Outcome Measures Reported in First AAAHC Institute Non-Clinical Study of Colonoscopy Procedures in Ambulatory Healthcare Centers

WILMETTE, Ill. -- Staffing and scheduling practices, the amount of patient time spent in ambulatory healthcare centers, and billing and collection methods are key factors in the efficiency of healthcare centers performing colonoscopy, one of the most common outpatient care procedures. Overall, patient satisfaction was high across all centers. These are among the findings from the first non-clinical study of colonoscopy in ambulatory healthcare centers conducted by the AAAHC Institute for Quality Improvement, a subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC). The study assessed performance measures on key non-clinical aspects of performing colonoscopy, including administrative and financial processes and patient satisfaction outcomes. Findings include:

• Staff costs per procedure ranged from $15 to $1,065 (median $70). Factors cited for low costs included employing a primarily part-time staff, using a rotational “call-off’ list for staff cutbacks when census is low, and having nurse managers who work alongside clinical staff

• Supply costs per procedure costs ranged from $5 to $77 (median $37). The organization with the lowest cost cited “comparison shopping” for the best prices as the prime factor in keeping costs down.

Patient Satisfaction

In general, patient satisfaction was high regardless of how the ambulatory healthcare centers ranked on the non-clinical outcomes measured.

• More than 97 percent of patients rated their overall experience as positive, 2 percent rated it as neutral and less than 1 percent rated it as negative.

• 94 percent of patients indicated their procedures were scheduled as soon as they wanted.

• 40 percent of patients had to wait past their scheduled procedure time, of these, 32 percent waited longer than expected and 26 percent waited less time than expected.

• 98 percent of patients said healthcare providers showed concern for their comfort.

The AAAHC Institute Colonoscopy Non-Clinical Study was conducted between July 2004 and January 2005, and included 40 organizations that together perform more than 130,000 colonoscopies per year. Real-time data on factors including scheduling, patient processing, staffing, facility time, billing, collection and other costs associated with the procedures were gathered. Data from organizations that completed study questionnaires for 15 or more procedures were used in the benchmark analyses. Included in the final analyses were 725 colonoscopy cases from 31 organizations.

The purpose of the AAAHC Institute Ambulatory Surgery Non-Clinical Studies is to provide opportunities to initiate performance measurements on key administrative and financial processes and outcomes. The studies were undertaken by the Performance Measurement Initiative (PMI) of the AAAHC Institute, which also has completed a non clinical study of ambulatory health care centers that perform cataract surgery. Other AAAHC Institute studies of ambulatory healthcare organizations are under way, including studies of liposuction, medical events, asthma and myringotomy.

The Study Results In Depth

 A center needed to have performed at least 15 procedures in order for its data to be included in the benchmark analyses. A total of 725 cases from 31 facilities were included in the benchmark analyses. Findings include:

-- Supply Costs. Per procedure costs ranged from $5 to $77 (median $37). The organization with the lowest cost cited “comparison shopping” for the best prices as the prime factor in keeping costs down.

-- Staff Costs. Costs per procedure ranged from $15 to $1,065 (median $70). Factors cited for low costs included employing a primarily part-time staff, using a rotational “call-off’ list for staff cutbacks when census is low, and having nurse managers who work alongside clinical staff.

-- Staff Time. Time devoted to scheduling a procedure ranged from 2 to 22 minutes, and time spent registering patients ranged from 10 to 59 minutes. Factors that lowered scheduling time included efficient IT systems, using forms pre-printed with the CPT codes for the most commonly performed procedures, and working closely with physicians’ offices to schedule procedures. Time spent processing patients was lowest for a surgery center staff that worked closely with the endoscopist’s office staff, and that had patient consent forms completed at the physician’s office during the pre-procedure consultation.

-- Facility Time. The time patients spent from arrival at the facility until they were ready for discharge ranged from 81 to 243 minutes. Factors contributing to reduced patient facility time were: giving patients HIPAA and insurance forms prior to the procedure, having one nurse admit and assist in the procedure and recovery of the patient, using pre-printed pre-, intra- and post- procedure forms with minimal narrative, and pre-arranging transportation for prompt discharge.

-- Billing. Staff time spent for billing ranged from 2 to 30 minutes and billing days after procedure ranged from less than 1 to 11. Low billing time was attributed to charge sheets that included procedure codes. These sheets are checked off by the attending nurse and verified before entering into the system. Using billing software, staff familiarity with codes, and billing every day when procedures are finished also were associated with lower billing time.

-- Collection. Average time spent on collection ranged from 0 to 40 minutes and average days to collection ranged from 7 to 98. The least time spent on collection was attributed to careful coding, electronic filing, frequent checking of account status online, good rapport between facility staff and claims staff, having insurance contracts loaded into the IT system, prior verification of benefits, collecting patient co-pay prior to or at the time of the procedure, and patient pre-registration by business office staff to assure accurate information.

In general, patient satisfaction was high regardless of how a center performed on efficiency measures. When asked to rate their overall experience on a scale from 1 (worst) to 5 (best possible), more than 97 percent rated their overall experience as positive (77 percent at 5 and 21 percent at 4), 2 percent rated it at 3 (neutral), and less than 1 percent rated their overall experience at 1 and 2 (negative). Other highlights:

-- 94 percent of patients indicated their procedures were scheduled as soon as they wanted. 40 percent of patients had to wait past their scheduled procedure time, 32 percent waited longer than expected and 26 percent waited less time than expected.

-- 98 percent of patients said healthcare providers showed concern for their comfort; 99 percent said their healthcare providers listened carefully and showed respect for what they had to say; and 99 percent said their providers spent enough time with them.

-- 96 percent of patients reported they returned to their daily activities as quickly as anticipated. 99 percent of patients were satisfied with their comfort level after they left the facility

The AAAHC Institute is among the few organizations to provide ambulatory care providers with opportunities for benchmarking on a national level. The AAAHC established the AAAHC Institute in 1999 to provide ambulatory healthcare organizations opportunities to participate in quality improvement and performance measurement studies and educational programs. To date, the AAAHC Institute has conducted and published 22 clinical performance measurement studies and has convened annual national forums on quality improvement in ambulatory healthcare. Involvement in clinical performance measurement is a signal to patients, government agencies, professional liability insurers, and third-party payers, that an ambulatory health organization is concerned about continually improving the care it provides to its patients.

Source: AAAHC