Hospitals rely on elective surgeries as a source of up to 50% of all revenue, allowing them to take losses on a range of high-cost service lines to remain profitable. The COVID-19 pandemic laid bare the impact of reduced surgery volume, with hospitals suffering immediate revenue loss and negative profit margins.
As surgical service lines return to pre-pandemic volumes, it’s imperative for hospitals to have the right technology tools and best practices in place to maintain safe, accurate, and efficient surgery workflows. Not only does better efficiency lead to increased revenue; it also improves the experience for both healthcare professionals and patients by lowering risks, complications, and delays.
Two tools, in particular, can play a pivotal role in streamlining the surgery scheduling process: Shared terminology and automated Current Procedural Terminology (CPT) coding. These tools may be overlooked, but successful implementation and use of shared terminology and automated coding can have several key downstream impacts before, during, and after an elective procedure.
The Importance – and Challenge – of Streamlined Surgery Scheduling
According to a report from Strata Decision Technology, hospitals lost an average of $3 million per month when elective procedures were canceled to treat the initial surge of COVID-19 patients. Given healthcare’s low margins, that’s a difficult loss to take.
Streamlining the scheduling process offers hospitals a clear opportunity to recover needed revenue. Facilities can complete more efficiently with less waste and time spend while still meeting staffing, safety, and quality requirements.
For many hospitals, though, this process is easier said than done. Many factors contribute to running a successful OR, from coordinating surgeons’ schedules to tracking surgical equipment to providing enough time to clean and restock supplies. It’s also important to consider the needs of the patient – both before the surgery – to ensure that appropriate pre-operative procedures have been completed, and after, to prevent patients from waiting for a vacant recovery room.
Many areas of hospital operations are involved in surgery scheduling, and getting everyone on the same page can be a tall order. One of the easiest ways to streamline is to get everyone to speak the same language. That’s where shared terminology and accurate mapping to CPT codes come into play.
The Role of Shared Terminology and Coding
Clinical terminology is constantly changing. In 2020, healthcare saw nearly 400,000 unique updates to terminology across a range of conditions and procedures. Some updates were planned, but others were not – including rapidly implemented ICD-10, SNOMED, CPT, and LOINC codes for COVID-19.
The right codes are critical for accurate diagnosis, treatment, billing, analysis, and clinical research. Vagueness in terminology and coding inconsistencies can lead to operational and clinical issues such as inadequate prior authorization submissions, incorrect room set-up and preferred supplies at the ready, as well as charge capture setbacks such as delayed payments or denied claims altogether.
With so much at stake, hospitals shouldn’t leave the task of managing clinical terminology and CPT coding to home-grown solutions that require significant resources and regulatory oversight, all of which can disrupt clinical and billing workflows. In many cases this is extremely difficult for internal teams to manage as many CPT code descriptions are very broad and do not exactly line up with the clinically stated procedure name. Unless the facility has strict policies in place, coding these individual procedures becomes very subjective.
Technology solutions that are purposefully built to monitor for updates to clinical terminology and automatically map updated procedure terms to the appropriate billing and reference codes offer a number of key features:
- Shared terminology allows for accurate communication of critical scheduling details, such as the length of the procedure and any required staff and equipment needs.
- Using a single, precise naming convention for a given surgical procedure helps hospitals more accurately determine average time and case duration, reducing the uncertainty about how long to reserve an OR room.
- Automated coding ensures the proper use of CPT codes, which cuts down on denials and get reimbursements to hospitals faster. For prior authorization, this reduces the likelihood that a payer will authorize a different (and incorrect) procedure or deny an authorization due to a lack of detail.
- In addition, automated coding routinely updates the Centers for Medicare & Medicaid Services inpatient-only procedures list. Knowing which specific CPT codes initiate inpatient-only status, versus which procedures can be done in an ambulatory setting, ensures proper reimbursement as well as compliance with clinical quality guidelines.
4 Benefits of Elective Surgery Scheduling Optimized by Shared Terminology
The key features of shared terminology and automated coding solutions have a downstream effect on elective surgery scheduling. Here are four core benefits of an optimized scheduling process.
1. More accurate documentation. Consistent terminology and coding ensure proper documentation of surgery across the entire perioperative process. This eliminates the need to repeatedly collect a patient’s history and physical information, ensures that patients receive the right preoperative preparation material, and reduces the risk of errors and avoidable complications from an improper procedure. During and after surgery, clinical staff can more accurately document exactly what happened, which ensures accurate coding and billing while also aiding in patient care and recovery.
2. Better room management. Precise terminology and coding for each procedure helps hospitals allocate a specific block of time for a given procedure more efficiently, as they can analyze the average length of time for all procedures with a given code. This helps staff see at a glance when rooms are available – not just in the OR but in recovery as well – which means patients spend less time waiting for their rooms to be ready. Scheduling in blocks also provides maintenance staff with a more exact indication of when an OR will be vacated and ready for disinfection.
3. Streamlined supply chain management. Knowing exactly which coded procedure is taking place in which operating room at which time ensures that the right surgical equipment and supplies are available. This cuts down on waste and brings predictability to the process of reordering supplies. More importantly, it ensures that fewer surgeries need to be canceled due to a lack of necessary equipment.
4. Efficient staff management. Shared terminology provides insight across a health system into which procedures are slated for each facility at a given time. This is critical for scheduling sought-after surgeons who work at multiple hospitals in a system. It also ensures that the appropriate number of required physicians, nurse practitioners, physician assistants, and support staff are present. Better staff management and scheduling reduce the number of procedures that must be canceled due to a shortage of personnel.
Hospitals lost a significant revenue source when COVID-19 forced the cancellation of elective surgeries. Now that these procedures are up and running again, organizations need to ensure that their elective surgery programs are running smoothly. Scheduling workflows can be improved through the adoption of shared clinical terminology and automated coding, which provide more accurate information about critical procedure information to stakeholders across the health system. This enables more efficient surgery scheduling, allowing hospitals to bring in much-needed revenue while meeting patients’ care needs.
About David Bocanegra, R.N
David Bocanegra, R.N., is a Nurse Informaticist at Intelligent Medical Objects (IMO). In this role, David provides project management and clinical expertise for IMO’s health IT solutions to improve healthcare data enablement across the healthcare system. David has been a Registered Nurse for 28 years with the majority of his experience in Emergency Nursing.
