Slow Surgeons and Insurance Payments

[DirtDocMD]

We’ve all dealt with it (though some less than others). The SLOW surgeon. The same folks who complain about a few extra minutes to turn over the room, but routinely do 2-3 hour lap choles, 6-8 hour CABG’s, or 3 hour single level ACDF’s.

Obviously, they don’t get paid more for THEIR time, but WE get paid more. The hospital gets paid MUCH more (because of extra OR use). Ultimately, we “know” that longer surgeries usually lead to worse outcomes, so THAT costs more, too.

Are any of you guys aware of any SERIOUS attempts by insurance companies or hospitals to remedy this sort of “behavior”??

I’ve seen some surgery centers yank blocks from guys like this (Why give a block to a guy who can only do two cases in the amount of time another can do FIVE??), but am continuously amazed at hospitals/administrators, who won’t hesitate to inform us of complaints of “slow” partners or CRNA’s that take an extra 10 mins to get a case going, but turn a blind eye to surgeons who struggle to do 3 gallbladders in a single day.

It doesn’t just create problems for anesthesia staffing. It causes problems for other surgeons, too, when they can’t get their add-ons going in a timely fashion because “Dr. Slo-mo” has a room tied up all day.

There are always “extenuating” circumstances, and speed isn’t everything, but are any of you aware of any hospitals/insurance companies that compile data on surgical times, and sanction those who are routinely at 2-3 TIMES the mean or median (not just a “little” slow)???

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[bigdan]

I’ve worked in 3 different health systems, in 3 different states.

The slow surgeons are described as “meticulous”, if anyone acknowledges the snail pace at all. We were told the the EMR would allow for block times to be set by average case length...that hasn’t happened, and we’re a 100 cases/day place, so we have the data.

The ONLY thing that matters is the money, brother. It’s a case in a room and a patient getting billed.

 

[Hoya11]

I’ve worked in 3 different health systems, in 3 different states.

The slow surgeons are described as “meticulous”, if anyone acknowledges the snail pace at all. We were told the the EMR would allow for block times to be set by average case length...that hasn’t happened, and we’re a 100 cases/day place, so we have the data.

The ONLY thing that matters is the money, brother. It’s a case in a room and a patient getting billed.

Exactly. Hospitals do not dare say anything to the slow surgeons

 

[AdmiralChz]

Exactly. Hospitals do not dare say anything to the slow surgeons

Not necessarily. It depends on if there is a better option readily available and if there has been any measurable complications. Also surgeons that get pushed back by other surgeons tend to get pretty angry.

We have a GYN who routinely takes 5-6+ hours for lap/open hysterectomies, and loses quite a bit of blood. These cases went into the late afternoon delaying add on cases - the other surgeons and admin weren’t thrilled. We have 3 OB/GYN groups that operate there so it wasn’t hard at all to come up with an action plan supported by the medical staff - for now, that surgeon has to do larger cases like that with a staff co-surgeon for a few months to see if improvements can be made. If not, those privileges will probably be revoked.

There are several other examples of this as well in our system. In fellowship we had issues with a few exceptionally slow and not so great cardiac surgeons and a similar path was taken.

However if you are in a less-than-desirable area and only have 1 or 2 surgeons of a given specialty paired with difficulty recruiting, then there isn’t much that will be done unless true patient harm happens.

 

[Neopolymath]

This happened to a local neurosurgeon surprisingly.

 

[dchz]

This happened to a local neurosurgeon surprisingly.

I've heard about this, are you in the Dallas metroplex?

 

[Neopolymath]

I've heard about this, are you in the Dallas metroplex?

Southeastern US! Was shocked given how even a slow neurosurgeon makes the hospital a lot of money. 100+ case a day type place though so perhaps there was more surgeon-surgeon arguing.

 

[AdmiralChz]

Another thing to consider is the rise of bundled payment models. Those surgeons with poor outcomes and prolonged recovery (especially the latter, it’s a big difference between 1 and 3 day stay for a standard THA) will have great difficulty.

 

[Twiggidy]

We’ve all dealt with it (though some less than others). The SLOW surgeon. The same folks who complain about a few extra minutes to turn over the room, but routinely do 2-3 hour lap choles, 6-8 hour CABG’s, or 3 hour single level ACDF’s.

Obviously, they don’t get paid more for THEIR time, but WE get paid more. The hospital gets paid MUCH more (because of extra OR use). Ultimately, we “know” that longer surgeries usually lead to worse outcomes, so THAT costs more, too.

Are any of you guys aware of any SERIOUS attempts by insurance companies or hospitals to remedy this sort of “behavior”??

I’ve seen some surgery centers yank blocks from guys like this (Why give a block to a guy who can only do two cases in the amount of time another can do FIVE??), but am continuously amazed at hospitals/administrators, who won’t hesitate to inform us of complaints of “slow” partners or CRNA’s that take an extra 10 mins to get a case going, but turn a blind eye to surgeons who struggle to do 3 gallbladders in a single day.

It doesn’t just create problems for anesthesia staffing. It causes problems for other surgeons, too, when they can’t get their add-ons going in a timely fashion because “Dr. Slo-mo” has a room tied up all day.

There are always “extenuating” circumstances, and speed isn’t everything, but are any of you aware of any hospitals/insurance companies that compile data on surgical times, and sanction those who are routinely at 2-3 TIMES the mean or median (not just a “little” slow)???

Unless the hospital is losing money paying nurses overtime them you probably won’t hear much of anything as far a change. Even then they probably just shuffle the “call nurses” to that room who are already getting paid to stay late.

I used to also get uptight about slow surgeons until I realized I’m basically paid by then hour, now I just make sure my iPad stays charged.

 

[aneftp]

As long as slow surgeons balance the fast surgeons. Hospital/admin will let it slide.

Kind of like how surgeons see anesthesia peeps.

Hey. I got fast turnover anesthesia person.

At the end of the day. Revenue is revenue to the facility. 2 lap choly taking 5-6 hour Or block is better than zero OR time being utilized.

They measure OR utilization. That is the real key stat. If OR block utilized at least 80% of the time. They are good.

Fine tell the surgeon to take their business elsewhere. U have no replacement for that surgeon. No anesthesia revenue either.

U cannot have ur cake and eat it here. The good comes with the bad. Deal with it.

And using a private for profit surgery center as example is not a good example. Cause those same for profit surgery centers will also refuse to do Medicare patients cause it will cost them too much in facility fees for some equipment being used.

 

[DirtDocMD]

Ag

Unless the hospital is losing money paying nurses overtime them you probably won’t hear much of anything as far a change. Even then they probably just shuffle the “call nurses” to that room who are already getting paid to stay late.

I used to also get uptight about slow surgeons until I realized I’m basically paid by then hour, now I just make sure my iPad stays charged.

Agree, but when it’s Medicaid, it’s less than $80 per hour. Medicare is not much more.

 

[Twiggidy]

Ag

Agree, but when it’s Medicaid, it’s less than $80 per hour. Medicare is not much more.

And that’s why you blend units.....if possible

 

[narcotics999]

How about the surgeons who just bring in medicare/medicaid pts to the hospital? I heard one example that for each case the surgeon does, the hospital loses at least a grand.

Suits are not very happy. Not sure what they can do.

 

[DirtDocMD]

And that’s why you blend units.....if possible

That’s fine, you get $250 an hour “blended”, while ultimately the group is only generating $80 an hour. Doesn’t mean much these days with all the “corporate anesthesia”, but if you’re in a private group, the group is effectively “subsidizing” coverage of these cases/slow surgeons.

Back when one of my old groups followed surgeons, we’d routinely discuss dropping this sort of business. There was no point in hiring guys and paying $400k, to cover $250-$300k of business, and causing everyone misery, to boot.

Anyway, hospitals DO charge insurance more for more OR time, and my point of bringing this up was to question why Insurance would pay for someone who takes 3x as long.
Ultimately, “bundled payments” will make this a non-issue for the insurance companies, but it will obviously benefit busy hospitals to have quicker surgeons at that point, if OR demand is exceeding OR supply. Two articles below:

https://www.ormanagement.net/Clinical-News/Article/06-18/What-Is-a-Minute-Worth-in-the-OR-/48791

http://ether.stanford.edu/asc1/documents/management2.pdf

 

[deleted162650]

How about the surgeons who just bring in medicare/medicaid pts to the hospital? I heard one example that for each case the surgeon does, the hospital loses at least a grand.

Suits are not very happy. Not sure what they can do.

Take/re-assign their block time.