High-Volume GI Centers Are Humming

Efforts to keep your GI center running on all cylinders should focus on one all-encompassing goal: optimizing efficiencies. That’s according to gastroenterologist Lukejohn Day, MD, FASGE, chief medical officer at the Zuckerberg San Francisco General Hospital and Trauma Center and professor of medicine at the University of California, San Francisco. 

Performing efficient care is the single most important issue GI centers should focus on because it’s the most effective way to increase revenues and profit margins, according to Klaus Mergener, MD, PhD, MBA, MASGE, immediate past president of the American Society for Gastrointestinal Endoscopy and an affiliate professor of medicine at the University of Washington in Seattle. Dr. Mergener says outpatient GI care is a high fixed cost/low variable cost business — procedure outcomes and equipment needs are largely predictable — meaning volume is key and marginal profits are high.

He likens the cost versus profit equation to an airline’s business model, which involves spending a lot of upfront money to buy planes and hire pilots and staff. Once these elements are in place, the extra cost of putting one more passenger on a plane is nominal and produces pure profit. On the flip side, airlines lose significant amounts of money when planes take off with cabins full of empty seats. The same idea applies to endoscopy centers. The fixed costs of the facility, equipment, physicians and staff eat into profits if the daily schedule isn’t filled with money-making cases. On the other hand, cases added after the fixed costs are covered fill the coffers with net income.

To maintain a full schedule, Dr. Mergener suggests putting processes in place to prevent last-minute case cancellations. For example, call patients the day before their scheduled procedure to remind them of their appointment and to find out if there are issues or concerns that would prevent them from arriving on time. 

Educating patients about prepping for their procedures is also key to keeping the schedule packed with cases. Dr. Mergener suggests providing clear written instructions on how to properly take bowel preps before colonoscopies to prevent aborted exams that leave procedure rooms empty. Patient communication apps are also an effective and efficient way to keep patients informed about the next steps in their care (see “Make Smart Investments in Efficiency”).

Dr. Mergener believes clear communication with patients is invaluable on a more basic level. Treating them like human beings instead of just another case in the middle of a busy day makes them feel safe and prepared for their procedures, a lesson that has become especially acute throughout the pandemic. “Being a wizard in the endoscopy room is great,” he says, “but clinical skill doesn’t matter if we don’t connect with our patients.”

Running a high-volume GI center requires a team commitment to improving efficiencies and thinking about how to drive productivity with data-driven actions, according to Dr. Day. “Look at what metrics have been published and linked to improving efficiencies, and then make sure to choose metrics you can validate, track, monitor and share,” he says.

Efficiency metrics are so ingrained in the culture of his practice that the info is shared with patients. “If they see the data, they know we’re committed to safety and quality, and that must be the ultimate goal when trying to work as efficiently as possible,” says Dr. Day. 

If you’re not confident enough to reveal the inner workings of your workflow to patients, Dr. Day suggests analyzing these data points when looking for ways to streamline how your staff works.

• Turnover times. This is a valuable process to track because it’s an accurate measure of efficiency across multiple phases of patient care, according to Dr. Day. He used room turnover times in his endoscopy center to identify opportunities for quality improvement, such as having staff communicate through a digital tracking board that tells them when procedures begin and end. “This tool provides a clear visual cue to let staff know key procedural steps, so they can plan ahead accordingly in preparation to turn over rooms and get patients ready for the next case,” says Dr. Day.

Equipment standardization is critical for endoscopy centers focused on a high volume of colonoscopy screenings and EGD procedures, notes Dr. Mergener. “Don’t mix and match endoscopes from different vendors,” he says. “When you standardize equipment, you can operate with less inventory and less staff training.”

He says the number of scopes needed to optimize efficiency depends on your facility’s reprocessing throughput and workflow and suggests analyzing historical case volume data for insights into how many scopes to maintain. Assume one patient will be undergoing a procedure while an endoscope is being reprocessed and another scope is readied for the next case. Then extrapolate the total number of endoscopes you need based on how many rooms you run in parallel and how many cases your physicians perform in a day.

Staff must be trained on how to properly reprocess the endoscopes in your fleet based on written instructions for manual cleaning and high-level disinfection received from the scope manufacturers.

“Regular maintenance of automatic endoscope reprocessors and investing in updates of the equipment are also important ways to ensure staff have access to the most up-to-date models and care for scopes efficiently and correctly,” says Dr. Mergener.

• Duration of care. Knowing how much time patients spend in your facility can help your team optimize their experience, according to Dr. Day. Recording and tracking their door-to-door delta provides a clear indication of how well efforts to streamline your processes are working. “Time is valuable for patients,” he says. “You increase their satisfaction and operational efficiencies by limiting how long they spend in your facility.”

• On-time starts. Dr. Day says tracking this metric shows you when and why delays occur throughout the day and how they’re impacting your schedule so you can implement ways to address them. When cases don’t start on time because patients aren’t clinically prepared, show up late or don’t show up at all, take a closer look at your pre-procedure instructions. Do they note the expected arrival time, directions to the facility, parking tips and clear expectations for required actions such as stopping specific medications or completing the bowel prep? “Identify two to three key pieces of information to share with patients prior to their procedures to help reduce delays and no-shows,” says Dr. Day.

Remember that tracking efficiency metrics is worthwhile only if the data is used and shared. Dr. Day says this should happen in a stepwise approach that’s focused on how improving efficiencies benefits staff and patients.

Data transparency has been a gradual process in his practice. It started with sharing the metrics with executive leadership, allowing them to better understand and validate the data, and making sure the information being tracked would benefit patient care.

After identifying key metrics to track, Dr. Day suggests sharing the data with providers and staff. “This step clearly communicates what the organization is measuring,” says Dr. Day. “It also engages staff in the work that needs to be done to make necessary improvements.”