Perioperative priorities post-COVID-19

Hello and thank you in advance for your time. My name is Tim Jensen and I'm a Vice President within our clinical analytics division at Optum, and I spend most of my time, a large majority of my time, out talking with surgical and clinical leaders across the country about their challenges and priorities. And as you can imagine, across the past 45 days, maybe 60 days, that conversation has been dominated by the COVID-19 pandemic, and the challenges and the devastation that's caused on so many of our provider clients across the country.

You know, I think the headline that we're all aware of for this discussion today is that elective procedures have been halted really across the country, all regions of the country. And it's having, as I mentioned earlier, a really negative financial effect on so many of our provider organizations.

And so a couple of data points I'd use to illustrate that point. Number one, I garnered this from our research colleagues, but essentially for your average hospital or health system, elective procedures make up on average about 51% of their revenue. And then to take a little bit of a deeper look at the surgical service line, that service line alone typically is approximately 11% of an organization's volume and over 40% of their revenue. And so if you put those two kind of market metrics together, I think it tells most of our partners, our client partners, that, in particular elective surgery is going to be under the microscope when we're able to get back to business. And being able to be as effective in getting and garnering that business and getting it into your health system as possible will be an incredibly important priority for almost every one of our hospital and health system partners.

Some folks will be receiving, I think there's a school of thought that, there are some that will be receiving pretty significant reimbursement through the CARES act. But so many other providers that weren't in as hard-hit areas are still feeling the same impacts of having to shut down their elective business and really their profit center.

So, I know that's kind of a gloomy picture. I think if there was one sort of silver lining, I've heard from some of the perioperative leaders I've spoken with it is that, maybe for the first time in a long time, with the reduction in volume and the reduction of the day-to-day business, they have the opportunity and the time and capacity to really look at their ORs and say, you know, how would I build this if I was starting from scratch? Where are the opportunities for improvement? I was talking with a client, a partner, a surgical leader in the Northeast, just last week who is going through how they were tearing down their block schedule and starting over. And really this providing an opportunity to really dig into some of those projects that I think are difficult for surgical leaders to execute when they're also managing the day-to-day business.

So what are the focus areas for perioperative leaders? I think what I'm hearing and if I was to draw out two major themes, you know, a little bit from an analytics perspective and certainly clinical analytics is where we spend a lot of our time with our partners - but two of those big focus areas, I think number one would be volume prioritization. So how do I get volume back into our, our hospital and the kind of volume that we want to prioritize once the floodgates open. How do I get the most out of my operating space by bringing in the volume that will best help us meet our financial goals? And then number two is, really understanding my true capacity opportunity, or an organization's true capacity opportunity, how much more can they get out of their operating space today before they move into next step procedures like opening new facilities, scheduling more hours into the evening and, then true incident recovery.

Let me talk about those two items. I think I'll talk about the second one first and then circle back to the volume for prioritization. But again, coming from the perspective of analytics, the conversations I have with perioperative leaders all the time is about really knowing yourself through your data, and being as honest and informed about performance as you can be. The candid truth that I see is that so many organizations don't have the tools and processes that they truly need to know themselves, and maximize the opportunity that they have within the current operation before moving into next steps. To give you an example, I think a lot of times when we work with a provider organization and we come in and develop a best practice kind of process and methodology around OR utilization and block utilization, and implement those processes, we often uncover as much as a 20% additional capacity opportunity for folks that they weren't aware that they had. And so, when you think about capacity management then, if the questions are, how are you measuring that? What kind of metrics are you looking at together, and in unison to understand capacity and where those opportunities exist? Again, just having the right data methodologies and processes are going to be extremely important to that process.

I've actually shared a slide, which you can see on the screen now, that articulates a little bit more around the data that I think is so important to folks when they think about capacity. So if you're looking at the left hand side of the page, of course, key utilization metrics - how are we using our rooms and our ORs at an extremely granular level, block holder utilization, typically a ripe area  of opportunity for folks to do more with that capacity. But going beyond that as well, so looking at efficiency, it's always part of the picture. Are we getting in and are we starting on time? Are we turning rooms over effectively? Are our cases taking the appropriate amount of time? And then finally, I think another component to this that's extremely important is scheduling accuracy. So are you scheduling the appropriate amount of time for the procedures on your schedule? I think when folks are scheduling too much time, it creates large gaps of capacity that folks can address, and then too little time of course creates a backlog in the OR. So really honing that and being as precise with scheduling as possible is really important, as well as looking at preoperative processes. So I think I hear a lot of folks say, you know, a good outcome begins at the point of scheduling the case. So do you have the appropriate time in pre-op to do all the clinical things that need to be done, but also the revenue cycle things that need to be done. Whether it be getting medical necessity requirements complete, or authorizations, ensuring that the financial as well as the clinical outcome, will be strong. I think that a lot of organizations really are looking at those preoperative processes as well. And I think what's extremely important about this is, you can't really look at capacity by looking at one of these four things in a vacuum. For example, if you have a surgeon who takes twice as long to complete the same simple elective procedure as his or her peers, their utilization will be inflated. So if you were just looking at a utilization metric, you'd understand that they're a high performer. But if they're moving slowly through the OR, that's a piece of the puzzle, so to speak, that you need to understand. And so that's what I mean when I talk about the right data and methodologies to look at these problems and understand them together in an integrated data set with the ability to get granular.

Let me circle back now to volume prioritization, which you can see on the right hand side of the slide. I think four key themes that we were hearing from a surgical leaders around the types of analytics that they needed to be able to prioritize the right way. And so they boiled down into four kind of theme areas. One would be profitability and payer mix trending. Of course surgery is a profit center for the hospital, it's kind of one of the main challenges with this time and with this pandemic, and so getting back to profitability is extremely important.

Recovery time - so folks are looking to prioritize cases that won't be spending a lot of time in the hospital for a whole bunch of reasons, staff management, clinical reasons, et cetera.

Number three is the staffing piece of this. So, do you have the right staff and the right kind of mix of talent to be able to support these cases.

And then finally, supplies used. So in areas and pockets of the country, procurement is extremely difficult for certain areas of supplies. We've all heard about PPE, and some of those items, but really understanding the supplies needed on individual cases and being able to flag areas where just procuring the right supplies are going to be difficult is another part of the prioritization exercise.

And so those are really the four areas that we're doing kind of deep work with surgical leaders across the country today to help them understand that opportunity a little bit better. Those are some of the themes that we're hearing and how folks are prioritizing this work, again, from an analytical lens.

I would encourage you to find some time to also view the video from my colleague Gary Smalto, who will also be taking a lens on this issue, but a little bit more of a lens from the perspective of strategy, strategy execution, and again, that term of incident recovery.

So, I'd just like to say thank you in advance for your time and interest today, and we'll be continuing to provide new updates periodically as we manage through this crisis together. But again, thank you. Be well and goodbye.