PAY CHECK You can take steps to control the cost of staffing — one of the highest expenses on your facility's books.

Payroll is one of your most expensive line items, but preserving the bottom line and maintaining a happy workplace don't have to be mutually exclusive goals. Here are 6 creative approaches to staffing and case scheduling that can help you generate revenue without sacrificing valuable and valued members of your surgical team.

Take a hard look at the schedule. Identifying gaps that are costing your center money is the first and easiest way to plug the financial hole caused by inefficient staffing. Lulls in the middle of the day are difficult to fill with cases, and getting staff started on a project may be challenging if they have to shift gears back into OR mode in just a few hours.

To keep downtime to a minimum, scour the surgical schedule for unused block times and quickly replace the OR assignments of low-volume surgeons with docs who bring revenue-generating cases to your center. If your surgeons always attend academy meetings, open their blocks during those weeks for other specialties. Ask surgeons to notify you of their vacation plans at least a month in advance. If you know they always take time off at the end of their kids' school years, open up those block times, too.

It's difficult to fill schedule gaps with cases if you wait until the last minute to try to do so. One unused OR per week costs $200 for a $25/hour surgical tech and $320 for a $40/hour nurse. Even if that only happens once a month, that's $6,240 in gross wages annually — not including benefits paid — with no revenue generated to offset it.

Don't be quick to cut staff. Cutting hours and laying off staff will save money, but it could negatively affect your bottom line in other ways. Cutting hours can reduce a nurse's or tech's take-home pay, forcing them to find sources of supplemental income or look to another facility for a higher paying position. Morale could drop after the loss of team members, causing the remaining staff to also seek employment elsewhere, which might leave slim pickings for keeping your rooms fully staffed.

Additionally, your surgeons might not have their first choice of staff if you've cut their favorite team members' hours or days. Bottom line: Cutting staff should be a last resort.

Assign shifts creatively. If you have to make a drastic staffing move, first consider reallocating staff to staggered shifts and offering physicians OR times after office hours. Meeting the scheduling requests of surgeons and offering employees a chance to alter their regular hours without affecting their take-home pay is a win-win for everyone.

Poll your physicians to see if any would be interested in time slots after 3 p.m. and 5 p.m. If there's enough interest, consider adding a 10:30 a.m. to 7 p.m. surgery shift to complement your 6:30 a.m. to 3:00 p.m. clinical teams. This schedule tweak may also increase the morning shift's efficiency, because the evening team can set up rooms and pull supplies for the next day's cases.

Recruit part-time employees. Part-time employees offer several benefits to a staffing schedule. First, they're more willing to commit to regularly scheduled days than per diem workers, who might hold out for the highest bidder. There's more opportunity to pick up highly qualified part-time help who need to keep their income level closer to full-time wage earners, especially because some centers have reduced the number of full-time employees to comply with the Affordable Care Act's health insurance mandates for employers of 50 full-time employees or more.

Even if you offer reduced benefits, such as health insurance and paid time off, to part-time employees, based on their hours worked, your center will still save money, compared with staffing full-time employees. You'll also be able to cover changing surgery schedules more nimbly.

Bolster your per diem roster. What about the dreaded threat of understaffing? You know, that situation where you've let staff have a day off only to have Dr. Smith book a D&C. You can call your previously scheduled staff to see if they can cover the case, but they've likely made plans to enjoy the surprise day off. In addition, they may expect to work their full shift if they decide to come back in, which would blow any revenue from the add-on case. Before you make those calls, consider checking with per diem staff. These on-call workers can be used most effectively to fill in during low-census days, especially when they're cross-trained in all aspects of perioperative care.

Reconsider overtime for part-timers. Even in states where overtime pay is mandatory after 8 hours per shift, those extra hours can be less expensive for part-time staff than for a full-time employee working 40 hours per week. In the case of the $25/hour surgical tech, a 40-hour week would total $1,000 in gross pay. If a part-time worker at the same hourly rate works 24 hours per week with an additional 2 hours of overtime, you'd pay her only $675, not to mention the cost savings you'll realize by not paying benefits.

STAFFING SOLUTION
4 Tips for Hiring Per Diem Staff

ON CALL Per diem workers can help out in a pinch.

• Ask around. Surgeons, nurses and techs likely know who's looking for additional income and who'd be a good fit for your existing team.
• Always check references. Don't let desperation to staff a case result in the greater problems of interpersonal or medicolegal issues.
• Work with HR. Double check to make sure you're complying with the legalities of hiring per diem workers in your state.
• Keep files current. Build a full employment file, complete with training and credentialing documents, to comply with accreditation standards. Using a staffing agency can eliminate some of this legwork, but usually results in higher wage costs.

— Corrie Massey, MBA