How will you address the backlog of postponed cases against the new, normal demand? How will you address supply, labor, and capacity constraints?
For many health systems, the answer is going to be prioritization. Leaders shouldn't expect to be able to relaunch everything at once, so you need to determine which services to prioritize immediately and which ones to phase in over time.
To effectively prioritize elective procedures, consider clinical urgency, strategic and financial importance, and the feasibility of safely performing the procedure.
Example variables to consider
Follow these steps to effectively prioritize elective services based on these variables.
Step 1: Tier elective procedures based on clinical urgency and position in care pathway
Start by grouping procedures into categories of clinical urgency to guide rollout timing. There are several options for grouping based on clinical urgency, including published guidance by the American College of Surgeons (Elective Surgery Acuity Scale and Medically Necessary Time-Sensitive (MeNTS) Prioritization) and CMS. Organizations can use a tiering methodology of their choosing; you may have even previously tiered procedures when canceling electives.
You should also weigh a service's position with certain care pathways. Some diagnostic services, for example, may not be considered "urgent," unless you consider their importance for identification of higher acuity services. So you might decide to restart imaging and lab immediately for some indications, including cancer and outpatient pre-surgical scans.
Step 2: Compare strategic and financial importance of elective procedures
Next, evaluate the importance of each service for system goals and priorities. For example, is a service a critical component of your strategic plan, key contributor to system reputation or brand, or core for any research priorities?
Then, determine the financial attractiveness and competitive opportunity for each service. Look at average margin per case to identify the most profitable cases. Consider pre-crisis market share to identify services where you have a competitive edge. Systems should prioritize services with existing high market share to ensure they can maintain market position.
Finally, evaluate if there is opportunity to gain a competitive advantage by restarting a procedure earlier. This may be the case in markets where competitors have paused a high volume of elective procedures, creating opportunity to convenience patients by offering the service sooner at your site.
Step 3: Assess feasibility of providing elective procedures
After prioritizing services based on clinical urgency as well as strategic and financial importance, determine how feasibly your organization can safely offer elective procedures, based on capacity, labor, and supply constraints, as well as testing availability.
Starting with capacity, consider the volume of cases backlogged and the new demand you expect once elective cases are resumed. Determine the average length of stay and procedure (OR) time per case and compare to bed and OR capacity available. Further, consider the probability that patients undergoing a procedure will require an ICU stay and weigh this probability against ICU beds available.
In terms of labor, consider the surgeons or proceduralists needed for each case and determine how much capacity these physicians have. Weigh whether an anesthesiologist is needed, and how many other members of the surgical team are required. Finally, consider the nurses needed for post-operative care.
For supplies and equipment, the main variables to consider are the availability of PPE and ventilators, but organizations may also consider the availability of blood, paralytics, and sedatives. Organizations should also ensure the availability of widespread testing for patients and staff at their facility, weighing the turnaround time for test results, and the impact on procedure scheduling.
It is important to note that the limiting factor for feasibility will likely differ by organization and even by service. For many organizations, limited PPE or staff and ease of new testing processes will be the variables most constraining the resumption of elective procedures.
Overall, organizations should start by understanding the feasibility of offering the most clinically urgent tier of procedures. Availability should be used to restart these cases first whenever possible, though current constraints may make simpler procedures more feasible for some organizations in the short- and mid-term. As such, the ramp-up process will require ongoing monitoring of case mix and capacity, with the goal of balancing clinical urgency with feasibility.
Summarize metrics from steps 1-3 in a prioritization grid to compare across elective procedures.
Example Prioritization Grid
Sample values shown below. Organizations should tailor based on available data.
Just released: Your checklist for resuming elective procedures
As state officials begin lifting elective procedure restrictions, health system strategy leaders should prepare plans to resume procedures. This guide outlines important factors to consider when developing those plans to help you pinpoint potential gaps in strategy.