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MEDICAL PRACTICE
STRATEGIES & ISSUES

Enhancing Productivity

By John Spiekerman

Gastroenterology Consultants of San Antonio (GCSA) is a large, diverse physician practice offering all
areas of gastro-intestinal (GI) care. Like most physician groups, it excels at patient care and delivers
service that is frequently recommend to friends and family without hesitation. The typical struggle with
a physician practice is to gain alignment regarding the most valuable activities.

In the practice of gastroenterology, working in an ambulatory satisfaction are up significantly. Physician owners are more pro-
surgery center (ASC) and using a snare and other techniques to re- ductive and efficient.
move polyps to improve patient health is the most desirable part of but why? What was done that made this change successful?
patient care. Most GI physicians prefer procedures in an ASC set- How did this situation develop? It is very well-documented that
ting over seeing patients in clinic. The preference is logical, since efficiency is valuable. Efficiency is about doing the same with
the ambulatory setting offers more medically interesting work, de- less. Improving labor efficiency to produce the same level of
livers the satisfaction of seeing results in a short period of time, output in less time translates into profitability because the com-
and involves less paperwork. The challenge is to define, communi- pany spends less. The challenge is to figure out how any physi-
cate, and manage an expectation of business performance in this cian practice gets into a situation where valuable areas of the
key area of the practice. business operate at a loss.
All practices, including GI, struggle with individual management Physicians are well-educated leaders of patient care. They
of schedules to maximize providers’ personal satisfaction or pro- communicate with patients and staff constantly, but the business
ductivity. The consequences of a schedule that ignores business ef- communication back to them is all too often limited to a sum-
ficiency causes a very expensive ripple effect throughout the mary of monthly charges and a profit and loss statement. GCSA
practice. GCSA has been able to recognize the cost of inefficient found itself operating areas of the practice at a loss because of
scheduling and began working to better utilize resources more effi- a lack of communication about the financial reality of a specific
ciently. service. The lack of communication was not intentional, and the
The communication of the costs and benefits of a change were overall monthly financials being reviewed by physician leaders
presented in the form of break-even analysis. It was very easy to looked healthy.
get a unanimous consensus not to operate an ASC room unless op- We had failed to look at the business operations on a daily
erating costs could be covered. As a result, ASC rooms would only basis. So daily schedules were broken down to manageable
be available to physicians who had enough cases to cover the cost pieces. The most basic measure is per physician, per room, per
of operations. The data would be tracked for all physicians at all day; breaking the business operations down into pieces that could
locations and reviewed weekly. be measured and understood by everyone. Once the facts were
It was no simple task to communicate to physician owners that understood and seen by all, the solution was very clear – consol-
they would not get the time they wanted! The collaboration be- idate some ASC rooms together and close others. Consolidating
tween leadership, spearheaded by physician owners holding each schedules is a very normal part of managing a business, but a de-
other accountable, teamed with clear, simple communication tail that can be easily missed. It was a very basic change that was
about the why, and a plan to track results was crucial to the roll- successful because of simple, actionable data implemented with
out of the change. The results have been subtle when looking at physician leadership.
the practice on a daily or weekly level. However, the results, when
consolidated on a monthly and quarterly basis, are impressive John Spiekerman is Executive Director of Gastroenterology Consultants of
from this very simple change. Most importantly, patient and staff San Antonio.

24 San Antonio Medicine • January 2020