Surgery Coordinator Benchmarking AASA Webinar November 4, 2015

1. Surgery Coordinator BenchmarkingAASA WebinarNovember 4, 2015

2. Presenters Lonn McDowell, MHA, FACHE, FACMPE Vice Chair and Director for Administration Department of Surgery University of Florida College of Medicine Athena Tingberg, MHA Candidate c/o 2016 Administrative Intern Department of Surgery University of Florida College of Medicine

3. UF Health Department of Surgery • 58 full-time faculty & postdoctoral researchers • 68 residents & fellows • 56 mid-level providers (36/20 Split) • 160 UF & Shands staff • 7 subspecialty divisions • Acute Care • General • Pediatrics • Plastics • TCV • Transplant • Vascular

4. Surgical Coordinators • Official UF Title • “Clinical Service Representative 3” (CSR) • Currently 19 FTEs in the Department • All report to one manager, but each Coordinator focuses on Division/Subspecialty • Cost per Coordinator (Non-Exempt) • Salary Only $38,480 to $49,674 • w/ Benefits $54,987 to $70,984 • Total Departmental Cost of $1,143,859 • Very skilled staff – Critical to Departmental Function

5. Surgical Coordinators General Duties • Schedules all surgeries, as well as any pre/post-op appointments that are needed • Prepare for clinic by screening schedule to ensure that all patients have appropriate testing prior to visit • Schedule ancillary testing needed for patient care • Answer incoming calls/messages from patients • Work with Patient Access Center to help schedule referrals in a timely manner • Act as a liaison between physician and patient. • Help explain plan of care to patient

6. Opportunity for Improvement • The UF Department of Surgery (DOS) currently appoints one to five Coordinators to each surgical division • Divisional P & L statements follow appointment • Divisional offices are geographically disparate • The DOS lacks an objective metric for determining the point at which an additional Coordinator is needed (Or if efficiencies can be gained due to a decrease in the complement of faculty/workload) • Currently need is driven from Coordinator to Faculty • “I need some help.” • Creating a benchmark to pinpoint the level of Surgery Coordinator support each Division (overall Department) needs could improve standardization and overall efficiency

7. Surgery Coordinator Benchmarking • Phase I: • Collect existing data/metrics • Analyze correlations between Divisions • Phase II: • Assess workload of surgery coordinators • Management Engineering Involvement • Interviews • Observations • Phase III: • Refine data for objective benchmark

8. Phase I: • Collect existing data/metrics • Analyze correlations between Divisions Where are we? How did we get here?

9. Methods of Analysis • Division-specific data collection • Clinical/Surgical productivity • cFTE contributions* • OR case volumes** • wRVU totals** • New patient visits** • Return patient visits** • Clinic sessions* • Session = Half-day clinic period * Actual 12 months of data (7/1/14-6/30/15) ** 9 months (7/1/14-3/31/15) annualized to 12 months for comparison

10. Methods cont. • Data analysis • Surgery coordinator FTE per surgeon • Many coordinators assist more than one surgeon per subspecialty • Divisional metrics per surgery coordinator • Analyzed by subspecialty/Division • Surgical yield rate • Surgical cases / New patient clinic visit • Surgical cases / Clinic sessions • Surgical cases / cFTE

11. Preliminary Data

12. Preliminary Data

13. Preliminary Data

14. Preliminary Data

15. Preliminary Data

16. Preliminary Data

17. Preliminary Data

18. Other Information/Comparators Surgical Yield

19. Other Information/Comparators Surgical Yield

20. Other Information/Comparators Surgical Yield

21. Other Information/Comparators Surgical Yield

22. Phase II: • Assess workload of surgery coordinators But…We are Different! But…How Different?

23. Work/Activity Sampling Study • Assessment of work-related tasks of surgery coordinators • Self-assessment software through Microsoft Excel • Quantitative evidence to compare workloads between divisions • Consists of the following steps: • Identify the employees to be sampled • Define the activities to be observed • Estimate the sample size based on desired level of accuracy • Develop the random observation schedule • Make observations and record the data • Estimate the proportion of time spent on the given activity

24. CSR Employees Sampled

25. Activities Observed

27. Click to add graph/image

28. Click to add graph/image

29. Unit Breakdown of Hours per Day Spent on Tasks

31. Management Engineering Recommendations • Sample size requirement limitations • Potential areas for improvement • Epic Inbasket Upkeep : Acute Care • Insurance Authorization & Follow-up : Plastics • OR Utilization Tasks : Plastics • Post operative scheduling : Transplant • Clinic Clean-up : General • Patient Forms : Acute Care

32. Phase III: • Refine data for objective benchmark Show me the Science! Does it mean anything?

33. Data Refinement • Removed all Acute Care Surgery Faculty • Burn, Trauma and Surgical Critical Care • Removed any Faculty in a “transition period” during the measurement period • Can be Annualized, although Faculty on the way in (or on the way out) generally have skewed data • Removed any Faculty without clinic sessions (most of the VA – split Faculty) • Less need for surgical coordinator assistance • Removed any residual MLP influence from data • 49 Clinical Faculty reduced to 28

34. Individual Data Similarities?

35. Individual Data Similarities?

36. Individual Data Similarities?

37. Individual Data Similarities?

38. Individual Data Similarities?

39. Individual Data Similarities?

40. Normalized Data

41. Normalized Data

42. Normalized Data Individual Divisional

43. What’s the Answer? • CFTE, CASE #s and wRVUs have the most correlation between Divisions. • Need metrics that allow us to plan ahead -more than look back • CFTE is set in advance • Case #s are primarily a look back and are more difficult to budget (departmentally) • wRVUs are historical and are budgeted per faculty member • CFTE and wRVUs can have a weighted correlation.

44. What’s the Answer? ((CFTE / 1.1) X 0.35) + ((wRVU/12,000) X 0.65) • CFTE (“Patient Care” Effort Assignment) is established for each Fiscal Year • 1.1 slightly below the median for all individuals • Smaller denominator = more liberal calculation • wRVU from a full prior year can be utilized for existing faculty and budgeted wRVU can be used for new faculty • 12,000 slightly below median for all individuals • Smaller denominator = more liberal calculation • Weights of 0.35 and 0.65 are inversely proportional when comparing Standard Deviations

45. Discussion • Limitations • Sample size • 49 clinical faculty reduced to 28 • Time period of data collection • One full year would have been better than 9 months analyzed • Two full years would have better than one • Issues already “corrected” for • Acute Care, Transitional Faculty, VA Faculty, MLP’s • Assumes we had the “right number” of coordinators working during the data collection • Not entirely convinced • All coordinators are not the same • Varying levels of experience, backgrounds, time in current positions • Divisions are in fact different to some extent • Plastics functions more like a private practice • Transplant receives “coordination” assistance from the hospital • TCV maintains longer, fewer, more wRVU-intensive cases

46. Future Considerations • “Benchmarks are directionally correct.” • “The sum is greater (more accurate) than the parts.” • Should the formula/guidelines be used as a “maximum?” • How often should the formula be calculated/utilized? • Annually, bi-annually? • Can/should the wRVU function of the formula be based on subspecialty-specific UHC wRVU benchmarks? • Can it be made more objectively specialty specific while still retaining departmental validity/relevance? • Can more basic “coordinator” functions be centralized to lower level positions? • Added efficiency or possibility for increased error • Operations follow finance or finance follow operations?