Maximizing capacity for rescheduled elective and routine care

Kelly-Krulisky-300x300Right now, it may be difficult to know when your health system will start to reschedule your elective and routine services postponed as a result of COVID-19. Each day these services are suspended translates to a loss in revenue for your system, but it also means another day patients must wait for their needed services, creating a growing backlog in demand (especially if certain service lines were operating with a waitlist prior to the pandemic).

Though the exact timing is still unknown in many states, it’s important to start analyzing scenarios, based on cancelled services as well as historical volumes and yield, to identify the patients who will have the most urgent need and to target specialties and services that will help restore your revenue and cash flow. Once you have those targeted services and populations in mind, it will be essential to pivot your operations to react. How can your health system operations start preparing to maximize your capacity?

Open up your scheduling

Small changes can have great impact when it comes to your scheduling templates and releases. Partner with your providers to encourage flexibility and adaptability during the post-COVID-19 time through a few changes that will help get patients in the door as quickly as possible:

  • Remove scheduling blocks and open up the templates. As much as possible, allow any visit types to be scheduled into any time slot.
  • Where blocks are still needed, institute block releases if slots are not full 48 hours in advance.
  • Expand primary care. Your internal medicine, family medicine, pediatric, and gynecology practices will now be more important than ever to help get patients caught up on their routine and preventative care, but also as referral networks into your specialties. Consider opening clinics for after-hours and weekend coverage where possible. Additionally, can you extend availability through telemedicine and/or APP offerings?
  • Strategize around your specialty care. How are you using your surgeons versus your advanced practice providers? Plan to maximize your surgeons’ time in the OR by directing non-surgical cases and new patient consults to your APPs.
  • Proactively contact your target patient populations based on your historical volume and cancelled services analysis. Depending on your current set-up, this can be accomplished via an auto-dialer, outbound pushes through your patient portal and/or email, or by designating a subset of your scheduling team specifically for outbound calls.

Tighten up your referrals

Now that your schedules are wide open and your primary care capacity is up, are your referral patterns in place to keep the volumes inside your network?

  • Run a report on your historical outgoing referral volumes to target providers with higher-than-average external referrals and understand the motivation behind their referral patterns.
  • A simple tweak to your system – for example, requiring providers to enter a reason if they select a referral class of “outgoing” – may prompt providers to pay more attention to the workflows and where they are sending patients.
  • Do your referring providers in the market (e.g., your standalone physician offices and practices) know everything you’re doing to increase capacity to accommodate your patients?
  • Make sure your internal and external provider data is as up-to-date and correct as possible prior to the upcoming spike in patient visits/referrals. This can be achieved through coordinated efforts between your credentialing team, provider master team, and referrals team.

Prepare your OR

Due to the high margin and yield, it will be important to think critically around streamlining your OR operations.

  • Where have you historically had blocks to prevent scheduling or closing specific rooms and why? Can these blocks be removed so that as many rooms as possible can run simultaneously? This may require flexing staffing, cleaning, and/or supplies, finding alternate storage, etc.
  • Create a strategy around how procedures will be prioritized. Look at the amount of surgical time available versus the waitlist and account for considerations such as patient urgency, destination service lines, procedure length, and procedure revenue.
  • Make sure all patients who will be rescheduled are sent to get new labs and pre-surgical testing as their prior results may no longer be valid.
  • Are there opportunities to run your ORs for longer stretches of time?
  • Adjust OR block release schedules and Block/Room Utilization metrics to account for adjusted supply and demand.
  • Do you have an ambulatory surgical center (ASC)? There may be procedures that can shift entirely to your ASC so your inpatient facility can focus on more acute patients.

Don’t forget your financial clearance processes

In addition to the regular payer changes that take place each month, COVID-19 will create a huge increase in the number of coverage changes as we anticipate the high volume of people who have lost their job, have a different job, or whose financial situation has dramatically changed since the start of the pandemic.

  • Expand your normal batch eligibility runs to look additional days into the future for verifying coverage on scheduled appointments.
  • Shorten your automated coverage verification duration window (i.e., from 30 days to 15 days) in the month where you anticipate the highest number of coverage changes, and then restore it to your previous setting ongoing.
  • While there is never a good time, perhaps now is an opportunity to look at available real-time authorization options and target specific services (e.g., CT, MRI) where they would be the most impactful.
  • Coordinate workflows between your financial clearance and your financial counseling processes to ensure a smooth handoff and to proactively seek for sponsorship linkage or arrange payment plans with your self-pay population.

What should success look like?

Success will likely look different for each health system, your individual circumstances, and the circumstances of your state and region. However, it should be anchored in your analysis of scenarios based on historical volumes/yield and cancelled services. The ability to successfully flex your operations to match the patients, volumes, and services highlighted and prioritized in your strategic analysis and plan toward revenue recovery will be your true definition of success.


Topics: revenue cycle, featured, COVID-19

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