Driving Efficiency & Throughput

Driving Efficiency and Throughput in the Gastrointestinal Endoscopy Suite The Impact of Contract Partners on Positioning Hospitals for Success WHITEPAPER

AMERICAN HOSPITALS AND HEALTHCARE SYS- Finding Opportunity in the TEMS ARE UNDER FINANCIAL PRESSURE DUE Current Healthcare Environment TO THE RAPIDLY CHANGING LANDSCAPE OF THE INDUSTRY. Increasing head counts, clinical Operating room and procedural-based expenses con- innovation, and population health initiatives are con- tinue to make up a significant portion of total hospital tributing to shrinking operating margins. Further operating expenses. Based on a 2017 National Health exacerbating this trend is a shift from volume- to value- Statistics Report, in 2010, 48.3 million surgical and based care, resulting in heightened pressure to deliver non-surgical procedures were performed, of which cost-effective care. As hospitals and healthcare sys- 25.7 million (53%) were performed in hospitals. Surgical tems assume increasing financial responsibility for the interventions on the digestive system accounted total cost of care, they must find ways to effectively for 10 million (21%), of which 7.3 million (73%) were mitigate this risk. endoscopy of the large intestine, small intestine, and polypectomy.4 One response to this pressure has been market consoli- dation in the form of hospital mergers and acquisitions. An opportunity exists to drive down procedural-based Analysis by the American Hospital Association (AHA) expenses by leveraging outpatient endoscopy suites. has shown hospital mergers and acquisitions have been Third-party service providers can serve as an effective successful in reducing hospital operating expenses by partner to improve performance in these endoscopy leveraging volume and scale to distribute the financial suites by providing clinical staffing support and supply 1 risk. But these actions alone will not be enough to chain management in this setting to facilitate significant combat projections of a negative operating margin by cost reduction, as well as support increased case volume, 2 2025 for a majority of hospitals, a forecast that predates enhance case tunrnover and throughput, and ultimately COVID-19. Pandemic-related trends already show increase procedure volumes. Notably, the application declining case volumes and rising labor expenses, with of third-party service providers to hospital-based and reported median operating margins falling to –8% in freestanding outpatient endoscopy suites represents March 2020 for hospitals nationwide, down from 4% a strategic and adaptive framework to improve both 3 in February 2020. As a result, the lion’s share of hospital patient care and the bottom line, which will be of ampli- leaders must continue in search of cost-reduction mea- fied importance as hospitals and outpatient centers sures and new revenue streams—again, particularly on begin to recover from COVID-19 and begin to practice the other side of COVID-19. in a new normal. The shift to ambulatory procedure areas may also increase as hospitals continue to grap- This whitepaper explores the key advantages of con- ple with COVID-19–positive patients and the general tract partnerships by first identifying industry trends patient population will not want to be admitted or visit and the challenges hospital leaders and managers face, hospital centers. and then by analyzing how third-party service provid- ers can help to drive down expenditures and increase procedural volume, thus boosting hospital revenue. Three Key Trends for Hospital Such analysis and operational strategies are of value Leaders to Watch to hospitals at all times, but will be of particular ben- efit during the “surge” in case volume from restoring Trend #1: Increasing regulatory requirements elective surgeries post COVID-19. The benefits of pur- lead to increased labor hours not directly related poseful insourcing reflect the experience at Ochsner to patient care. LSU Health Shreveport, as shared in this whitepaper, Health systems, hospitals, and post-acute care provid- where the endoscopy department benefited from a ers spend $39 billion annually to comply with no less targeted, continuous contract service solution amid than 629 discrete federal regulatory requirements. An a large health system merger. average-size hospital dedicates 59 full-time equivalents 1

DRIVING EFFICIENCY AND THROUGHPUT IN THE GASTROINTESTINAL ENDOSCOPY SUITE 8 (FTEs) to regulatory compliance, of which more than the needs related to direct care. However, the finan- 5 25% are physicians and nurses. The shift toward value- cial pressures hospital leaders are facing make further based care is a contributing factor to an already heavily increasing labor expenses unappealing. Moreover, regulated industry. In an era where hospitals are see- hiring additional non-clinical team members will likely ing shrinking operating margins, the potential financial not be looked upon favorably post COVID-19 when upside associated with value-based care programs can hospitals’ cash positions will be as tight as ever. The have a substantial impact on the bottom line. burnout and additional stresses caused by COVID-19 will most likely lead to earlier retirements, and that also The Centers for Medicare & Medicaid Services (CMS) means losing experienced staff. Hospital Value-Based Purchasing (VBP) Program financially incentivizes hospitals to meet certain per- As a result, increasing administrative responsibility is formance criteria centered around four key domains: shifted toward current clinical employees. In the AHA safety, clinical care, efficiency and cost reduction, and analysis of the regulatory burden, they found that the care coordination. The VBP program mandates that most burdensome regulatory activity was condition of 2% of payments for all participating hospitals be with- participation (CoP), the administrative work required to held then redistributed based on their performance. qualify for the Medicare program. Roughly 45% of the CMS announced that for FY 2020, the average net VBP CoP activities were placed on clinical staff, including 5 payment adjustment is 0.16%; however, the highest- physicians, nurses, and allied health professionals. It is performing hospital will receive a net increase in pay- no surprise that administrative burdens associated with ments of 2.93%, while the lowest-performing hos- documentation and the electronic medical record have pital will receive a –1.72% net decrease in payments. been cited as a contributing factor to provider burnout. The proportion of total hospital costs for patient care The Agency for Healthcare Research and Quality has accounted for by Medicare and Medicaid was 60% in dedicated significant resources to combat and prevent 6 2017. Considering many hospitals are operating on provider burnout. Nonetheless, burnout and employee single-digit margins and the significant proportion of dissatisfaction lead employees to quit, resulting in staff costs linked to these VBP programs, failure to perform shortages and increased responsibilities placed on or comply can dramatically affect the financial stability fewer employees. and viability of the hospital. In addition, poor outcomes related to lapses in infection control or other regulatory The known effects of provider shortages are delays activity can have a devastating effect on the bottom in patient care, increased rates of medical error, and line, especially for smaller centers who may not have decreased patient satisfaction. Hospital managers are the staff or expertise to keep up with the ever-changing left facing a catch-22: how to balance the administra- rules and regulations and demands for more advanced tive activities that are necessary to comply with regula- technology. As such, for the time being, hospital man- tory requirements and directly related to their financial agers and leaders have no choice but to meet these standing with the clinical and operational activities nec- regulatory demands. essary to fulfill their clinical mission. Traditionally, complying with regulatory demands has Trend #2: Lower-cost outpatient services combined involved hospitals hiring more employees or increas- with quality- and value-based reimbursement ing the demands and workload of current employees. incentives leads to increased volume demands Labor continues to be hospitals’ single largest expense, on capacity-constrained endoscopy suites. and the healthcare industry became the largest source Patient preference along with clinical and techno- of jobs in the U.S. in 2017 with little evidence to suggest logical advances have been driving a shift to out- 7 a slowing of growth. Most of this growth has been due patient procedures and services over the past two to increasing numbers of administrative and clerical decades. However, managed care organizations and workers, as opposed to clinical staff hired to address value-based reimbursement models also generate 2

DRIVING EFFICIENCY AND THROUGHPUT IN THE GASTROINTESTINAL ENDOSCOPY SUITE significant financial incentives that favor the outpatient Clinical quality has also seen improvement due to data- setting. CMS reimbursement for top gastrointestinal (GI) driven clinical standardization. However, in the race procedures, both in freestanding ambulatory surgical for value, hospital revenues per admission have seen centers and outpatient hospital departments, contin- a decline of 3.5% relative to non-merging hospitals, 1 ues to increase, while hospitals’ outpatient services rev- which is statistically significant. Trends in endoscopy enue almost doubled between 1994 and 2016.9 also suggest a declining volume in colonoscopy, upper 11 endoscopy, and flexible sigmoidoscopy. Value-based reimbursement incentives also focus on preventive and population health screening services In addition to the benefits of scale, the benefits of ver- with efficiency-based performance metrics. Together, tical affiliation and acquisition were highlighted. Value- these forces generate significant demand for out- based care incentivizes cost-effective care, which has patient services to be performed in a timely manner. resulted in a shifting of care to the lowest-cost setting. For many hospitals, this occurs without an increase in Vertical integration has become a way for systems to structural capacity or increased labor, and thus oper- effectively manage expenditures by internalizing deci- ational efficiency must be optimized in order to meet sions related to right care at the right place and time. target volume metrics. Again, these endoscopy suite Although ownership is the preferred arrangement for volumes will likely balloon even further in volume due optimal affiliation, hospital leaders emphasized the to the surge in rescheduled elective procedures post importance of business segment expertise and the role COVID-19. of effective joint ventures and non-hospital partner- 1 ships as a source of said expertise. Trend #3: Hospital mergers and acquisitions result in complex integration of systems and staffing models. Large health systems continue to dominate the U.S. Vertical integration has become a way hospital market with the percentage of hospitals that for systems to effectively manage are a part of a health system increasing to 66% in 2017.10 expenditures by internalizing decisions A database analysis of hospital acquisitions from 2009 related to right care at the right place to 2017 conducted by the AHA found that acquisi- and time. tion was associated with a statistically significant 2.3% 5 reduction in operating expenses per admission. Findings highlighted that volume and scale are key benefits to how mergers and acquisitions help miti- Given rapidly shrinking operating margins, hospital gate the increasing financial risk hospitals are taking on acquisitions and mergers focused on ownership and in the transition to value-based care. control will not be enough. In order to succeed, hospi- tals and health systems must restructure and redesign 5 The same study conducted qualitative interviews care by eliminating variation and reorganizing service 12 with hospital leaders. Although the benefits of scale delivery to avoid any unnecessary capacity. Tapping include consolidation, supply chain optimization, and third-party strategic partners to help take on some elimination of redundant administrative operations, of the human capital burden makes sense because it these activities resulted in only 1.5% to 3.5% savings shifts consumption of expensive resources like capital for hospitals. Leaders noted in the interviews that the equipment and repair service contracts for said capital true benefits of scale were realized through investment equipment to a risk-share model. in healthcare IT infrastructure that aids consolidation and operational streamlining. A key benefit to scale As the U.S. healthcare system continues to evolve and included mitigating the financial risk by spreading out markets consolidate, hospital managers will continue to fixed overhead expenses across increased volume. be pulled in all directions by competing environmental forces. These include the following: 3

DRIVING EFFICIENCY AND THROUGHPUT IN THE GASTROINTESTINAL ENDOSCOPY SUITE • Regulatory requirements take up more labor hours, workforce. Efficiency is critical in this environment. One leading to decreased clinical productivity and source of efficiency can be provided by third-party reduced employee satisfaction. service providers who can streamline processes and drive efficiency and throughput. For high performance • Value-based care incentives shift care to the out- to truly be a benefit to hospitals, it needs to be coupled patient setting and target population and preventive with the efficiency that contract partners are able to health metrics challenge capacity constraints. provide. Here are top examples of how contract part- ners can help hospitals. • Hospital mergers and acquisitions result in org ani- zational restructuring and corporate gov ernance Reason #1: Outsourced partners in endoscopy structure that can contribute to operational road- services improve throughput with timely and blocks directly impacting performance and care. efficient management of capital lease equipment and repairs. These challenges are present and will continue to be Technological innovation not only is critical to improved challenges that hospital managers face. Third-party patient care but also facilitates a hospital’s cost- service providers can offer support in adapting to these cutting efforts by shifting care to the outpatient setting. challenges. Advancements in endoscopic techniques and capabil- ities have resulted in the ability to treat and perform The continued challenge to find and fill positions with procedures in the outpatient setting. For instance, qualified candidates will also remain. It takes, on aver- gastric balloons can now be removed endoscopically, 13 age, 50 days to fill qualified positions, and that does without anesthesia or an incision. However, these not take into account the orientation and training gains can only be realized if the technology is available required to bring that individual up to speed to work to providers through adequate capital investment. independently. With any technology or equipment, repairs and main- tenance are necessary to seamless operations; there- fore, having an adequate amount of capital equipment Top Three Ways Contracted is as crucial as careful management of the equipment’s Services Position Outpatient repairs, inclusive of “repair and exchange” programs Endoscopy Suites for Success for damaged equipment (to ensure equipment is avail- able). Outsourced partners can help across all of these Current trends in the environment have placed signif- dimensions. icant stress and pressure on hospitals, and GI/endo- scopy suites are no exception. An increasing amount The financial impact of unavailable equipment is of time is spent on compliance as a result of regulatory often understated. As providers compete for scarce demands that are directly tied to quality and compli- resources, wait times increase for patients. Barriers to ance incentives. In addition, providers and staff are per- effective and timely management of capital equipment forming more non-core functions as a result of volume include the complex organizational structure and hier- demands. This leads to operational inefficiencies, poor archy common to hospitals and healthcare systems. productivity, and decreased throughput, culminating This is often exacerbated in large health systems. in longer hours and increased overtime leading to As reported by the AHA, the number of hospitals in employee burnout and turnover. This is a vicious cycle. health systems in 2017 was 3,494 (66%) compared with 10 3,259 (60%) in 2012. Managers may find themselves Hospital leaders and managers are searching for ways taking on tasks that they would not traditionally take on to handle more cases, schedule more patients, and (e.g., managing supply chain, scheduling patients, and keep up with regulatory, compliance, and quality met- vendor relationships) to limit head count. In taking on rics that directly impact their shrinking budget and these necessary activities, costly inefficiencies may be 4

DRIVING EFFICIENCY AND THROUGHPUT IN THE GASTROINTESTINAL ENDOSCOPY SUITE realized due to decreasing bandwidth of employees appointment, the more likely they are to no-show.14 and staff. No-show rates of 12% to 24% have been reported in outpatient endoscopy suites and contribute to 15 According to Alyssa Rapp, CEO of Surgical Solutions, underutilization and decreased revenue. According to a healthcare solutions company that specializes in pro- Branim, no-shows must be managed at Ochsner LSU viding minimally invasive surgery support, it is third- Health Shreveport because they are one of the biggest party service providers that are uniquely positioned barriers to productivity: “That is why keeping us from to obtain, maintain, and care for valuable capital lease being down a scope is a huge thing,” he says. equipment and their associated repairs through pre- ferred relationships with capital equipment manufac- As Rapp explains, ensuring timely repairs and access turers: “As a contract partner, we are very successful to replacement equipment is critical to the success of working with hospitals as an unbiased expert resource outpatient endoscopy. “Partnering with third-party ser- to help identify roadblocks to their efficiency and vice providers like Surgical Solutions not only improves throughput in the operating room (OR), many of which turnover for the patients being seen, but further offsets we can help them solve. When we partner in that con- increasing no-show rates,” she says. sultative capacity, we can be very impactful. We work in tandem with our partners to identify and address prob- Reason #2: Nurses and surgeons are able to lems.” For instance, by managing repairs and repair function at the top of their license, increasing contracts, there is an incentive for third-party providers hours spent on direct patient care and increasing to complete tasks expeditiously. This can prove very employee and patient satisfaction. useful to hospitals, especially during times of reorgani- Providers and staff spend increasing amounts of time zation like mergers or acquisitions. functioning outside of their license (e.g., doing more admin work), which results in decreased productivity, Case Study Insight. Ochsner LSU Health Shreveport operational inefficiency, and burnout (i.e., less satis- includes North Louisiana’s only Level 1 Trauma Center faction). RN staff no longer have to focus on shipping at its 452-bed hospital in Shreveport, Louisiana. With repairs, requesting loaners, tracking scopes, and wor- more than 3,400 employees and the Ochsner LSU rying about standardized procedure for high-level dis- Health Shreveport Physician Group of approximately infection and tracking scope use. Labor remains the 16 500 physicians, Ochsner LSU Health Shreveport serves single largest component of healthcare costs. The more than 135,000 patients with more than 600,000 vis- number of full- and part-time hospital employees con- its annually. When asked about the benefits of partner- tinues to increase, reaching 6.15 million in 2019.10 The ing with Surgical Solutions, Perry Branim, GI Director at AHA reported that more than 25% of physicians, nurses, Ochsner LSU, shares: “When a scope breaks down, now and allied health staff make up the FTEs dedicated to we get a loaner right away. That has been significant regulatory compliance. Quality reporting is a part of positive change for us. Through our own biomedical compliance and is also a significant performance met- department, it used to take weeks or even months to ric, especially related to endoscopy and OR procedures. get a loaner scope in. Or, by the time the loaner came in, The quality reporting burden is magnified by the tran- we would have already gotten the repaired one back.” sition to value-based purchasing models due to non- standardization of reporting requirements across models.5 Lack of capital equipment readiness can further neg- atively impact hospitals and endoscopy suites by Case Study Insight. At Ochsner LSU Health Shreveport, contributing to longer wait times for patients. Longer Branim experienced firsthand the challenges inherent wait times negatively impact no-show rates. A New to quality reporting when the outpatient endoscopy England Journal of Medicine article highlights the suite switched from time-based billing, as is typically correlation between wait time and no-show rates, in seen in operating rooms, to procedure-specific bill- that the longer patients wait to be scheduled for an ing. As a result, productivity in the GI/endoscopy suite 5

HOW EFFECTIVE PARTNERSHIPS SUPPORT EXCEPTIONAL, COST-EFFECTIVE HEALTHCARE switched to a procedure-specific benchmark of time dynamics are more consistent, and I like knowing what per patient. The current benchmark for a standard I have to do every day from when I walk in to when endoscopy procedure is approximately five hours per I leave. The training I received prepared me for the patient. Outside of the operating physician, the pro- daily challenges I face. Consistency and high reliability cedure utilizes a nurse and a technician. Based on the are built into every process we do, with the aim of pro- current benchmark, the nurse and technician can spend viding exceptional patient care each and every day.” two-and-a-half hours on each patient. Considering the perioperative check-in time, in-procedure time, recov- Hospital leaders and managers can utilize third- ery time, and transport time, this is a reasonable metric party service providers to provide necessary for a high-volume, streamlined endoscopy suite. labor that can be recognized as variable operating expenses not related to direct labor costs. Other As stated above, no-shows and cancellations are benefits of this type of strategic partnership include expensive, resulting in wasted capacity and lost reve- service-line optimization. As Rapp points out: nue. Screening colonoscopies can now be scheduled “At Surgical Solutions, technicians are cross-trained for without a referral or physician appointment, but still the operating room and endoscopy suites, enabling carry risks associated with bleeding, perforation, and them to own the processing of all endoscopes within medication complications, and can result in day-of a hospital, regardless of designation.” This flexible cancellations if not properly managed. Established pro- approach also supports the procedure areas, with vider means of mitigating this behavior include tele- technicians available to support bedside and emer- 15 phone reminders and preassessment appointments. gent procedures 24/7, often a sticking point for hospi- tals to achieve without on-call and overtime expenses. At Ochsner LSU Health Shreveport, Branim hired four full-time licensed practical nurses (LPNs) dedicated to Reason #3: Effective partnerships leverage scheduling and mitigating the risk of no-shows and knowledge and experience to facilitate the cancellations. Their work, as well as the time needed for implementation of clinical standardization and sterile processing by technicians, is not included in the best practices. five labor hours per patient allocated for the hospital’s Following are the top five Joint Commission require- productivity performance metric. Failure to meet this ments most frequently identified as “not compliant” benchmark is directly tied to financial reimbursement during surveys and reviews from January 1 through for the hospital, staffing, and budgetary support that is June 30, 2019: necessary to operating the endoscopy suite. 60% > IC.02.02.01 – The organization reduces the In this environment, service providers serve as a viable risk of infections associated with medical equipment, solution to help hospitals meet productivity metrics devices, and supplies. as well as improve employee and patient satisfaction. “It was by contracting out the sterile processing staff 56% > LS.03.01.35 – The organization provides and that Ochsner LSU Health Shreveport was able to recover maintains equipment for extinguishing fires. approximately 100 labor hours per week,” states Rapp. “These hours translate directly into technician and nurs- 52% > IC.02.01.01 – The organization implements ing staff spending increased amounts of time on their infection prevention and control activities. core functions and less on-call and overtime.” 46% > EC.02.03.05 – Maintain fire safety equipment A Surgical Solutions technician at Ochsner LSU Health and fire safety building features. Shreveport stated she is happier as a Surgical Solutions technician as opposed to working as a medical assis- 45% > EC.02.02.01 – Manage risks related to hazard- tant at a hospital-run outpatient clinic: “The work and ous materials and waste.17 6

DRIVING EFFICIENCY AND THROUGHPUT IN THE GASTROINTESTINAL ENDOSCOPY SUITE Third-party service providers add consistency and SURGICAL SOLUTIONS SERVICES AT A GLANCE expertise to sterile processing through consistent and reliable staffing. Moreover, third-party service providers To help your facility improve financial/operational serve as expert resources for hospital managers and performance and physician satisfaction with leaders. As infection control efforts and hospital audit- better OR management and greater efficiency, ing increase nationwide, having a reliable service pro- Surgical Solutions’ customized programs include: vider decreases the stress experienced by managers. Case Study Insight. At Ochsner LSU Health Shreveport, Expert handling of scopes and instrumentation prior to partnering with Surgical Solutions, one out of by highly experienced team members seven technicians took turns rotating in sterile process- ing. Repetition by Surgical Solutions technicians built Our CRCST technicians are on hand for every consistency and expertise, yielding greater certainty case. They’re accountable for: of the byproduct in endoscope reprocessing. While • Pre-, intra-, and post-procedure technical performing a routine audit of endoscopes, an on-site support Surgical Solutions representative noted poorly legible • SPD, decontamination, prep and pack sterile processing documentation. Through collabora- tion among Branim, the Surgical Solutions technicians, and an on-site representative, a sterile processing audit procedure and reporting system was created. Repair maintenance management As a result, data from the audit was reported to the infection control director on a monthly basis. A collab- Surgical Solutions assumes the logistical pro- orative relationship was formed where both OSHU and cess and cost of: Surgical Solutions work hand in hand to demonstrate • Instrument and scope repairs and dispos- compliance with all infection control standards for the ables for lap aroscopic procedures (e.g, endoscopy suite. trocars, cannulas, etc.) • Maintaining your contractual requirements “This audit initiative was not the result of a failed review for rebates through trace sales reporting or an attempt to meet new compliance standards,” explains Rapp. “It was the result of having contract experts embedded in the day-to-day operations who Access to capital proactively worked with the hospital staff to identify an unmet need and then utilized their resources and • Deliver the instrumentation and equipment experience to create and implement a solution that was to support all scope procedures in the OR valuable for both parties.” and endo suites Specialization for providers leads to efficient and • Acquire physician-preferred disposables and improved patient outcomes. “The same can be said for equipment technicians whose core responsibility is to sterilize and All services and products by Surgical Solutions process endoscopes,” adds Rapp. “Their expertise lends are charged on a price-per-case basis, trans- itself to identifying inefficiencies and gaps in the system, forming your fixed costs into variable costs. and they are dedicated to helping hospital managers perform well as it directly reflects on their organization.” Click here for a free on-site assessment to see how efficient your facility can really be. 7

Conclusion REFERENCES In the post-COVID-19 era, there will be increased pres- 1. Noether M, May S, Stearns B. Hospital Merger Benefits: Views sure on hospitals—and in GI/endoscopy suites, specifi- from Hospital Leaders and Econometric Analysis: An Update. AHA. Sept 2019. 2. Hayford T, Nelson L, Diorio A. Projecting hospitals’ profit margins under cally—to reschedule all of the cases that were cancelled several illustrative scenarios: working paper 2016-04. Congressional during the Global Pandemic of 2020. “The biggest Budget Office. Sept 2016. 3. Kaufman, Hall & Associates LLC. National Hospital Flash Report. April benefit of contract partnership post COVID-19 is the 2020. ability of hospitals to flex up their access to human 4. Hall MJ, Schwarzman A, Zhang J, Liu X. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. National capital, capital equipment, and repairs management health statistics reports. Feb 28, 2017. on a variable basis,” says Rapp. “This is the moment 5. Regulatory Overload: Assessing the regulatory burden on health sys- tems, hospitals and post-acute care providers. AHA. Oct 2017. to leverage partners like Surgical Solutions because 6. American Hospital Association 2019 Chartbook, Chapter 4. that can support hospitals and ambulatory surgery 7. Thompson D. Health care just became the U.S.’ largest employer. The Atlantic. Jan 2018. centers in their recovery post COVID-19.” 8. Kocher B. The downside of healthcare job growth. Harvard Business Review. Sept 2013. 9. Abrams K, Balan-Cohen A, Burbha P. Growth in outpatient care: The role Whether it is doing more running between cases or of quality and value incentives. Deloitte. 2018. 10. American Hospital Association 2019 Chartbook, Chapter 2. keeping everything moving as quickly as possible, these are benefits that drive greater consistency in ster- 11. Peery AF, et al. Burden and cost of gastrointestinal, liver, and pancre- atic diseases in the United States: Update 2018. Gastroenterology 2019; 156:254-272. ilization and high-level disinfection activities and help 12. Decline in utilization rates signals a change in the inpatient business providers to maintain consistency of operations, even in model. Health Affairs Blog, March 8, 2013. DOI: 10.1377/hblog 20130308.029038 the face of the maximum productivity anticipated and 13. New York-Presbyterian. Advances in gastroenterology and GI surgery. 2016. expected of clinicians in the post-COVID-19 environ- 14. Ryu J, Lee TH. The waiting game: Why providers may fail to reduce wait times. N Engl J Med 2017; 376:2309-2311. DOI: 10.1056/NEJMp1704478 ment. The case study insights from Ochsner LSU Health 15. Berg B, et al. Estimating the cost of no-shows and evaluating the effects of mitigation strategies. Med Decis Making. Nov 2013; 33(8): 976-985. Shreveport, in partnership with Surgical Solutions, 16. Gamble M. Where can hospitals find labor cost savings? Becker’s demonstrate a scalable model for hospital leaders and Hospital Review. Oct 2013. Available at: https://www.beckershospital review.com/finance/where-can-hospitals-find-labor-cost-savings.html. managers to emulate to address the surge in elective 17. Top 5 most challenging requirements for first half of 2019. The Joint surgeries post COVID-19 and beyond. Commission online September 4, 2019. CONTRIBUTORS ALYSSA J. RAPP CEO of Surgical Solutions Founded in 2007, Surgical Solutions V is a Chicago-based healthcare ANESSA BUIE, MD, MBA University of Chicago, Research Analyst, solutions company that provides Surgical Solutions mission-critical services to hospital operating rooms for minimally invasive surgeries. ANTHONY DAWSON, RN, MSN Chief Clinical Officer and Chief Operating Officer, Surgical Solutions Copyright © 2020 by Surgical Solutions. All rights reserved.