Sounding the Alarm On Block Time Inefficiency

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Erik Sunset: All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, we deliver healthcare solutions that take the pain and costs out of broken workflows like with Op Note, which gives ASCs and their affiliated clinics the power of instantly generated operative reports approved from the point of care with images.

Erik Sunset: If you need ’em, you can learn more about Op Note and all of our solutions at docbuddy.com. And welcome back. It’s, uh, it’s been a little while since we’ve recorded a show. Uh, we wanna be sure to wish you a happy 4th of July weekend. It’s Monday, July 7th while we’re recording this one today. So hopefully everybody had a chance to spend the 4th of July with friends and family.

Erik Sunset: I. And part of the delay on our next episode of the show, we’ve got a couple of good ones that have, uh, recently been released. Um, most recently with friend of the show, Jessica Bush. She’s always great for the latest takes on leadership and dev, developing positive culture at your healthcare organization, whether that’s an ASC or not.

Erik Sunset: So definitely take a look at that. [00:01:00] But we spent a lot of time on the road in June and really even going back for that, something like April. But in no particular order, the DocBuddy Roadshow has been at the Gulf States Excellence ASC Conference in beautiful New Orleans. We’ve also been to Scottsdale where we supported the Arizona ASCA Annual conference.

Erik Sunset: We were in Texas at the Tasks Annual Conference with some of the team at Becker Spine. And we’re on just a little bit of a breather now until we’re onsite in Orlando for F-S-A-S-C. That’s when I’ll be at, uh, myself, along with our RVP sales of our East Territory, Kent Darbro. Uh, so we look forward to seeing all of the fscs attendees in just two short weeks, and I guess it’s more like three if you really, uh, count it the, the right way, two and a half, somewhere in there.

Erik Sunset: Uh, but the focus for today’s episode is around a relatively recent Becker’s article, and it’s called ASCs Sound, the Alarm on Block [00:02:00] Time Inefficiency. And this is something that we’ve been sharing around internally with all the members of the DocBuddy team that’s gotten a lot of discussion, um, out of us as a group just because it’s, it’s such an interesting topic with interesting timing.

Erik Sunset: Um, when you look at the ASC, you’ve heard us talk before about, uh, sort of being underserved in a technology, uh, sense. Some of that, um, is that obviously ASCs, were not a part of the High Tech Act. No real requirement to go paperless and getting EHR. Although I’m an EHR absolutist, I still think there’s a lot of good reasons for an ASC to have an EHR.

Erik Sunset: You know, along with, uh, utilize, utilizing DocBuddy op note for their operative reports. But between a lack of staffing, a lack of time, everybody running around with their hair on fire, essentially that’s at the ASC. You know, there’s not a whole lot of time to really evaluate, uh, good solutions for your surgery [00:03:00] center.

Erik Sunset: Um, it ends up being sort of like a pressing need where we gotta fix this right now, uh, today, as opposed to a more deliberate shopping around. Let’s take a look at a bunch of different vendors. You know, I, I don’t wanna say that anybody’s making a snap decision ’cause I, I actually don’t think that’s the case, but there isn’t a whole lot of time to be strategic when you are stuck working sort of on the front lines, um, of the ASC day in and day out.

Erik Sunset: So hopefully that’s a good way to set the table. Um, and when you look at this article, which of course we’ll have linked, we love our friends over at Becker’s. We love, uh, getting to comment on some of their editorial. Oh, and this is, uh, this is no different obviously, but this, uh, block time inefficiency that so many ASCs are working to overcome, fighting with it every day.

Erik Sunset: It’s a hidden profit killer. ASCs still have huge challenges, uh, on the staffing front. Shrinking reimbursements. I know, I know we, we’ve talked about that at [00:04:00] length. Um, but still fighting through these post COVID staffing issues. Having to really adjust to the reality of shrinking reimbursements. This is a massively, massively overlooked threat where ASCs are bleeding money daily.

Erik Sunset: Yes. Daily. Um, because whether your or, or any or at your facility is in use or not, or are paying for it, and a lot of centers across the country are hemorrhaging revenue through poor block time utilization. And for our listeners that are maybe not so well versed in what we’re discussing here, block time utilization means that for every minute your facility is open, you need to be having procedures in a given or pretty much the entire day.

Erik Sunset: Or you’re under utilizing that operating room, right? Like you wanna be maximizing the amount of time you’re doing procedures in each or at a facility. And ultimately, for every minute that you’re not doing a procedure in an OR that you could be, it’s losing you money. So [00:05:00] a few of the major pain points called out in this article, obviously around underutilized operating rooms, sitting idle despite big infrastructure equipment and staffing investments, uh, going into keeping the, the lights on at your facility.

Erik Sunset: Uh, so some of those are pretty, pretty tough headwinds. You know, they probably show up more on like a balance sheet than on, than on a, a p and l, you know, with the exception maybe of um. Uh, payroll. But another aspect of this is maybe a little bit more in control at the ASC level. Um, and that’s around your scheduling practices.

Erik Sunset: And there’s a lot to unpack here. So to start being certain that a given procedure begins when it’s, when it’s scheduled. Two, so late starts are a big no-no, that’s hurting or utilization room turnover time. Uh, that’s another. Big area where ground can be made up. Um, but again, staffing is tough, right? Uh, you [00:06:00] need to have staff on hand to be able to turn over a room.

Erik Sunset: And then the sort of the third leg of the stool is around inefficient block scheduling. And where I think the timing on this article is really interesting, um, is that we talked about a little bit. More of, um, looking to fix a problem fast at the ASC right as oppo, as opposed to a more strategic investment, a strategic shopping, a more deliberate process.

Erik Sunset: But this inflection point that we’re seeing through the first half of 2025 is that from our vantage points and from my vantage point personally, ASCs are more open to good, meaningful technology now than I’ve ever seen them in the past. And what do I mean by that? Everybody knows there’s a ton of software out there, whether it’s for healthcare specifically, whether it’s a new AI product for healthcare, whatever it is, right?

Erik Sunset: There’s a lot of software out there. That doesn’t mean it’s good. That doesn’t mean it’s meaningful. That doesn’t mean [00:07:00] it’s useful. It doesn’t mean it’s cost effective, right? Like there’s just a lot of software on the market. Uh, but through 2025, like I said, ASCs are much more open to hearing about solutions that help them do more with less.

Erik Sunset: So you’ve heard us talk about that with DocBuddy quite a bit. You know, our op note solution helps facilities do more with less, how you’re able to let the surgeon keep the workflow they really like, which is dictation. Talking to generate their operative reports, but then you get a digital outcome for the rest of the facility where that operative report is generated instantly.

Erik Sunset: There’s no weight on transcription. The signature is added from the surgeon’s phone, and then that completed operative report is piped back to the ASCs core software. So in a lot of cases, that’s HST and a lot of cases that’s, that’s CIS or one of the CIS family or products. So nobody has to move that operative report anywhere.

Erik Sunset: It’s transmitted in real time to the ASC software. It’s [00:08:00] also going back to the provider’s clinic, and this is all reducing the amount of time it takes to get that claim into the revenue cycle. So we’re all about doing more with less.

Erik Sunset: Being able to squeeze, um, more juice from that turnup, you know, like get, get more juice outta that turnup. That’s another aspect of this. And I think something along the lines of a block time scheduling optimizer is, is going to be huge.

Erik Sunset: Obviously you need to have procedures happening every minute that you’re open. So having a block time, uh, optimizer, I think that’s something ASCs will be really open to. Uh, but coming back to the, the main pain point, pain points, so under underutilized or poor scheduling practice and then anes anesthesia shortages, this one is brutal.

Erik Sunset: This is a big external factor where facilities are being forced to turn, turn down cases, sometimes the day of, and operate below the capacity that they should be. So canceling cases under utilizing [00:09:00] ORs. That’s tough. And this is a year. Uh, this is a climate rather where the big management companies, we heard this at healthx, the Big five management companies are expecting to spend a lot of money on anesthesia subsidies and, and, uh, being able to provide that stipend so they can ensure that they have the anesthesia coverage that they need.

Erik Sunset: And then interestingly in the article, one of the experts called out that the old 7:00 AM to 3:00 PM Monday to Friday model is no longer sustainable.

Erik Sunset: It may no longer be sustainable academically, but you need to ask yourself as a facility, do I have the staffing coverage? I would need to be open longer or to be open more days like are, can my workers be here? Maybe you can, maybe you can’t. Something to consider, do I have anesthesia coverage for this new set of operating hours that I would, I would like to keep.

Erik Sunset: That’s a [00:10:00] big issue as well. Something very big to consider. And then kind of tying this all together, the financial impact of um, let’s call it improper or utilization. So you’re directly losing money if you have an empty or when you could have a patient in there. You’re losing revenue. The fixed costs are gonna continue on no matter what’s happening in that or so, infrastructure, equipment, bank notes, staffing costs.

Erik Sunset: And then you’ve also got this self-inflicted error of missing a case, but still paying that anesthesia stipend. So you’re getting basically double dipped that you didn’t do a case you were supposed to, so you incur all of your normal fixed costs, but then you’ve got that variable cost of anesthesia. Or you could, depending on your arrangement with your anesthesia group, obviously if they’re employed, this isn’t a problem for you in the same way that it is for somebody that has third party or outsourced anesthesia.

Erik Sunset: And then you just have to think about this in terms of the opportunity cost and then the compounding effect that poor utilization affects the overall center [00:11:00] profitability and sustainability. So I’d highly encourage you to take a look at this article to see one of the more creative solutions, uh, to this.

Erik Sunset: Block time utilization problem that so many ASCs have. There’s a really, uh, compelling model where a manager reviews the three month schedule for all of their, all of their surgeons vacations, and then is immediately offering up those vacation slots to other physicians within their group. And then they have a deadline for backfilling, and then there’s a second round of offers and they’re just continuously monitoring to ensure they have physician and an anesthesia coverage for all of the procedures that would otherwise be rescheduled because the appointed, uh, procedure, uh, the appointed provider was gonna be on vacation those days.

Erik Sunset: So they’re seeing a big increase in utilization rates, measurable revenue increases, and then better resource allocation across divisions. That group obviously has the size to be able to dedicate [00:12:00] resources to this task. Not everybody does. One other solution that we’ve already called out is extending your operating hours.

Erik Sunset: You know, maybe Monday to Friday, seven to three isn’t right for your center anymore. Uh, longer hours are becoming the standard to meet patient demand. So that’s a good thing. And as centers, uh, adapt to shifting volume patterns and demands of certain specialties, if you’re at like a multi-specialty ASC or collection of asc.

Erik Sunset: You need to be taking into account. Do you have the staffing to pull that off? You know, every state has different labor laws. Um, depending on if a employee is salary exempt, uh, from overtime, or if they’re not exempt from overtime, can you keep somebody there for 12 hours a day? Would you want to just food for thought?

Erik Sunset: I’m not saying that’s the right thing, but things that need to be considered in addition to your anesthesia coverage. And then the part of this article that seems kind of like a no brainer to me is using some type of analytics driven scheduling. [00:13:00] We’ve already kind of touched on this, but you gotta really be able to monitor your, your, or usage patterns.

Erik Sunset: You gotta use data to make block schedule adjustments between your different practices that are sending you procedures. You gotta be looking at these, uh, analytics regularly of demand for or time versus capacity. And then be proactive in identifying either underutilized slots or potentially underutilized slots, because again, that is just money being left on the table.

Erik Sunset: And if you’re really sharp with your analytics, you’re gonna be able to decrease labor costs. You’re gonna potentially reduce anesthesia, stipend waste as well. And depending on your arrangement with your anesthesia group, you may able may be able to get back to the table and fine tune your agreement so that you’re in better alignment with the analytics that you see.

Erik Sunset: Um, if you’re gonna change your operating hours. Things of that nature and just overall better resource, uh, allocation. You know, you have the data to back up why you’re doing something instead of [00:14:00] just thinking that you’re doing the right thing. They’re not always one and the same, no matter how smart we think we are.

Erik Sunset: Right. And then obviously there needs to be a highly collaborative scheduling approach between your clinics that send you procedures and the facility itself. Um, and this is where there’s some really interesting things, uh, that we’ll be able to discuss moving forward, that this is traditionally. A very manual process.

Erik Sunset: It’s phone calls, it’s emails, it’s faxes, it’s returning voicemails, it’s returning encrypted emails, and it’s just this sort of ugly feedback loop where it’s not a, it’s not a very clean way to exchange information. But as the ASC, you know, this is really like one of the first steps in your revenue cycle is having procedures scheduled, you know, and then you get into, or optimization and block time optimization from there.

Erik Sunset: Um. But you gotta be really collaborative with your practices and make it easy not [00:15:00] only for them to schedule procedures with you, but make it easy for you as the facility to accept procedures from your practices in their given block time.

Erik Sunset: And we’re just about through here. We wanna, we want to close out a couple, uh, final thoughts as we discussed this fantastic Becker’s article, which of course we will get linked in the show notes. But the bottom line here is the block time and efficiency is really a controllable profit drain that. Some ASCs are ignoring some aspects of what’s controllable is up for debate, right?

Erik Sunset: Like you’re not in control necessarily of all things at all times, but you gotta be able to control what you can control to limit the loss. And you know, there’s even an opportunity here that if you have limited the loss to enough of an extent and you’re proactive in block time utilization and or utilization.

Erik Sunset: You’re gonna end up with a competitive advantage over the other facilities in your area that maybe aren’t doing as good of a job. Maybe you end up with the bandwidth to [00:16:00] do more procedures as opposed to the facility down the street. And in the future, obviously the, the cutting edge highest success ASCs are gonna be those that optimize every minute.

Erik Sunset: Of their operational capacity. That kind of goes without saying, but if you’re only looking at this problem of, or utilization through the lens of stopping the loss and not in maximizing patient care and maximizing revenue to the center, you know, you may be missing out on that second half. So one thing I’d be curious to hear from any listeners out there at the ASC or at practices that are feeding procedures to an ASC.

Erik Sunset: How do you currently handle block time management? What are your biggest challenges with or utilization? What’s the level of anesthesia shortage you’re seeing in your markets? I don’t think there’s very many markets that are untouched by this, obviously for my, for the listeners out there that have employed anesthesia.

Erik Sunset: Lucky you. And then finally, [00:17:00] any thoughts on how AI or more advanced scheduling and analytics tools impacting this space? We’ll be interested to hear what you’re seeing out there. And with that, let’s put a bow on the episode. Um, as always, be sure you are subscribed on Apple Podcasts, Spotify, YouTube, and on behalf of the entire DocBuddy team, we want to thank you for listening.

Erik Sunset: And until next time, I’m your host, Erik. We’ll talk to you again soon.