How to illuminate and improve exam room utilization rates

Insight Article - November 1, 2020

Business Operations Technology

Practice Efficiency

Rich Miller

Exam room utilization is an area of practice management that still operates largely in the dark, according to a recent study. The survey of executives by Porter Research revealed that nearly two-thirds of health systems lack visibility into exam room utilization, costing them significant amounts of revenue.1

Operational efficiency is a key factor in helping practices recover from COVID-19-related losses. As a result, it’s concerning that 72% of survey respondents said that their clinics function at about 20 points below the optimal room utilization rate range of 80% to 89%. The respondents also noted that not hitting their capacity targets decreased patient throughput and resulting revenue. A lack of visibility into exam room utilization may diminish patient satisfaction and loyalty by increasing the amount of time spent waiting for care.

However, with every challenge comes opportunity. Most medical groups manage exam room space independently by department and manually. 

Current challenges

Typically, staff within each practice and each department are responsible for developing their own capacity management strategies. It’s little wonder that the Porter Research respondents believed subpar optimization was caused by issues such as:
  • time-intensive processes (19%)
  • lack of integration with other systems (18%)
  • poor transparency (13%).
Other factors cited included a lack of accurate data in real-time, along with difficult-to-use and/or error-prone processes.

Although half of those surveyed indicated that staff use technology to ease room management workflows, none of the technology was designed to address exam room utilization. Among the other half of respondents, 20% said they manage capacity through Microsoft Excel spreadsheets. The remaining 30% don’t use any software for exam room scheduling.

No matter the method used, the study data supports what most practice managers intrinsically understand: Room utilization is managed mostly in isolation. This explains why the process has been such a historical burden. Yet, it also shines light on the path forward.

Fixing these long-standing capacity concerns requires us to step back. We need to think about the relationship between our exam room space and the people who occupy it. We need to turn an opaque, disconnected function into one of real-time, interconnected transparency. 

Once we do, there are opportunities to achieve significant return on investment (ROI). For example, the orthopedic director at one large regional health system calculated that each of their providers could potentially see 10 to 15 additional patients each day through more effective room utilization, generating at least $2,000 more per provider per day.

While improved billing opportunities are one aspect to consider with ROI, another is through the lens of saved operational expense. For a vice president at a different health system, each 1% rise in exam room utilization creates an annual savings of $140,000. That number results from the ability to increase patient throughput without investing in new office space or staff.

Effective solutions

To better manage capacity, practices need to be able to connect three different “dots”: rooms, providers and patients. Available rooms must be equipped with the right tools to care for patients as their providers are ready to see them. What good does it do to have an open room, for example, if it doesn’t have the phlebotomy chair needed for the patient’s diagnostic test? Or the ultrasound machine needed for the obstetrics patient?

Unfortunately, the patient appointment book is not enough to ensure effective utilization of the right space as it’s needed. Instead, practices should consider solutions with these attributes:
  • Digitized. Manual spreadsheets and tools cannot efficiently keep pace with all the daily changes within practices. Instead, platforms should provide transparency to all stakeholders and allow real-time adjustments. This is the only way to keep exam rooms from sitting open — or being double-booked — when Mrs. Smith cancels her appointment, Dr. Jones goes home sick or someone schedules an urgent appointment for Johnny’s suspected appendicitis.
  • Standardized. Standardizing room management processes across departments and/or practices is essential — especially when opportunities exist to share physical space. Practices should consider standardizing not only workflows but also terminology. “Semantic consistency” is what sets the foundation for robust data analysis at the department, practice and enterprise levels. For example, all stakeholders should understand that neither Dr. Jones nor Dr. Brown will need exam rooms when one is on vacation and the other is on PTO.
  • Streamlined. Once processes are digitized and standardized, practices can then gain the efficiencies possible through technology. Tasks such as repurposing rooms, adding or removing providers and accommodating provider schedule changes can be coordinated and documented in real time at the practice and enterprise levels, regardless of where the change is initiated.
  • Intelligent. Platforms should be capable of “tagging” room attributes, such as where it’s located, or that it contains the phlebotomy chair or ultrasound machine noted in the previous examples. Such insights make it easier to optimize room selection based on patients’ needs and providers’ locations.
  • Measurable. Like anything else, exam room utilization must be measured against targets before it can be improved. Room management solutions should offer data and analytics tools that let medical groups track and benchmark relevant utilization metrics.

The advantages of insight

The research study confirms that optimal exam room utilization can’t be accomplished through limited-visibility manual processes done in isolation. But it also highlights ample opportunities to turn this long-standing challenge into financial and patient care benefits.

In the short term, optimizing capacity gives medical groups a way to use existing space and resources to begin recouping losses related to COVID-19. In the longer term, however, the benefits include not only increased revenue opportunities, but also more satisfying care experiences for providers and patients. 

Insights from #MPEC20: Managing capacity in the era of COVID-19 protocols

New infectious disease safety protocols have affected medical practice capacity for months, which has direct effects on patient access, provider productivity, revenue and cost management, and provider satisfaction, Miller noted during his session at the 2020 Medical Practice Excellence Conference.

“If your organization is not effectively managing capacity, you’re missing out on the opportunity to see more patients, and that results in more unrealized revenue, but also the potential for patients to go elsewhere for care,” Miller said.

Despite more hospitals, health systems and practices adding electronic scheduling, Miller said most still lack real-time visibility into where providers are and the capabilities of the rooms in which they’re providing care.

The COVID-19 pandemic is forcing practice leaders to make capacity management considerations a priority. That includes creating a broader understanding of who and what is included in capacity. In the context of the pandemic, this means enhanced tracking of workers turning over rooms or transporting patients, or other nonclinical workers in laundry or cafeteria settings.

Miller also asserted that it means working to improve the speed and accuracy of communication when requesting an on-call provider, as information can sometimes be rushed and incomplete when a unit secretary or administrative worker, faced with such urgent requests, reaches out for the on-call physician.

The pandemic “really demonstrated to us that we have to have a real-time view into our resources and into our capacity,” Miller said. “In the past, it was much more a question of finances. Today, it’s actually about saving lives, it’s about protecting providers. ... The urgency around capacity has changed dramatically.”

Steps for adaptation and management

Miller pointed to three action steps for practice administrative leaders to follow once they have a technological solution that fits the framework outlined in this article:
  1. Identify and centralize resources: Centralizing your system allows a practice to float support staff between different areas, especially if cross-training has been completed for different departments.
  2. Determine patient access needs and flow: Understand how many patients can fit into a waiting room at any time, if you continue using a waiting room at all. Also document how much time is needed for turning over rooms.
  3. Optimize resources based on capacity and demand using analytics: Integration of data from your scheduling system will be crucial to continuously adjust and improve operations.

Note:

  1. QGenda. “Improving Capacity and Revenue through Effective Room Management.” Whitepaper. Available from: bit.ly/3jVcoyZ.

About the Author

Rich Miller
Rich Miller
Chief Strategy Officer QGenda Atlanta, Ga.

RMiller@QGenda.com

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