It is often said that the operating room minute is the most expensive unit of time in healthcare — but that doesn’t mean it’s necessarily central to ASC profit margins.
Michael Verdon, DO, a neurosurgeon and chief medical officer at Dayton (Ohio) Neurologic Associates, said that framing is exactly what’s holding practices back.
“The last thing as a surgeon I want to do is go to the office,” Dr. Verdon said during a panel at Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago from June 11-13. “Guess where I generate all of my revenue from? It’s not in the operating room, it’s from the office.”
In orthopedic and spine practices, surgical volume is determined upstream by how many patients are evaluated, triaged and converted in the clinic.
“The billing comes from the operating room,” Dr. Verdon said. “It’s more important to have a decision to create the billing than to perform the activity. So it’s much more powerful to leverage that from my office and have a higher conversion ratio, so I have more to chase.”
Most practices, Dr. Verdon argues, fail to act on that insight. The office is understaffed relative to the OR, patient triage is inconsistent and surgeons spend time seeing patients who don’t need a surgeon — crowding out those who do.
To address this, Dr. Verdon and his team built a clinically validated digital intake tool that patients receive after a referral comes in. The tool screens for clinical red flags — difficulty walking, bowel or bladder symptoms, duration of symptoms — and uses those data points to triage patients before they arrive. The result is a more efficient system for funneling fewer low-acuity visits toward consuming surgical time, creating higher conversion among patients who do get scheduled.
“We’ve created a clinically validated digital intake that you would give to a patient after referral comes in,” he said. “For me, personally, [it] increased my throughput by a factor of two, which is a big deal. I’m a single surgeon in a competitive market.”
Dr. Verdon said a competing health system cut into his referral volume by 50%, but his surgical output remained constant because the intake tool allowed him to do more with the patients who still reached him. At other practices using the tool, surgical throughput has improved by 10%, which Dr. Verdon noted translates to millions of dollars at the facility level for a practice doing 300 cases a year.
The backend data the tool generates has also surfaced operational problems that were previously invisible, including bottlenecks around prior authorization.
“We found that there were issues around a prior authorization delay,” he said. “Which insurance was going to give us a harder time, which surgery was going to be harder to get authorized, and then what we could build a strategy around.”
Dr. Verdon frames the broader challenge as a mentality problem as much as an operational one.
“I have to get out of the implanter mentality and be a true operator of a practice in a facility and say, ‘W my margin and where do I make it?’” Dr. Verdon said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
