Sunday morning, I'm very impressed with the turnout. Let's see here. So my financial disclosures here. I'm the shareholder of Case Control. I'm a chief medical officer. We're a surgical platform that helps surgical coordination and management. So other disclosure, I'm an unabashed homer. I'm a native Texas resident and we're the perennial losers. But if you're a Cowboys fan, don't tell me. I've wasted too much money on this team. I'm not gonna do that. All right, so we'll check in here. All right, so we'll start with my objectives here. So the goal here really today is to help you guys with the tools you need to develop a data-driven surgical pipeline. I want you to be able to walk out of here to recognize the most common reasons that cases get mismanaged. I want you to help develop the strategies to recover lost cases, how to increase the accountability and transparency of this process so it's not a dark siloed thing that happens with individual surgeons. And ultimately, help you maximize the surgical throughput with the ultimate patient and practice surgical experience. But before we get too far, I hope you didn't think this was just gonna be me droning on up ahead. I want you guys to take out your phones and scan this. We're gonna make this an interactive, dynamic discussion. There's gonna be polls. There's gonna be things that we can discuss together. While you're doing that, I'll get set up. Just make sure you put your name in there and make it that much more engaging. Okay, so let's make sure everything is working. I'm going to start off with a question. So which emoji on the screen there perhaps best describes your current surgical scheduling feelings? Is the poll working for you guys? Okay, cool. You love it. You would have changed nothing. You're like, eh, good enough, but we're open to new ideas, work in progress. Interesting. So we got quite a diverse group here. We see we got some, got some, a lot of folks are open to new ideas, work in progress for some. All right, there we go. So clearly nobody loves it, we can establish that much. We can see that a lot of people don't have a strong opinion but some people are kind of where I was once upon a time, scheduling is blank and we need help now. So without further ado, let's move forward. So you know, surgery scheduling is a big deal and I'm guessing that all of us at some point have mismanaged a patient. And you know, there are 51 million patients don't actually make it to the OR as planned. And in fact, this leads to over $50 billion of waste annually. And you know, this is, that's something to think about. And this problem is real, you know, this is Janet, she came into my office one day and you know, she had this patella fracture, she needed surgery. My team, you know, had to scramble to get her on deck for surgery, you know, she overcomes her fear, her anxiety to have the surgery. Your son flies into town to help, you know, help her during this tough period. Only though she comes into the ASC to discover that, oh, we're missing a cardiac clearance. You've heard this story before and she has to go home in tears. And you know, she comes to me and I'm just like bothered by that in this day and age that we're still having this happen. And maybe it only happens once every couple of months but that's money out of your pocket. And my experience really got me to begin to wonder, you know, how many other patients like Janet out there? And I started asking my admins for help. I said, what I thought was a straightforward question. I said, hey, you know, what is my booking rate? How often are patients not making it to the operating room? And when cases are canceled, why are they not making it to the operating room? And my administrators kind of just gave me some blank stares and they couldn't really immediately give me the answers. And you know, surgery is the most vital part of my practice and I said, how could this be? You know, this is what we do. We're surgeons, we're operating our practices, trying to deliver surgery. Why can't it be better? So, I'm gonna take it to another question for you guys here. Sorry, I got too many devices here. There we go, okay. So, the poll should be open. How do you measure your booking rate? That is, do you even track how many surgical candidates or recommended surgery that actually make it to the operating room table? And you know, it's important because it's like anything else if you don't measure it, you can't fix it. And you know, if you don't have a handle on the scope of the problem in your own practice, and don't be bashful because if yours was anything like mine I am presuming that's why a lot of you are here today. Again, quite a diverse set of responses we're seeing. We definitely have. All right, so it looks like a large majority of you, I mean, this audience is the appropriate audience, I guess, but a lot of you are working on systems or some of you have systems in place to track and monitor this data. Well, let's dig a little bit more into this. You know, in my experience, working with 100 different practices, they're often astonished to learn that over 35% of the candidates are mismanaged and don't make it to the OR table as planned. And, you know, that's a lot of money left on the table, no pun intended. You know, the good news is that over 72% of these patients are actually recoverable. And with enhancements to the surgical coordination process, often you can get these folks back to the operating room table. You know, in my practice, it was, we implemented a data-driven pipeline and immediately this produced results. We saw a decrease in the cancellations. And when we compared year over year, it was amazing that we already see 40 plus more patients and over 300K more in collections as a result. So, you know, it wasn't too long before my partners noticed and it's kind of what got me passionate about this subject. You know, being able to help my peers also and other practices, you know, work smarter, not harder. Because these are patients that you took a lot of marketing dollars to get them through the door. You got them to sit in your clinic. You found out that they needed something that had surgery. Maybe you got them through some imaging. You know, it's not an easy journey to get to the point even where you decide that you need surgery. And then after all of that, to not have them go through to the final step, that's significant. So my own practice, how does your scheduling team stack up? And that's the question. So to start, what are the KPIs that you could track to understand the performance of your vital scheduling processes? Often, when I talk to practices, I ask them, how do you know who's a good scheduler? How do you know who's an underperforming scheduler and who needs help? And, you know, it's very important data to track to understand how to enhance the surgery pipeline. These are just some of the KPIs that, you know, some of the basic ones that I use to track my team's performance. You know, what is their booking rates, time to schedule, number of patient touch points they have, cancellation rate, holding rate, reschedule rate, and the number of cases that they're managing. One of the first steps is I invite all of you to try this exercise when you go home. I know this slide is difficult to read, but if you haven't done so already, take a case and follow it start to finish in your practice. Map every interaction, every piece of information exchanged, and every single party that was engaged to help organize it. And you'll come up with a workflow diagram. And this diagram here illustrates that these rainbow-colored swim lanes are basically different parties and individuals at the practice that are touching this case. These black diamonds represent decision points. And every single one of these decision points represents a potential bottleneck, a potential pitfall, a potential hazard on the way to the OR that could trip up the process. And so if someone doesn't, you can see there's so many people with their hands in it that if someone doesn't take ownership of this process, you're essentially doomed for mediocrity. The surgery will get done. Some surgeries will get done very well. But if you don't have someone kind of overseeing this, there's just too many people for anyone to necessarily take the responsibility for all of it. You have to have someone in charge of it. So how do we establish this data-driven gold standard? And really we need to do this to increase our availability and accessibility for these patients to our care. One common or easy starting point to think about is probably the person that has the biggest role in this whole process, which is obviously the surgery scheduler. They're sitting at the center of this nexus. And they can be one of the most underappreciated assets we have. Maybe not in this audience because you guys are here for a reason, but when your schedulers are unavailable, some of you may have noticed that everything comes to a screeching halt. I had one of my schedulers go on medical leave and I was mesmerized, like, oh my gosh, the whole gravy train comes to a screeching halt. It can't be this way. Your business continuity can't depend on a single point of failure. When the schedulers go on vacation or, in fact, we took a survey and we found that, surprised to learn that 78% of schedulers are actually afraid to take vacation or dread taking vacation or breaks because they find it stressful. This is really a setup for turnover in this day and age where it's hard to find staff. That's a big deal. We have noticed actually this trend tends to be larger in greater practices where maybe management is more than an arm's length away from the scheduler staff. Other red flags to think about, do your schedulers feel overwhelmed and frustrated? If you dig into, oh, sorry, I'm not, if you dig into their day-to-day responsibilities, it can be very repetitive and mundane. And so our data shows on average it takes each case as much as six hours of work cumulatively and multiplied by hundreds of cases, this can be very exhausting for a scheduling staff. So being cognizant of that and whether or not they're getting overwhelmed is important. Are your patients constantly, good schedulers also, have you had trouble retaining a good scheduler? That's important. How many times in your practice do you find that your good schedulers are having to pick up the slack from maybe a not as strong scheduler? That's a problem because that's not a great incentive for doing a good job, right? If you keep pulling your good schedulers to pick up the slack of others. Are your patients constantly wondering what's happening? That can be another red flag because ideally many different messages need to be disseminated to many different parties and stakeholders. And often the party that gets neglected the most is the patient, because there's many other critical stakeholders and the ones that need the most attention, often the highest party tasks end up taking a lot of the surgical scheduler's capacity. So the patients end up getting the short end of the stick sometimes. And then if you start to notice that your scheduler's volume is beginning to, the time to schedule is starting to increase, that may be also a sign that your scheduler's getting burnt out. These are how we leverage some of these KPIs I was talking about earlier. If your system is not collaborative and schedulers cannot share their work, this becomes a fast track to poor job satisfaction. And then finally, the last piece there, if you notice your hold or your cancellation rates all of a sudden are going above the historical average for that scheduler, your schedulers are probably starting to get stretched in and things are starting to fall through the cracks. So these are kind of just some surrogate markers when you're watching a big practice to kind of see, okay, there may be trouble brewing somewhere. Bottom line is, you know, the continuity of this process, you know, you gotta, it shouldn't be so dependent on one scheduler. And if your surgeons are married to specific schedulers, that could be, create challenges. Okay, so let's talk about what a recipe for success might look like. You know, we know that your schedulers to be the most effective, they have, for your schedulers to be very effective, we need to have certain recipes and steps for success that are common across the whole workflow to ensure that we have a consistent process that can ensure success. So we'll go, I want you to pay close attention to each of these steps and we'll kind of go through each of them one by one. So the first one is to start, your scheduler to be most effective, their workflow is really predicated on good information flowing from the surgeon. So let's start there. Let's open up our polls again. Let's talk about, how do your surgeons communicate with your staff the new cases that you're scheduling? Are they using their wonderfully legible handwriting to completely and comprehensively fill out those paper forms? All the codes, all the post-op equipment, implants. It's interesting, again, a diverse group of responses. We still have folks with the paper. We have electronic submissions. We have a hybrid. And each surgeon has their own method. So let's take the corollary question to this. I'm going to ask you another question now. How many of you have ever attempted to try to standardize this process? I hear a few chuckles. Clearly, my peer surgeons are a problem. We got, almost everybody responded. Good, so we definitely have some superstars in the room that have successfully implemented some standardization of this process. We have some folks that are working through it and have been partially successful. And there's also a lot of folks that have encountered tons of resistance. So let's talk a little bit about that. Sometimes disrupting the status quo can be very difficult. And especially for a process that lives in the dark, I invite really your decision makers to think about the cost of inaction. Sometimes your biggest obstacles actually can be the surgeons and staff. Without a data-driven pipeline, you can't even recognize the bottlenecks or leaks in this. And so it's important to remind them that even one case loss is really impacting the long-term financial health of the practice. For the non-believers, well, first, surgeons, let's start with them. Surgeons are, just like how they chronically underestimate how long it takes them to do a case. Surgeons chronically underestimate how many cases they're losing. I guarantee you, it's more than you think it is. And I've repeated this experiment many, many different times, many different practices, and they're always shocked to learn how many they're leaving on the table. It's just, if you don't have, again, if you don't measure it, you don't know it. One thing you can do is to, these are some of the pros you can highlight to them. But sometimes even showing a list is not enough. And they're just like, well, my practice is different. I don't lose any patients. I'm just a very busy surgeon. I don't believe you. For the non-believers, here's what I consider you recommend doing. Do a chart biopsy of all the patients that that surgeon has seen in the last three to six months, let's say, and make a note every time surgery was recommended in the clinical note, okay? And then reconcile that and see how many of those actually went to surgery. I'm willing to bet you that there's actually cases that are falling through the cracks that when you show the data to the surgeon, it becomes harder to argue with it. And it's not hard, it is laborious. And you could assign an intern to do it or talk to me, I can show you some tricks on how to do it later after the talk. But there's definitely ways it can be done. And that's actually how we had to do it in my practice for some of the non-believers. We actually got with my admin, we had a cohort of surgeons that were like, yeah, this makes total sense, we're gonna do it. And then we had a few surgeons that were always like, no, no, no, my practice is, you don't know, my practice is, nobody ever leaves my practice. And it was funny because sometimes those are the surgeons that were the biggest at risk of losing patients. You'll find actually the busier, very high volume surgeons, sometimes there can be issues with long waits and stuff. And it's not that they don't like the surgeon, it's just that the system doesn't allow them to proceed with their surgery. And sometimes when you present that to a surgeon, then they start asking the right questions. Well, wait a second, you mean that I could be doing more surgery, but the system is preventing me to? And then all of a sudden you start getting a lot more excited about the ideas. So once you adopt a common mechanism for receiving the case postings as a start, you have to standardize that because if you don't have quality data coming in, you're not gonna be able to implement a quality surgical pipeline. The next priority should be establishing a common method for delegating and dividing this work up on these cases. You can't keep these silos, otherwise you're gonna burn out schedulers, it just doesn't work. And the way you do is you can pull these case requests. And if you can't get your staff away from it, let's say you just cannot extract them from the paper forms, okay, fine. Even if you do paper forms, you can still standardize that to some extent and then perhaps put it in a common digital workspace. Have someone in your office responsible for immediately scanning it and putting it in a digital workspace so that it's accessible to everyone. All staff needs to know what cases are coming through the pipeline. This means using tools to make it apparent who's working on what. They need to ensure that nothing falls through the cracks by keeping it all in a central place. You never wanna misplace that posting sheet. And so by putting it in immediately, that won't happen. Depending on your EMR, it may take some work to accomplish this, but there certainly are tools. And I encourage you to reach out to your account manager for your EMR and to find ways you can share this information. There's also, outside of the EMR, I've seen many different things. There's shared spreadsheets. You could make sure yours is HIPAA compliant, obviously. I'm sure some of you have Microsoft 365. You could leverage tools that you already have in your product suite there, such as the productivity, there's like Microsoft Planner. Great centralized ways for your practice to work on it. When you put it into the shared workspace, it becomes just, bottom line, more transparent, accountable, and collaborative. So once you get this digitized, the next step is you want to audit and track the progress of all these cases within this shared workspace. So we're going to open up to another question here. What I want to know now is, not can your individual schedulers by themselves track things, but can your team as a whole effectively track and audit the pending cases? Are there essential documentation there, such as the postings, the authorizations, clearance, assistance requests, et cetera, et cetera. Got almost all the responses. And good. I'm very encouraged to see that in some shape or form, a lot of you are already using mechanisms to try and audit this to make sure nothing falls through the cracks. There's some of you that are still working on that, but that's good. And going back to standardizing this, it's also standardizing the elements that each scheduling member needs to work on. And so you want to make sure that these are just some elements that need to be considered. You want to make sure the beneficiary, you have a payer that's in place that can help with your surgery payments. You want to make sure the resource is available. Obviously, the OR, the tools that are needed to do it, the vendors are available. You want to make sure the patients are appropriately prepared for the surgery. If they're a high BMR, can they go at your ASC? You want to make sure all these things have been considered. Are the clinical notes ready? Your staff will need that for the authorization process to be complete. Has the pre-authorization been done? We don't want to be stuck in error purgatory. We want to make sure everything has already been I's dotted, T's crossed well before they make it to the OR. Medical consultants, have they checked off on the surgery? Is this patient someone who needs the cardiac or the PCP clearance? Similarly, diagnostic tests, results, is everything complete there? The financial considerations, it's a big financial burden. You want to make sure that they've got their estimates and that if there's prepayments pending, if you collect up front, have they been obtained? Your DME workflow, have they've already been dispensed? And finally, patient education, often the step that gets neglected, but very important. And this can help inform a dashboard and everybody can see the progress so that it's very easy to understand what everybody's working on and what has not been complete. So next, most critical step is probably communication. And this is really one of the most critical aspects of surgery scheduling. These are just a few of the parties that are attached to surgery scheduling. And it's by no means a comprehensive list, but these are just some of the folks that may be involved. And think about how you want to prioritize this in your communications. What we have found is that, in most cases, what we have found is that ideally all these parties should be receiving consistent, clear communications. And interestingly, when we look at our data, we found that a minimum of 34 touch points of all comers, for some reason, there's a much higher trend to completion. And so it's just a statistic that we've noted. A bottom line is, I think the main idea here is excess communication keeps cases out of trouble. But this is a tedious process and transcription can be frustrating, be repetitive. And what we find is that, as you can imagine, if a scheduler is juggling hundreds of cases, keeping tabs on the status of each of these parties, producing the information that they specifically need, can be all consuming. No one answers their phone anymore. Actually, 89% of practices find that contact with their patients is very challenging. And only about 24% of practices are currently leveraging text. So you can think about that. 63% actually rely on paper handouts when they're in the office to really communicate the surgical plan and goal. But to be honest with you, it's kind of like drinking from a fire hydrant. It's very difficult. If you've ever had surgery, you get this stack of papers. But really, what we find is that only 35% of patients actually read this and retain that information that they have been given. So you can imagine all this, the consequences of all this, the unintended consequences is that the patient ultimately feels lost, particularly undecided patients. These are sometimes the undecided, anxious patients. Sadly, these are often the patients that need the most hand-holding and probably need your help the most and also could stand to be the biggest advocate of your practice once they get their appropriate treatment. But instead, often it's the squeaky wheel that gets the grease and the patient that keeps pushing that the staff is stretched and they end up getting the most attention. The good news is there's many tools out there to help you guys with automating some of these interactions, vendor communications, form-filling, streamlining, many of some of these redundant aspects. And a lot of the EMRs have tools already for patient engagement and filling out forms. You just have to harness them. So we'll go to our last step in our recipe, and that's implementing a mechanism to kind of close the loop of communication. We'll open it up for our last poll here. And what we want to know now is how many of you guys have essentially like a confirmation step where you proactively monitor your certain schedules, are trying to assess if there's underutilized operating room time, looking back at what's on the schedule after it's already been scheduled, is kind of the concept here. It looks like my confusion may be a bit confusing. I don't see everybody answering. And I often tell, you know, this confirmation step really is, I say it's reserved for the overachievers, and those that really want to elevate their surgical practice. And partly that's because, you know, this is a very, there's already enough going on, and there's a lot going on, and there's, it's one of those things, once you've mastered the other steps, then I would only consider this kind of really last aspect. I thought this is a bit interesting to show. Confirmation really means implementing a process for reviewing the caseload and a fixed interval before they actually happen to see if you can pick up a few lost cases or missed cases. Reviewing the case sequence really makes sure that these cases are on the launchpad ready to go, and that some practices will also be able, you know, this is where you can leverage like a standby queue, for example. Like if you have cases that are a week out that can't get done, you can pull in another case that's on the launchpad. These are just some risk factors. There's some things we see in the data that, you know, probably some of these are common sense, but if you kind of take these into consideration when you're doing your confirmation step, these are probably patients that should deserve a little bit more attention. All right. I'm gonna kind of wrap it up because I know I'm hitting close to the end of my time here. So in summary, you know, these are kind of, you know, it really pays to give both your patients and staff the ultimate surgical scheduling experience. You know, you want to start by really coming up with a standardized way of producing this information for your staff. You know, you want to empower them to be able to independently schedule cases. It's gonna take buy-in from the surgeons. It does because it requires them to change their ways a little bit, but you have hopefully some information now to go back to them and explain why lack of standardization really impacts the health of the pipeline. You want to have a shared workspace where you can kind of foster that accountability and sustainability. And without the kind of shared workspace, I think you're setting yourselves, your schedulers up for problems. You want to be able to audit the checklist and audit a process that's auditable and really enforce that across the different schedulers. Communication needs to be clear and consistent and all parties need to be involved. A lack of communication will leave vendors, patients, ORs unprepared. And then finally, a final check of cases to really give that last little bit of opportunity to backfill cases can really give you an opportunity to ramp up the few more cases in the end. All right, so that really wraps it up. There is a Q&A section in your application there. We can revert to that if you'd like. I'm open to any questions you guys may have. Let's see here. Either vocally orally, anybody can raise questions if that really wraps up, or you can use the Q&A feature in that polling system that you're using. So it varies from practice to practice, but I would say the most common ones tend to be patients getting lost in the process, or sometimes the clearance is not being ready. Those will be lead to, and by the way, it's not 35% not making it to the OR, it's 35% being mismanaged and either getting a delay or a cancellation. Any other questions? We can, let's see our leaderboard real quick, just for fun, if you look at your phone, you'll probably see we have some superstars in the audience. Got a lot of peers around you that know this stuff, so there's a leaderboard I'm showing you on your phone. These are your peers, feel free to reach out to them. I'm sure they have a lot of resources. This is a great community we have at AAOE. Reach out to them, I'm available for any questions if you guys wanna speak with me. Happy to talk to you about my experience. Thank you guys, appreciate it. Thank you. Thank you. Thank you, Dr. DeJuan, we have a speaker gift for you. It was a cowboy's lapel pin, but we changed it out, so enjoy that. Thank you, great content all the way through from start to finish this week. I, for one, didn't realize that we likely have a big problem in our practice as well, so thank you for illustrating that. If you are claiming or applying for AAPC credit, the code is 84742HKE. Maybe able to get to that, actually.

data-driven surgical pipeline

surgical coordination

standardizing processes

key performance indicators

effective communication

case audits

proactive monitoring