Surgery scheduling is hard, but does not have to be. It’s true that surgery scheduling involves the patient, the surgery scheduler from your practice, the primary care physician, laboratory vendors, insurance / payers, surgery schedulers from the hospital/ambulatory surgery center (ASC) your surgeon is operating in, the medical billing department on your side and on the hospital/ASC side etc. Yes, it can truly get out of hand and your no shows or cancellations for surgeries could truly bring down the profitability of your practice.
It doesn’t have to be – use this guide and a surgery scheduling software to get a better handle on your surgeries.
Surgery scheduling workflow
It’s not really rocket science but yes, it does have quite a few moving parts. While working with the practices we manage, our conclusion had been that the high no-show and cancellation rates were due to lack of real time workflow status updates and the ability to methodically track next steps / dependencies.
Once we got all stakeholders on the same surgery scheduling software website, we posited that our surgical density would not only improve but our patient no-show and cancellation rates would also drop dramatically.
Fundamentally, here are the various steps involved in a surgery scheduling (preoperative and perioperative) workflow.
- Patient is identified by one of our providers as a surgery candidate
- The patient is then taken to a sub waiting room for a discussion with the surgery scheduler.
- The surgery scheduler has a discussion with the patient about the surgery, what to expect, how to prepare for it, what the next steps are.
- The surgery scheduler also explains the patient responsibility aspects of the surgery costs. This is where the surgery scheduler lets the patient know that we need the patient responsibility portion paid up front for us to book the surgery.
- The surgery scheduler lets the patient know that any overpaid amounts after account balance reconciliation would be refunded to the patient.
- The surgery scheduler then schedules the pre and post operative surgery dates.
- The surgery scheduler then also hands patients informational leaflets about the surgery, what to expect etc (i.e patient education handouts)
- The next steps include the surgery scheduler getting the appropriate prior authorization from the insurance/payer.
- Meanwhile, the surgery scheduler also needs to start getting the appropriate medical clearances. Either the surgeon or the patient’s primary care provider can do the patient history and physical to provide medical clearance for surgery and anesthesia. This really depends on the patient’s health and the patient’s payer’s guidelines
- Keep in mind that the clearances for history and physical should be received at least a week before the surgery depending on the patient’s health conditions.
- It is ALWAYS in your surgeon’s best interests to get the patient’s medical AND surgical history from their primary care provider. Here’s a good sample.
- For this, the patient does need to sign a consent/medical record release form as well. Once this is done, the surgeon’s office (your practice e.g.) needs to go over the history with the patient as a checklist. Often patients do not understand what is a surgery and what is not (a classic example is a C section). Here’s a checklist sample.
- The surgery scheduler also needs to dig deeper into patients’ medications and specifically ask for any over the counter “herbal medication” they might be taking. Most patients do not think that herbal medication can interfere with anything related to their surgeries – but they might interfere with anesthesia.
- Based on the age, medical history of the patient, sometimes, diagnostic testing might be required. This is almost never a standard list, but these are prerequisites of that particular surgery – and these need to be done, results obtained at least a week before the surgery. There’s a lot more information available here on Medscape.
- Patient education has to be enforced multiple times as patients are, understandably, anxious and might delay their care / surgery.
- The surgery scheduler should be advising the patient on preoperative fasting, medications, anesthesia, and postoperative care that the patient should expect.
- The reasons for fasting should be explained to the patient repeatedly – this is where most of our surgery cancellations occur. Patients simply do not understand that not fasting opens them up to chances of vomiting, nausea post operatively.
- Throughout this time, the surgery scheduler is / should be coordinating with the surgery center or hospital about the block of time and number of patients that they should be expecting.
- Until all the prerequisite steps have been met, the surgery cannot be confirmed from your practice’s side and unless you confirm the surgeries from your side, the surgical center runs the risk of losing revenues (their investments are significantly higher than yours).
- The better your surgery no-show rates are, the more advantageous blocks your surgeons get. Over time, we have noticed that some ASCs end up dropping some associated surgical partners because of the no show and cancellation rates.
- The surgery scheduler should be following up with and remaining in touch constantly with patients so they don’t cancel or back out.
- Patients that do not show up for the pre-operative appointments will most likely not show up for their surgeries either – following up with patients to ensure that they do show up for their pre-operative appointment is very important.
- Any laboratory/diagnostic test results and all medical clearance documentation should be submitted to the surgery department beforehand. This helps to avoid repeating procedures and therefore saving time + money.
- Following up with a patient after the day of surgery to ensure no complications occurred is CRUCIAL. The surgery scheduler needs to make that part of their workflow for the patient as well.
- Usually, the surgery center does provide all post operative care instructions, however, care instructions specific to your speciality should be followed through by your team. This could include the medications the patient can and cannot take, the correct way to take eye medications, eye and wound care, the appropriate emergency contact information that the patient needs.
- The surgery scheduler should also ensure that the patient does show up for their post-operative appointment the next day after the surgery.
- When the patient shows up for their post-op appointment, the coordinator should also ensure that the patient has follow up appointments (recommended) one week after surgery, one month after surgery, and three months after the patient’s surgery.
- The day after the surgery is typically the best time for the surgery scheduler or the front desk staff to follow up with a patient satisfaction survey. This truly helps with your medical practice marketing.
- Following up and following through this entire process with clear indicators of dependencies, full transparency between the patient, surgery scheduler on both your practice’s side and the hospital/ASC’s side, the surgeon is needed to ensure closing the loop on Surgery scheduling and successful surgeries.
How to use surgery scheduling software for success
In addition to our surgery scheduling software (contact us), here are some top vendors in the market.
What you need in a surgery scheduling software
As you look for a surgery scheduling software, look for these basic things to begin with. You can definitely look for a much longer list of features and functionality, but if you are transitioning from paper based and fax based surgery coordination, this is a good start.
Web based access
Your surgery scheduling software should be at least web based, and hopefully, also allow you mobile access. You don’t necessarily need a mobile app per se, but this surgical application should be accessible from your mobile. More often than not, your surgeons will be using the mobile version and you, yourself, will have to access this website from home and respond to comments/tasks from your mobile.
Having this as only a website limits real time updates/status tracking – in our experience.
Since you are looking for web based access to this surgery scheduling software, you are going to need to either install it within your office premises with no outside access (not recommended at all) or, you are going to have to go with a vendor that provides you HIPAA compliance and signs a business associate agreement (BAA) with you. Do not choose any scheduling software in the marketplace that do NOT sign a BAA with you.
Hopefully, the vendor can also show you HITRUST certifications (must have for larger hospital systems)
Authentication and authorization
There are multiple stakeholders and caretakers that are involved in the surgery coordination process. Each person should have access to the patient they are comanaging. This means that within your practice, your staff needs one level of access, meanwhile, your provider partners (e.g. the primary care provider of the patient) are going to need another level of access.
Think of it this way
- Your practice staff need access to all your surgery candidates
- Each one of your surgery candidates has (in all probability) a different primary care provider. Their primary care provider office needs access to this same patient record along with you – but should not have access to any other surgery candidates that you are managing.
- At any point in time, your surgery scheduler is going to be managing multiple associated surgery centers and the blocks at various surgery centers for your surgeons. Each one of those surgery centers are going to need access to the patients that are on their blocks while the other surgery centers / hospitals should not have access to these patients.
- Your biller is going to need to have access to your patients and so does the surgery center’s biller. But your biller needs to have access to all your surgery patients while the surgery center’s biller needs access to only a subset of your patients.
- Surgery scheduling is a lot more successful when you have the patient full involved and aware of the various preoperative and preparatory steps. So, your patient needs to have access to their own surgery “project” / “record” while they should not have access to any other patients’ data.
Rules based engine
As we all know, surgery scheduling needs processing quite a few business rules. These rules, prerequisites, steps needed before the next step can be given a greenlight – you should have the flexibility to define them.
You should have the flexibility to define these surgery checklists and business rules per facility where your surgeons perform surgeries and also for each procedure (since each process is different).
Surgery scheduling involves paperwork, faxes, phone calls, emails – a lot of it. If you constantly have to do things offline and then update your surgery schedule website manually, this is not going to work. Someone will drop the ball for sure and you will be back to square one.
Your surgery scheduling software should allow you to manage documents and versions of documents. These documents can be PDFs, images etc.
As you can imagine there are MULTIPLE parties that would be sharing and uploading documents to the surgery case – each stakeholder should have the ability to do so without any difficulty. This includes the patient as well.
Integrated fax management
In healthcare, we live in the world of faxes – there’s no getting around them. Your surgery scheduling software should integrate with your fax server and you should be able to see incoming faxes from the website itself. Once you receive faxes on your website, you no longer have to scan/PDF faxes received. You should be able to simply attach incoming faxes to surgery / patient records.
Multiple provider and sites
You should be able to (without a lot of staff overhead) manage multiple provider schedules and multiple surgery locations with your surgery scheduling software. E.g.
Managing multiple providers/surgeons/anesthesiologists should be simplified
Locations could be managed accordingly as well
Your surgery scheduler software should allow you to manage all your patients in one place and you should have the ability to run custom reports on all patients. It is crucial to look back on surgical density data and be able to report back on what transpired, what succeeded, what roadblocks remain etc
Same goes with surgery scheduling / coordination status. You should be, at any point in time, able to report to your physician leaders on the status of the surgery scheduling. Your partners at the primary care provider offices, surgery centers and the patient themselves should be able to tell where everyone is in the entire process/workflow, what the next step is and who is responsible for that next step is.
Due date for each step of the surgery scheduling workflow is VERY important for you to successfully meet your committed surgeries at the surgical center.
Most surgery scheduling software allow you to do these as it is a core part of their offering.
Real time communication tools
Surgery scheduling is all about communications – not playing phone tag or fax tag. Your surgery scheduling software should have built it
- Email capabilities so you can send an email specific to a surgery schedule and be able to act on an incoming email w.r.t the same
- SMS capabilities – since most patients prefer to receive notifications via SMS
- Messaging/chat/discussions capabilities that are centered around that particular surgery.. Not a generic messaging application. A generic chat is OK to have, but conversations around a case, needs to be around that case itself – else, things get mixed up and you lose track of the conversation that’s pertinent. We have seen this happening MANY times before.
Hopefully this small guide allows you to bring more surgical candidates to the surgery centers and close more loops with patients.