spend much time on, you mentioned prepayments, do you have to spend much time on post payments? No, so we collect upfront. 100% of the time. We don't allow patients to go back without collecting.
00:21:46
Speaker
Seems like a good policy. I've certainly talked to other centers that don't always get it or don't get the full amount of time of service and have to spend a lot of times on the back end doing the calls and leaving the voicemail. Yeah, it's hard enough to get collecting payments from the insurance, let alone patients. So it's definitely an absolute good policy to have is to collect payment upfront. Love it.
00:22:13
Speaker
Okay, so final question for you here, Kayla, and we do this with all of our guests. What is one thing that our listeners can do this week to improve their surgery center? I would say...
00:22:27
Speaker
patient experience, because patient experience, I mean, this can go in multiple different directions, but when your patient experiences a really good surgical day, they're gonna go out and tell their friends, and that's word of mouth, right? That's gonna bring more patients into your facility. I truly believe word of mouth is probably your best marketing strategy for any center.
00:22:53
Speaker
Not only this, your patient experience is going to stem from your surgeon leadership. So from a surgeon standpoint, no matter if they want to be a leader or not, when they slap that MD behind their name, they're automatically a leader. And so it's huge for surgeons to understand that if they're good leaders to their staff, their staff are going to have a more
00:23:20
Speaker
positive day and they're going to give the patients more positive experience as well. So it's kind of like a snowball effect.
00:23:28
Speaker
Love it. And I've seen studies to that effect in other industries as well, where it's like, hey, the happier a business's employees or staff are, there's actually a proven correlation many times to kind of the happier the customers are. So that makes total sense. And I love leading from the top advice there. So that's a great one.
00:23:53
Speaker
Kayla, thanks so much for being on this week. This is a great episode and I look forward to keeping in touch. Thank you for having me. I appreciate it. As always, it has been a busy week in healthcare, so let's jump right in.
Cybersecurity in Healthcare
00:24:11
Speaker
Two weeks ago, we shared a story about an ASC that fell victim to a cyber attack.
00:24:16
Speaker
Continuing with that topic, in this article by Healthcare Dive, they're sharing even more insights around cyber attacks. And perhaps the most alarming statistic is this one. 89% of healthcare organizations surveyed experienced at least one cyber attack in the last 12 months. So I just wanted to share three important callouts and reminders from this story.
00:24:41
Speaker
There are four primary types of cyber attacks. We have cloud compromise, ransomware, supply chain compromise, and business email compromise. Out of those who cited a ransomware attack, 67% reported an impact to patient care and 24% reported a rise in mortality rates, which is extremely concerning.
00:25:05
Speaker
The second reminder, as we likely head into a recession and you try to find new ways to tighten the purse strings, experts are concerned that healthcare orgs will cut cybersecurity budgets first. So I know it can be tempting, but it is just not worth the risk. Some health systems report having to spend up to $100 million just to recover from a successful attack. So don't roll the dice.
00:25:29
Speaker
And lastly, just because your ASC might be small compared to large hospitals or other health care systems, it doesn't mean you will fly under the radar. It's actually the exact opposite. Attacks on smaller organizations are on the rise because it's assumed that they have their guards down and less security measures in place. So I hate to start this off all doom and gloom, but the data is telling us now that now is the time to be more vigilant than ever when it comes to your cybersecurity.
00:25:59
Speaker
This next story is interesting and causing quite the debate.
Fairness of Charging for Patient Messages
00:26:03
Speaker
Should patients be charged for sending my chart messages?
00:26:08
Speaker
Within the last few months, a few different hospitals have actually started billing patients for some types of messages sent over this patient portal. Examples of those they're charging for would be inquiries about new symptoms, medication adjustments, new prescriptions, and really anything that requires extensive time reviewing a patient's medical history before they can give a response.
00:26:31
Speaker
The plan is that the fee will actually be built to the patient insurance insurance company with out of pocket cost for people on medicare ranging from about three to ten dollars and then the cost for patients without insurance will be a flat rate of thirty five dollars.
00:26:48
Speaker
To put it in perspective, Northwestern Medicine in Chicago said that over the course of three months, they only charged for less than 1% of my chart messages. So it's obviously not a big chunk at all. But as you can imagine, patient rights advocates are not happy about this. And they say it's just another way for healthcare to nickel and dime patients.
00:27:12
Speaker
For ASC specifically who are considering implementing a patient portal in 2023 or already have one or even for those who have two-way patient texting exchanges, it's just something to remain aware of. In theory, we wouldn't find ourselves in this situation and would actually invite the two-way patient dialogue and patient inquiries to ensure better outcomes.
00:27:35
Speaker
But I am really curious to hear how you feel about this. Is it fair to charge in order to protect the doctor's time? Or does it feel kind of morally icky to discourage patients from reaching out in a manner that we built for them to do exactly that? So please share your thoughts on HSC Pathways LinkedIn post. I would love to hear them.
Cost and Benefits of Pre-filled Syringes
00:28:00
Speaker
Our third story today is from Outpatient Surgery Magazine and it's all about pre-filled syringes. It's my understanding that these syringes are more common in the hospital space than ASCs right now, but perhaps that will start to change. Some of the benefits shared were superior safety, reduced errors, reduced infections, significant time savings, and reduced waste. The only real con that was shared in the article was cost.
00:28:30
Speaker
in a recent study is trying to counteract that argument of cost. They found that the use of manufacturer prepared, pre-filled, ready to administer syringes can actually reduce healthcare costs by decreasing errors compared with the traditional vial and syringe method.
00:28:49
Speaker
Specifically, the study found that manufacturer-prepared, pre-filled RTA syringes were associated with an estimated savings of roughly $182 per administration with a 94% reduction in errors. Now, this was just one study, so take it for what it is, but the numbers are certainly eye-catching considering we're always trying to reduce spend.
00:29:14
Speaker
And talking with some of my colleagues, I don't have a clinical background, so I needed to kind of ask some other people who do what they thought about this. And they agreed with the benefits previously stated, but also shared an additional concern that diversion prevention would need to be top of mind as well and keeping those large orders secure.
00:29:33
Speaker
So again, please join us in this discussion on HSC Pathways LinkedIn post. I would love to know if this is something your AAC would try or have tried in an effort to keep patients safe and costs low. And to
Innovative Use of Medical Drones
00:29:49
Speaker
end our new segment on a positive note, medical drones are saving lives and coming to a sky near you.
00:29:56
Speaker
England's National Health Service has started delivering chemotherapy drugs to the Isle of Wight via drones. By car and ferry, it takes four hours to deliver them, but by drone, it only takes 30 minutes. And for life-saving drugs that have a short shelf life, that's a huge win. It not only saves time, but it also saves fuel and money and reduces carbon emissions.
00:30:21
Speaker
Two other examples in Africa, drones have been used to reach remote communities, delivering vaccines for malaria, tuberculosis, and polio. And in Sweden, drones are being used to bring defibrillators to patients who are actively experiencing cardiac arrest and beating the ambulances to the scene.
00:30:42
Speaker
So I know drones have raised some privacy concerns since their inception, but when used properly in these scenarios, they've really done some incredible work and have saved lives. So we love to see any new technology, any new innovation. So this is a really cool story.
00:31:00
Speaker
And that news story 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'll see you again next week.