All right, so here we are to our next question and answer session. Eden, can we have our first question? So our first question is, what are successful methods practices have used to reduce cancellation rates and fill ASC schedules last minute? Yeah, so last minute, that's tough. You know, I mean, our goal is to know as much as far as possible when they're canceling. It's not too difficult to put in an upper endoscopy, colonoscopies obviously have other challenges. Plus, people just need to arrange rides and things like that. And so one of our goals is to make sure we understand the certification, the finances, make that as early as possible. That's not that easy. We've had some challenges with that, both with our JV partners and our billing staff that have been short staffed, doing that in a timely fashion. And so the other is really, we have a texting function, which is customized to really ping people at the right time to understand when they're canceling. And the best thing you can do is to try and figure out when they're canceling as early enough as possible. We do communicate with our staff so they're aware that they have, when there's cancellations, and we do have waiting lists. Some patients I understand that can come in earlier, so you can have waiting lists, staff, any way that staff can be aware of when there's an opening, right? And how to fill that, I mean, that really helps as well. Just do the best you can. Kim, any thoughts? So at our facility, we do, obviously, our pre-procedure phone calls a few days in advance. And we also contact our patients about a day or so before their actual appointment, just to confirm that they actually, whether they have their vaccination card or if they've been COVID tested. And that's actually where we find majority of our patients canceling. So as soon as we find out about that on our end, then we contact the physicians and their different practices to let them know, hey, if you have a patient that's waiting for a slot, this is what's available. And that does seem to work for the most part. I mean, it's obviously easier for upper endoscopies, but we're able to get some patients that are on a waiting list, perhaps, in once we know about those cancellations a couple of days prior. So that's been working for our center. Great. Yeah. I mean, we had the similar experience. I mean, it's always a struggle to fill your schedule so close to when it's time of procedure. It's easy to fill them up with EGDs. What we have done recently is that every provider, their medical assistants, they keep an eye on the schedule. And they usually, when the ASC calls them and there are cancellations a few days before the procedures, they try to put some new patients who are on waiting lists for the EGDs, especially, they just put them in and try to fill the schedule that way. But I mean, it's always a struggle. You have to just find some innovative ways to do that. Yeah. So the other thing that we do is we're being more flexible. So if it's my patient and you have an opening tomorrow, if they're willing, we'll get it on your schedule. They may not want to do that. It depends on the patient, but some flexibility there can help, especially short term, because some people, it's really important for them to get in. But they may not want to switch physicians, but some do. Do you look differently then at no-show versus cancellation? Are those tracked separately and what's that experience? Absolutely. Yeah. We track those separately. And if it's a no-show, the question there is why? Why is it a no-show? Right? There's various reasons. So you need to do an autopsy on that and find out why. And so if there are trends, what's the problem? What can we do to mitigate that in people no-showing? That's the worst case scenario, is people no-showing, I think. I agree. I mean, we also measure them separately. Actually, some time back, we have three ASCs. So in the ASC where I'm usually at, we look at these no-shows and we actually identify that if there is a lag time, if the patient is scheduled further apart from their clinic appointment, there are more chances they're going to be no-show. If they're closer to their clinic appointment schedule, there are more chances they're going to come in. So, I mean, you can find out many times the nuances if you look at them separately. Same thing at my facility. We do attempt to contact the patients that are no-shows. And then we also provide the offices a list of their patients that canceled or that are no-shows. And we do try to recapture those patients if we can in the near future. And then, Dr. Roman, you had mentioned something, just a clarification first, on 12 procedures per room or was it 12 patients per room per day? That was episodes per day, but you just need to have a target. I mean, that's just one kind of metric. And you need to, that would be episodes, that would be patients per day, right? But, you know, you can understand where profitability starts, right, relative to the number of procedures needed to meet overhead, depending upon your staffing and costs. But you should have a target that you follow and track. And really what you want, again, are full rooms, right? I mean, that's the main goal. And you need to meet the demand, but have rooms as full as possible. And then what is considered an optimal room turnover time? Well, again, I think, you know, I think sometimes we get hung up on that a little bit. I think the key concept is whatever your schedule is billed as. So if you do half hour, it's common to do half hour cases, right? Or maybe an hour for a double. I think the key is, is that when the patient's ready and the endoscopist is ready, the room is ready. I think that's the key. Turnover time needs to meet that. And so if there's delays in cases because you just can't go, then you have a problem with turnover. So you can focus on turnover time, but it's really, it's best to just understand that the room needs to be ready in whatever way. Yeah, that is one thing of which we had to change because of COVID. Because I mean, in our ASCs, we don't check for COVID tests before the procedure, we screen them based on the questions, but then, you know, we want to be sure and we want to have everyone safe. So we actually looked at our air circulation and we got it calculated, the amount of time. So right now our turnover time is about eight minutes per room, at least. You have to wait till, you know, eight minutes, the air is circulated, and then we bring the next patient. But prior to that, we try to make it as less as possible because you, you know, you want to get through the day quickly. So I mean, there was always a squeeze, try to make it four minutes or things like that. But as Rick said, I mean, it depends on a lot of factors when they are ready or not. And then do, what do you use and is it something that you can share? Are there templates online for a KPI dashboard? What recommendations do you have for a KPI dashboard? That is something I can probably share later on or send, because I actually initially thought about including it in one of the talks, but I did not, but we can, you, I can share with some of our practice dashboard later on, probably. Okay. That's wonderful. We can push that again. GILeap is a nice repository. You can already log in and get all the slide decks from today to our audience, and we can put additional resources in there. So we'll get that from Dr. Chowdhury and put that in there so that everyone can get access to it. We also have a question over here about how do you communicate to patients the difference between a fully covered screening and the potential it becomes diagnostic to avoid billing surprises? It's a common, that's a common challenge. I mean, we happen to, with our JV partners, actually they develop, we just have access to it. We have a couple of videos that address this. And so we have videos that we can actually send to patients, but we try to educate them as best as possible. I mean, this is such a challenge, right? And so written kind of information during the scheduling, we communicate it to them and to help them understand it. I think education ahead of time as much as possible is helpful. They don't all really understand it that well, right? But it's certainly, it's an issue as we all deal with. It's confusing. It's a confusion felt by the insurance companies, the payers, but whatever way you can communicate that, make sure you do try and communicate, I guess, is the key before the procedure, not at the time of the procedure. Yeah, I agree 100% with Drake. I mean, the thing that is most, the least understood is patients, their own insurance, what is covered and what's not, which is, I mean, it's so complicated. It's not easy to understand it, but we try to do that is we give some written information at the checkout or at the scheduling time. And they do go over that, that it's possible that it can become more of a diagnostic procedure. And most of the time, people are fine with these things because they do understand these are complicated things. And I mean, the majority, we don't have that often an issue with that. Kim, any additional thoughts from you? No, but I agree with what you guys are saying. We have a lot of patients that do call prior to the procedure. They were explained, let's say, at the physician's practice, but they want more clarification. So they will call in a few days and the billers in our department do a great job with really trying to explain it to the patients before time. You'd be very surprised. I mean, I'm sure you won't be surprised, but some of the comments that patients do state when they come in for their procedure. So it's quite comical. But that's a good point Kim made. I mean, your billers need to be educated, right? So they can handle those questions. And this is on ASGE's legislative agenda. This is something that we're trying to work on. We know it's an issue you all face and most importantly, our patients face. So that is something we are trying to address and looking to make headway on. We have, someone has a scenario here and it's a positive one about growth. We have been a practice with less than 50 employees for many years. We are rapidly growing and we need to hire more staff that will, and that's going to push them over the 50 employee mark. I know that changes, that'll change the health insurance and federal requirements, but I want to find out if other practices went through this and did it affect you negatively? So is anyone on the panel able to offer any thoughts on that or if not, we can, we can certainly see what resources we have for this person and get back to them. Yeah. I mean, I don't have any experience in that regard because I came into a pretty large practice. I really did not see that effect they had to go through that. Yeah. We made that transition a long time ago. I don't think I can help. No, me either. All right. Thank you.

cancellation rates

ASC schedules

customized texting functions

waiting lists

room turnover time