Welcome to GI Operations Benchmarking, Measure to Optimize Your Unit's Efficiencies, a presentation sponsored by the American Society for Gastrointestinal Endoscopy and the ASG Foundation Beyond Our Walls Campaign. My name is Eden Essex, and I will be the announcer for this event. Before we get started, just a few housekeeping items. There will be a question and answer session at the close of the presentation. You will be able to submit questions and comments throughout the event via the Q&A box. Please be sure to use the Q&A box and not the chat box to help keep us organized. Please note that this webinar is being recorded. As a registrant, you will have ongoing access to the recording when it becomes available in GILeap, ASG's online learning platform, in approximately one week. The presentation slides will be sent to you via email following this event, and will also be available in GILeap with the recording. Now it is my pleasure to introduce our presenter, Frank Chapman. Frank Chapman is the Director of Strategic Development for Ohio Gastroenterology Group in Columbus, Ohio, a 38-physician, single-specialty gastroenterology group with five endoscopic surgery centers. He is a trained and active Medicare surveyor for AAAHC. For the AAAHC, Frank serves as Chair of the Standards Development Committee. Additionally, Frank currently serves as Vice Chair of ASG's Practice Operations Committee, and has been part of the committee for over 15 years. To get the pulse of the audience, we'll begin with a few polling questions. So our first question is, what is your experience in participating in the GI Operations Benchmarking Survey? So we'll just keep this up for a second. Let us know if this is completely new to you, or if you've done it in the past. We really appreciate you letting us do these pulse checks. So a lot of you are new to this, so you're going to be learning a lot today about this survey. And thank you to those who are coming back to the survey. So our next question is, what is your unit's setting? So we just want to get a sense of where you all are coming from today. Be helpful to us. And what you'll see is there's a really great diversity here, and Frank will address, you know, the settings in his presentation and through the Q&A as well. So really a nice diversity here today. Everyone's interested in efficiency. And a final question that we're going to go ahead and ask you, does your unit participate in the ASG Endoscopy Unit Recognition Program? So that's looking at clinical benchmarking as opposed to operational benchmarking, which we're talking about today here. Really appreciate everyone's engagement in these polls. So just about a 50-50 split in terms of that. And I will now turn the presentation over to Frank. Okay. Thank you, Eden. We'd like to go ahead and get started by thanking and acknowledging those folks who actually worked on the survey results. They include Sufian Chaudhry, Anessa Heickes, John Martin, Tyron Rye, Ravi Singh, and Joe Vacari. And along with the entire ASGE Practice Operations Committee, who provided both review and comments on the result and also the data book. And a special thanks to Michelle Akers. Michelle has been the survey staff lead for several years on this survey. And without her yeoman's efforts and expertise, we simply could not have achieved this work. So thank you all. And a special thank you to Michelle. Okay. In this webinar, what we're hoping to do is take a look at the web-based entry and analysis tool to review how the analysis tool provides a more in-depth and more specific results for participants, identify some of the year-to-year trends when compared to this year's results versus the previous years, and take a look at some of the key performance indicators important for running an efficient unit. And then finally, a call for participation to continue this important effort. A lot of y'all are new to the survey, and we're going to talk about how important this is to the specialty in a few moments. Okay. The survey can be found by going to the ASGE website and navigating to the homepage, then go to practice support, GI operations benchmarking, and the direct site information is located at the bottom of this slide. Okay. This gives you an idea of the survey dashboard. And we identify seven different areas to provide. It also provides an indicator of progress in filling out the survey. The seven categories are demographics, and that includes four data elements, unit characteristics, that actually includes 32 elements, labor, that includes 29 elements, patient volume, 28 elements, revenues and expenses, 28 elements, and ancillary services, 15 elements. We also include a section on quality improvement and regulatory compliance. That section includes nine elements. For easy use, the tool also provides a complete list of data points before you get started, which should make entering data easier. And you can start and stop entering data at any point and go back later, pick up at the point where you left off and complete the survey. Those of you who have participated in the survey before might be excited to know in the new surveys, once you log in, if you have participated in a past year, the survey will actually self-populate those areas that you filled in in the previous year. So, there's going to be many elements that you don't have to re-enter. However, when you do this, please be especially careful to put in your new data, which will overwrite the old data. That's something you really, really want to make sure that you do so you're not repeating your old data. So, also on the landing page there, you have a section on the dashboard that is a report generator that customize reports and provides very specific data to the unit's performance compared to the unit's cohort. We call these key performance indicators or KPIs. So, let's take a look at what that actually looks like. Okay, this is an example of what a participant is able to provide themselves through their own web-based reporting and analysis portal. This gives you a great idea on the information that is provided and how easy it is to identify things you might want to work on. So, for each element, the participant's results are presented along with their entire cohort's performance at the 25th, 50th, and 75th percentile. This analysis allows a view in which expense KPIs are above the mean of the cohort or below. Knowing the variation, a unit's leadership can quickly focus on those elements that may need further review. In this example, the unit may wish to review their endoscopic repair cost, which comes in at 71st percentile of their cohort, significantly above the mean, and also their laundry and uniform expense in terms of comparison to the average cost. The laundry and uniform expense is at their 74th percentile. So, what this does is it very easily identifies for leadership where a unit might want to investigate certain metrics in terms of achieving greater efficiency. At the same time, it also tells you where you're doing a really good job. If you look at this scope expense per case, they're at the 40th percentile, which is excellent. Occupancy expense, which is a combination of your building lease or ownership expense, electricity, phone, things like that, and that's at 43 percent. Administrative overhead for this particular example is excellent down at 29 percent compared to the cohort. So, this really gives you an idea about the granularity and specificity of the data that a participant gets compared to a non-participant. So, for each cycle of the survey, the ASGE publishes the GI Benchmarking Data Book. This is an example of the most recent. So, basically, the data book provides an overview of the results, and for the current cycle, the data book contains roughly 40 pages of graphs and trends, some of which we're going to look at in just a moment. So, what's the difference between what a participant is able to view and what a non-participant is able to look at by purchasing the data book? It's really apples and oranges. Survey KPIs are tightly targeted to the participating unit and provides a focus on areas that may need improvement. We just saw that a few moments ago. The data book provides basically information concerning the entire cohort and also provides some year-over-year trends which aren't immediately available from the web-based analysis. So, let's charge in to some of the data book results. So, to give you an idea of what the last data book contained, basically, it contained the work of 56 units, 488 gastroenterologists performing over 410,000 procedures on over 377,000 patients during the calendar year 2018. So, the data book comes out the year after the capture period. So, the last we have is 2018. This survey, like everyone's life in the last two years, was disrupted a bit. So, we're going to talk about 2019 and 2020 data in just a minute. Most of the participants, and it's common to the participants in this webinar, were ambulatory surgery centers and also office-based endoscopy settings. The remaining 16% were hospital and academic institutions. And actually, in the most recent survey, that actually increased from a historic 7% to up to 60%, and we're really excited about that. I personally find the data submitted by hospitals and academic institutes some of the most interesting. In the past years, we've had several participants identified as reaching near ASC throughput levels, which is an excellent representation of how efficient these units can be. We encourage additional participation by hospital and academic units. We love to get that data. We want to get that large enough to where we can really highlight some of what we see going on in hospitals compared to ASCs. Okay, one of the major trends that we've seen in recent years is the expansion of hours of operations. When we started this all the way back in 2008, it was most typical for endoscopy units, especially ASCs, to be open eight hours a day. What we've seen over the last few years is extending hours, and what this does, it's a method of increasing capacity without significant capital investment other than clinical labor expense, although some of the units have been able to manage labor costs by customizing staff scheduling. These data show a shift by participating units from operating seven to nine hours, which was the largest reported in 2012, to now 72% in the latest, the 2019 data book, working or operating nine-plus hours. Some of you may have questions associated with fatigue for a gastroenterologist working nine-plus hours, and what we've seen is actually split days to achieve constant throughput and, you know, enhanced efficiency. So physicians are typically working half days, physicians and anesthesia providers typically. So at what point does increased efforts at reducing no-shows and cancellations return less of an improvement? This is another example of the survey providing a look at what might be normal due to participation numbers, and we always want to see greater participation, but we're a bit cautious as extrapolating data as predictive. What we typically look at in the data book is commonality of data versus a true predictive model, but here you can actually see that between, somewhere between 6% and 8% seems to be a good target. Above that or below that, it's sometimes hard to get your no-show and same-day cancellation rates below that, even if you spend greater and greater effort. One thing of note is that the max no-show rates that you can see there ranging from 20 up to 31% and then down again to 21% year over year, those typically are academic institutions which historically have very high no-show rates and also cancellations due to their patient mix and the reason they're seeing those patients. All units tend to have a question related to how many FTEs do you need to properly and efficiently staff an endoscopy unit. To me, the year over year commonality of these data is fascinating. While each year's cohort may differ, although some units do submit data year after year and we certainly appreciate that, you know, keep in mind these represent both pre-post endoscopic reprocessing staff and inter-room staffing, but to me the variation from 4.1 FTEs per procedure room through 4.6 in 2008 is a fairly stable and common number. So if you're wondering how many folks you need to properly staff an endoscopy unit, this actually gives you a fairly good target. Okay, this table gives a view of staffing on the basis of the number of rooms operated by the unit. It does appear that in large units, some efficiencies of scale are reached relative to staffing. If you look at the eight-room center and the 14-room center, their mean per room, and by the way, this is per room, is lower than the six or seven-room center. However, this is also a bit cautious because we only had one participant with eight rooms and one participant with 14. If you look at three-room centers through six-room centers and even seven-room centers, that we did have multiple participants, those numbers are fairly common, and if you go back to the previous slide, you don't need to move it back, but these approach that also. So that's always interesting to me to see if you reach economies of scale with large units. In viewing the data year after year after year, small units, one-room endoscopy centers, sometimes two-room endoscopy centers can be extremely efficient through sharing labor, the FTEs that they use, and then you get in the three, four, and five units, actually reach a point of a little bit of inefficiency compared to smaller units, and then, again, as you grow, you seem to reach that efficiency again. But, again, this gives you an idea of what you should be staffing your units, and if you're above this, it might be something that you want to look at in terms of how you staff versus how others staff. Paramixed results tend to be dominated by the percentage of participating ASCs and office units compared to hospitals and academic institutions where we'd expect a paramixed to lean more toward Medicaid and Medicare. However, the commonality of the year-over-year results with variation in participation can give you a good idea of what normal is for outpatient endoscopy. It seems like the low 60s in terms of a commercial payer mix is extremely common year after year. Medicare, around 30%, is very common, and then you look at Medicaid and self-pay. Also, charity and others. If you notice, much charity care has gone away with the advent of the Affordable Care Act, and patients who have selected some of the insurance that are made available to indigent patients. Okay, the impact of the multiple endoscopy rule actually increases the number of procedures on a day while it actually dilutes revenue per procedure. Typically, the multiple endoscopy rule is paid on 100% for the first procedure, 50% for the second, and sometimes 25 for the third. So as you bill multiple endoscopies, there is a dilution to the impact of revenue per procedure. And so therefore, what we actually look at is two things. We look at encounters per room per day and also procedures per room per day. Also, clinical labor is typically the largest component of cost. So within reason, clinical labor is fixed during a shift so that performing more cases during that fixed shift can significantly reduce your cost per case. So it's important to look at both encounters per room per day and also procedures per room per day. Okay, the data book presents results split between all settings. In the data book, we actually look at all settings, ASCs and office, and then split out again by hospitals and academic institutions. So this table illustrates the small variation that we see when looking at only ASCs compared to all settings. Again, this is really due to the significant participation by ASCs. As we can increase the participation by hospitals and academic units, we'll be able to identify more variation between the two settings and see where those efficiencies really lie and what can be expected both in ASCs, but also in hospitals and academic institutions, because those units also are trying to seek efficiencies just as much as we can find in ASCs and office operations. So this gives you what you might be able or you might be expecting throughput to be for hospitals and academic institutions. Oftentimes, hospitals and academic institutions in some settings are challenged to outperform one case per hour. And when you actually get into that, it's really interesting to look at why. Anecdotally, many hospital and academic units are impacted by transport. And that is, of course, getting that patient from a hospital floor down or up, I guess, to the unit. And that's always been a little fascinating to me because transport is typically one of the cheapest labor categories within the entire hospital, but oftentimes it's overlooked at what a key influence transport has in terms of running an efficient hospital or academic unit. In past surveys, we have had hospital units especially who have been able to achieve throughput very similarly to an ASC, which is an incredible efficiency mark for hospitals. And we always like to see participation because we try and drill down when we see outstanding performances as to why they have variation within their cohort that significantly outperforms others. So once again, please, academic and hospital units, please consider participating. We wanna increase that component of the survey far above 16%. I know a lot of you are on this webinar, so please, we really need your data. This to me is a fascinating metric. We actually, in the data book especially, we go into great detail in terms of staffing by pre and post in terms of endoscopic reprocessing and in room. And we also look at the licensure or certification of individuals within that to look at how endoscopy units are staffing in the room. And what I would, in this particular graph, I apologize, but the header has been left off. So what you have is you have the number of rooms in the unit, and then you have the participation numbers. You have the gross figures. And then the fourth column from the left is the most important. That is actually staffing per room. And what I'd like to do is call in reference to the ASGE guideline on minimum safe staffing, which was last reviewed and published in July of 2020. And the thing that's important about that is the criteria for safe staffing. They actually looked on the basis of the acuity of the case, the procedure requirements, the anesthesia, and also the provider. And so what the guideline says is for average risk endoscopy performed under deep sedation, propofol, and the propofol is provided by an anesthesia professional, such as a CRNA or anesthesiologist. The guideline established that one additional staff member, either an RN, LPN, or endoscopy tech is required. And you can see that many units are approaching that number. I will say that having been a surveyor and seeing a lot of endoscopy units over 17 years, and seeing the single additional person in a room running on NNASC or office average risk running on propofol, it's very common now to have a single additional staff member and believe it or not, the most common is a tech because the anesthesia professional actually has the responsibility for monitoring the patient. What we ask folks to do in determining what they need in terms of staffing is typically go down and do a list of tasks that are required, and then associated with those tasks, identify any licensure that's required to perform those tasks. And in most states, California is an outlier. But in most states, if you have an anesthesia professional pushing meds and monitoring the patient, there's actually no additional licensure requirements for tasks that are provided in the room. In some states that require a circulating nurse, that circulating nurse can actually be available immediately, typically outside the room in a common area should additional clinical staff be required. But this is an extremely important metric that all units should look at. Okay, clinical labor expense. Clinical labor expense is most often the largest single component of total expense for endoscopy. And what you see here is actually your, excuse me, average cost per encounter and, excuse me, cost per procedure. And once again, doing multiple procedures, normally your cost per procedure is diluted a bit. So if you look at cost per encounter, that gives you a little bit better idea of what your actual clinical labor expense is. This number is highly sensitive to such things as whether or not obviously the acuity of the case, so your staffing is designed for that. It's also extremely sensitive to what we just discussed, which is the variability of your licensure mix of individuals that are actually in the room. If you have two additional staff in the room and both are RNs, obviously that's going to produce a higher cost per case than if you have two additional staff, one's a tech and one's an RN. So I think it's really important when you look at identifying efficiencies and especially reducing clinical labor expense per case, which is, again, typically your largest component of total expense, that you look at a mix of licensure in the room. Yeah, labor, I mean, laundry expense, this is something that we believe has dramatically changed due to COVID-19. This is 2018 numbers. We're really, really excited to start looking at the 2019 and 2020 numbers because we believe that this has changed dramatically. A good exercise when evaluating laundry expense is to calculate the cost per case for laundry. That would normally include a patient gown, a pillow cover, two sheets, a blanket, and a surgical pad for every patient. That can give you an idea on what your average patient cost for laundry expense is. Before we went ahead and got into the COVID situation where PPE changed dramatically, that would allow you an idea of what your patient laundry cost per case would be per patient. Then you can actually look at the variation on that in terms of what additional PPE for clinical staff is. So that's a method of actually looking at laundry expense and seeing how efficient you are. This is a great example of a metric that's found within the survey that isn't easily available from other sources. So how much should you really be paying for scope repair cost? So if you look at the reported metrics from 2011 through 2017, once again, that had some extreme commonality to it. You had a different number of participants, you had a different mix of participants, some the cohorts different, but some units did participate year over year. But then all of a sudden in 2018, the most recent numbers that we had, we had a fairly significant jump. So we're really excited to look at the numbers for 2019 and 2020 to see if this is something that is going to be year over year, or if it was something that was just simply an anomaly, a blip that we're going to fall back down. When opening a unit or evaluating a fleet of scope purchase, I think everybody looks at how many scopes you need. Oftentimes you actually ask the vendor that's selling you those scopes, how many do I need? One thing that we have in the data book is actually a really detailed breakdown on the type of scopes. We have the same data, but it's broken down by colonoscopes, pediatric scopes, gastroscopes, and other scopes. So not only do in the data book, not only do you get, and of course the data book is free to participants, not only do you get this fleet information in terms of how many scopes you need, but also you get a breakdown in how many endoscopes you might need, and how many colonoscopes you might need, and whether or not you need ped scopes. Obviously one thing that's very sensitive here is your mix from upper or lower endoscopy cases. Okay, how often do you use your scopes? This has always been kind of an interesting slide or table for me. Typically an endoscope is used more than once a day. This table also exhibits how infrequently some low volume units turn over scopes. So this frequency indicator can provide the basis on if endoscopes should be purchased, or if they should be leased. Similar to the strategy of leasing or purchasing a car, if you're going to, if you expect low mileage, it makes a lot of sense to lease a car rather than purchase it. But if you expect high mileage, perhaps a purchase is a better idea. And here, if you're turning your scopes over 585 times per year, that's one scope, used 585 times or 783 times, that is an incredible volume. So in that case, you might want to purchase your scopes. If you're only using the average scope 125 or 123 times, that's a real good reason to lease scopes. So this is a very important metric for you guys to be aware of. Okay, device cost. This is also something that I think is very important for units to know. In the survey, we define devices as snares, biopsy forceps, clips, and other devices used for the performance of endoscopy. In the web-based analysis tool, participants, and also in the data book, we report the overall percentage of total cost that is commonly expected for units in terms of device cost to your total cost. The metric can actually provide an indication of the efficiency use of devices, especially clips. And in some cases, the variation in cost of other devices, such as forceps, what we see very frequently is that in units with high efficiency in terms of devices, that they standardize the snares that they use, they standardize the type of biopsy forceps that they use, and then they're able to purchase larger quantities of these and in turn negotiate lower prices because you're purchasing a larger volume of a specific device. If your unit is using a variety of devices, you normally may not be able to reach a point of efficiency. So this is something that in terms of efficient cost, everybody should take a close look at this. One thing that folks should look at is bottles per encounter in terms of path. So what we look at, what we have units actually report is the number of bottles per encounter. So in the last two years, from 1.3 to 1.2 bottles per encounter, that was fairly common, and that's also similar to what we saw in the past. The metric is very sensitive though to your case mix because the number of bottles and also the frequency of tissue sampling for upper endoscopy can prove to be generally greater than that of endoscopy, but it's also important in terms of validating for the unit if you're oversampling, which is something that you don't normally want to do. It really depends of course on the nature of the procedures that you're doing, but this is something that you should track. What my practices have done in the past is not only track this on a unit basis, but also on a provider basis and look at how often tissue is sampled, especially in terms of endoscopy, upper endoscopy and the frequency. There are some physicians out there that actually do tissue sampling on every upper endoscopy that they take. I was familiar with the case years ago that an upper endoscopy and EGD was done on a Friday in a hospital. The patient was brought back that Sunday and we were able to verify that the patient did not develop H. pylori from tissue sampling from Friday through Sunday. So tissue sampling, especially on repeat procedures, is something that you should be aware of. Now we do report average revenue per room. This is really just a ballpark number for folks to take a look at. This is highly sensitive to your case mix. It's highly sensitive to how many commercials you're doing versus how many Medicare Medicaid or indigent patients that you're doing. It's sensitive to colonoscopies versus EGDs due to colonoscopies pain higher than EGDs, but it is a number that people look for. So we want to go ahead and put that out for everybody to take a look at. Okay, future direction. The surveys for annual 2019 and 2020 are currently open. Historically, survey data has been used to support advocacy efforts. This is going to be really important for 2019 and 2020. We have antidotal evidence the impact of COVID-19 has increased the cost of endoscopy. We believe it's increased the cost of PPE. We think it's increased the cost of labor. We think it has increased the cost all the way around. We don't have any evidence. 2019 saw significantly reduced case volumes in some units. Some units were actually closed. Some of those units were able to rebound, but many have not been able to go ahead and reach the same level of efficiency in 2020 that we saw in 2018. So we're asking that everybody possible submit data for 2019 and 2020. This is extremely important. We need to verify how the cost of endoscopy has changed, and this is one of the only methods that we have of doing that. And with that, I'll turn it back over to Eden. Thank you, Frank. That was a really wonderful presentation. So folks, just to remind you, if you could put your questions in the Q&A box, and if you wouldn't mind providing just a little detail around them because Frank gave a very large and comprehensive presentation, so sometimes a little context helped. So Frank, our first question is, was the revenue per room gross revenue or net after expenses? I think you just recently mentioned this. Yeah, it's gross, and it's actually income only from facility fees. That's very important. We're not looking at adjustments for taxes, things like that. We're actually just looking at the captured revenue for patient services that comes in from facility fees. It doesn't include anesthesia professionals. It doesn't include the income from gastroenterologists, and that gives you a real idea in terms of why these numbers look a little bit different than numbers you might see in Becker's or other areas. When they're really talking about cost per case, we are limited in this report to the facility fee. Great, and you had referenced the minimum staffing guidelines, so I did go ahead and put that in the chat. If folks haven't looked in there, I put a link directly out to the minimum staffing guidance that Frank referenced in this presentation, so you have access to that. While other questions came in, I'm just going to ask you a question that I get a lot on the clinical side. Frank, we have so many metrics that we like to track, but then there's always what's the most important. We know on the clinical side, it's adenoma detection rate, ADR. Is there one metric that really shines among all of these relative to operations benchmarking that you would single out? Yeah, probably two things, and I mentioned it briefly. The first thing is throughput. Throughput reduces the average cost per case, sometimes dramatically. When I started doing surveys 17 years ago on small endoscopy centers, it was very common for office operations to be opened a half a day a week, and I really considered those units as kind of hobbies as opposed to attempts to really run an efficient endoscopy unit. In a half a day, it's really difficult to reach any level of efficiency. In a full day, hopefully, you try and arrive. A really good benchmark is 12 cases per room per day. In terms of looking at efficiency and income, if you can get, and by the way, that's adjusted for no-shows. That's actually 12 completed cases. If you can get to 12, as you move above 12, most of that really drops to the bottom line. The second thing that everybody should look at is clinical labor per case. Once again, that is typically your largest unit of expense, so by managing both of those things, it really gives you a head start in running a very efficient unit. Okay, let me ask you a couple kind of mechanical questions just about participating in the survey. I think people are starting to recover. We know there's still some staffing challenges out there, so they really now want to know when the juice is worth the squeeze. When you participate in the survey, I think you said that if you've participated in past years, it will automatically populate what you've already put in, and then you can kind of edit it. Is that correct? Yes, and there's actually an additional benefit in participating year over year. One of the challenges in the initial year of participation is taking your expense especially and categorizing them according to descriptions in the survey. As an example, you categorize device expense. Another expense that we have is a medical repair expense, which is other than scope repair or device expense versus medication expense. We split all that out, and what's left over is medical supplies. How you actually group those once your finance people or department heads actually get to doing that the first time, we really don't change those elements too much year after year. Once you have a methodology for doing that, it actually becomes easier year after year after year. Wonderful. Another question just kind of about participation is, what if I can't put together certain components? Is it an all or nothing survey? Do I have to do everything, or if there's a portion I can't complete, is that okay? Am I still considered a participant? Well, a couple of things. First of all, we look for real numbers. And some folks over the past have put in what appear to be plug numbers. In my expense, before I was administrator, I was CFO for both hospitals, for one hospital and a couple of groups. And I realized early on, there's no such thing as a big round number. 120,000 is not a real number in most cases. So we do look for real numbers. The second thing is there are areas, as an example, hospitals may not be able to get all of their expense data. And hospitals and academic centers sometimes can't get revenue only from endoscopy, because their units might be mixed. But typically, they can get their expense numbers. They can get their labor expense, as an example. They can get, say, their device expense. So one of the most important things that we look at is expenses. If you look at staffing and things like that, most of the elements, throughout the entire survey, everybody should be able to reach. And the majority of expense categories are probably going to show up in some form on departmental quarterly reports, things like that. So while we realize that some units may not be able to get everything, all units should be able to get the vast majority of elements. Okay. Now, specifically, we have someone asking, do you benchmark things like turnover time, setup time, those kind of things? No, we don't. That all actually flows in to throughput. There are units that operate with what might be considered zero turnover time. And by that, I mean that, at least in my mind, when I ran practices, what we would look at is that, in my mind, a turnover time is zero if the room and the patient is ready when the physician is ready to do the case. Oftentimes, a case will finish. The patient will be taken out to recovery. Staff will come in to turn the room. The physician will go out, typically discharge a patient, complete the report, and then they might go in and do the pre-procedure evaluation of the patient, and then they're ready to go. If they're ready to go at that point and the patient and room is ready to go, the throughput isn't actually impacted by room turn. If you look at units that have significantly lower throughput, typically, there's something in there impacting the lower input or throughput number that might be transport, that might be room turn. Those are things that, if a unit has throughput below what their cohort is, that's when they really need to start looking at what components of the process is delaying the next procedure, which might reduce the throughput number. And our next question is, do you benchmark accounts receivable aging? Actually, we look at aged AR. That's both captured and reported in the data book. It's available for participants in terms of their web-based analysis tool, but it is available in the data book. So that is something that we do capture, aged AR. Okay, we're going to jump back to your throughput question. So I think you've intrigued our audience here. So you are basing room turnover time on the readiness of the physician. Is that what you were saying? Well, if you're spending labor dollars to have a room ready way before a physician is ready for the next case, I don't know if that's an efficient use of those labor dollars. I'm not saying slow down. I'm just saying that I'm sure you might be proud of room turnover numbers that are outstanding. But if that provider is not starting that next case, or there's a significant gap between when the room is ready and the provider is ready, then that's something that I would definitely look into because that's impacting your throughput. Okay. Well, we just got another question in the queue. Is there data on how many cases per physician per day in the units? That's a good question. Not directly, but if you look at your throughput, we're looking at a room. One thing that's kind of unique about the way we've run the benchmark is we break everything down to the concept of a room day. And what that is, is what happens in one room on one day. And by being able to use that as kind of the central metric around which we wrap all these other metrics, you can actually compare, say throughput of a one room endoscopy center to the throughput of an eight room endoscopy center, because what you're really looking at is what happens in one room in one day. A physician can't outperform the schedule. That's one thing you should always look at. If you have low throughput, look at how you're scheduling because a physician can't do more cases than the schedule allows. And if the schedule is the limiting factor, you need to look at how you schedule. We actually look in both the survey and the data book at how people schedule and if they're using block scheduling, and if they're using block scheduling, how they divide that up. But that's kind of the closest thing we get to. Okay. And I'm going to take this as our final question before we give a few notes before closing. Is there any cost associated with participating in this survey? Only the cost internally that it takes to generate the data. As I mentioned, we don't charge for that. There is no cost for participation. And once again, once you go through this one time, you should have a template that's very easy to fill out year after year. So your internal costs of pulling all those numbers together and inputting it. And once again, the input's very easy, but pulling that together is easier each additional year that you do it because your finance people, your department people already know what we're going to ask. Okay. Thank you so much, Frank. We'll just have a few closing notes here. That was a wonderful hour. And as Frank mentioned earlier, the GI Operations Benchmarking Survey most recent data book analyzes the GI Operations Benchmarking last survey and is an easy-to-read format that contains over 125 performance metrics and trends. A complimentary copy is available to those who participated in that survey, or you can purchase a copy via GI LEAP, ASG's online learning platform that's at learn.asg.org. This award-winning survey is also recognized by CMS for public reporting. So specifically, it is a medium-weighted improvement activity for the Merit-Based Incentive Payment System, also known as MIPS. So on screen, you can see we have a few different programs that we offer through ASG that qualify as an improvement activity for reporting to MIPS. And this is indeed one of them. We want to thank you for joining us today. We hope this information is useful to you and your practice. If you have any questions regarding the GI Operations Benchmarking Survey, please contact the staff listed on screen or visit the ASG website for more information. This concludes our presentation. Have a great day.

GI Operations Benchmarking Survey

Frank Chapman

efficiency measurement

web-based tool

key performance indicators

staffing recommendations

revenue metrics

COVID-19 impact

healthcare professionals