Darren J. Friedman, MD, is a clinical assistant professor of orthopedic surgery at NYU School of Medicine and faces the challenge of practicing at multiple facilities. He operates primarily at two New York City hospitals — New York Downtown Hospital and NYU Hospital for Joint Diseases. Dr. Friedman shares five tips for physicians working at two separate facilities.
1. Establish protocols at each location and make them as similar as possible. Changing personnel is one of the biggest challenges of working at multiple facilities. This lack of continuity and familiarity between the surgeon and his or her staff can affect efficiency and patient safety, according to Dr. Friedman.
“Make sure to establish your protocols at each hospital so you can maximize the use of your time. Include how you like the room set up, how to position the patient and what tools you want to use. If you do it the same way every time, the staff will pick up on that,” says Dr. Friedman.
Creating a written list of supplies for commonly performed procedures that nurses can review prior to surgery is another way to ensure similar surgical experiences at each location. “Standardization is critical to minimizing mistakes,” he says. “If protocols are reproducible, it will create fewer errors.”
Checking out the facilities at a new hospital prior to performing your first surgery can also be beneficial to establishing these protocols. “It can be frustrating when you start as everyone needs to get used to your idiosyncrasies and how you do things, but it is important do the same thing every time no matter how frequently or infrequently you go into a hospital.”
2. Understand payor differences between facilities. Due to contracts and other considerations, surgeons may find one procedure or type of implant is covered at Facility A but is not covered at Facility B. This can be of particular concern for orthopedists who may be more familiar with a certain type of implant.
“I use a certain prosthesis for shoulder surgery, and only one hospital allows me to use the implant because the other hospital has a contract with another company,” Dr. Friedman says. “I don’t have experience with the other implant, so I do all of my shoulder arthroplasties at one facility.”
Dr. Friedman notes that while surgeons should receive the same reimbursement if an implant is not covered, it is important to understand ultimately what the costs may be to the facility. “You don’t want any surprises or find out prior to the surgery that an implant won’t be covered or is not allowed at the facility where your patient is scheduled,” he says.
For example, Dr. Friedman wanted to use a particular type of bone graft for a patient who was scheduled for surgery at Facility A. However, 72 hours prior to surgery, he discovered the graft was not allowed at Facility A and had to switch locations. “Discovering payor issues or contractual obligations late in the game is frustrating for patients and physicians,” he says.
3. Know what kind of equipment is available at each facility and prepare to adapt. Similar to personnel issues, hospitals also vary in the type of equipment available to surgeons. Dr. Friedman notes that these variances require surgeons to be adaptable and willing to perform procedures in more than one way.
“At my old facility [prior to coming to NYU], I became used to performing shoulder surgeries on a table with an articulated arm device for patient positioning. At the new facility, I had to learn to do it without it,” Dr. Friedman says.
For this reason, Dr. Friedman emphasizes the need for surgeons to be prepared to perform surgery in a new fashion if necessary due to differences in equipment.
4. Block time is essential to success. When managing two facilities, it is important for surgeons to get block time in the operating room, whenever possible, at both facilities. By having set operative days and time, the surgeon’s office will be able to expedite scheduling.
However, working at two facilities can be problematic when dealing with urgent cases that need to be addressed on days outside of a surgeon’s block time, according to Dr. Friedman. “In this instance, my staff calls both facilities, and we book a location based on where it will be easier to perform the case and where the patient will best fit into the schedule,” he says.
Dr. Friedman does note that if he is operating at one hospital and an emergency comes up at the other, the residents on duty must handle the situation until he is able to come to the facility.
5. Patient experience is important when determining where to have surgery. Providing the patient with the best possible surgical experience is essential to having a successful orthopedic practice. Patients are also becoming savvier when it comes to “shopping” for healthcare. Dr. Friedman says that physicians should present the patient with all the information about all locations available to them allowing the patient to make an informed decision.
“There is a lot of competition in New York City [where I practice],” Dr. Friedman says. “I let patients know the pros and cons of each facility, including implant issues and any other issues important to their surgery. Sometimes, patients might just feel more comfortable at one location as opposed to another because their internist or family doctor is associated with the facility.”
Dr. Friedman also suggests obtaining preauthorization and insurance verification for patients prior to scheduling surgery to help make the patient’s experience smoother. By setting the process in motion earlier, the office staff can stay on top of any potential problems or issues that would otherwise delay an already scheduled procedure.
Darren J. Friedman is a clinical assistant professor of orthopedic surgery at NYU School of Medicine and an orthopedic surgeon with Seaport Orthopedic Associates in New York City.
Thank you to Erin Herbst at Hill-Rom and Allen Medical Systems for arranging the interview with Dr. Friedman. Learn more about Allen Medical.
