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This restart strategy can reduce year-end elective surgery losses by 65%

By Lauren LawtonTara Viviani

December 15, 2020

    In October, Advisory Board experts pre-populated several versions of the Covid-19 Elective Surgery Cancelation Impact Estimator with benchmark data. While these sample calculators incorporate a multitude of variables and are best used as a starting point to adjust before viewing results, the outputs of the average scenario can provide insight into the typical hospital's losses.

    Ready to restart elective surgeries? Here are 3 steps to prioritize your services.

    For example, we found that assuming two Covid-19 peaks from March 2020 to 2021, the average hospital could handle 82.9% of all canceled and new cases. This corresponds to notable elective volume and revenue losses:

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    Considering all hospital volumes, scheduled and otherwise, these figures represent a total year-end volume loss of 13.5% compared with a non-Covid year. This aligned with additional estimates from our colleagues who found that the average health system may end the year with between 87% and 91% of its typical capture assuming two Covid-19 surges.

    But these figures are based on a restart strategy where all services and visits are prioritized equally. And as nearly 100 hospitals have again postponed scheduled procedures, this raises a crucial question: How might a service line-specific restart strategy reduce year-end volume losses for the average hospital?

    We went back to our average hospital scenario to model it out. Our finding? The average hospital could reduce year-end volume loss 64.9% by strategically restarting and clearing key services. That's a change from 8,200 to 2,900 volumes lost.

    How we did it

    1. First, given bed capacity was the limiting factor for the average hospital in our Covid-19 cancellation and rescheduling model, we organized subservices by their total bed capacity contribution per volume. Unsurprisingly, outpatient subservices had a far lower contribution than inpatient subservices.


    2. Second, we pulled in the total number of backlogged, or canceled and to-be-rescheduled, scheduled surgery volumes per subservice from the entire cancelation period. To this, we added the new scheduled procedure demand per month, times the number of months in the restart period, by subservice. Altogether, this gives the total backlogged and new demand scheduled surgery volumes at the subservice level.


    3. Third, we sorted these subservices by least-to-greatest capacity contribution per volume and greatest-to-least total backlogged and new demand volumes. This resulted in an ordered list of strategic subservices to prioritize for maximum volume clearing.


    4. Finally, we went in order of this priority subservice list, allocating the capacity required to clear all backlogged and new demand volumes on the "Elective Restart Planning" tab of the Covid-19 Elective Surgery Cancelation Impact Estimator.

    What this means for you

    There are two ways this run can inform your strategic planning.

    1. First, if you have the data available to update the estimator with hospital-specific volume and bed ALOS figures, we recommend using the four-step methodology above to build a custom restart strategy for your facility.

      Please note that while you're clearing these volumes by subservice you will need to clear multiple subservices simultaneously to maximize surgeon and staff availability.


    2. Second, regardless of whether you have this detailed data or the time to analyze it, you can use our service prioritization list as a starting point in guiding your strategy.

      First on our list was all outpatient subservices with greater than zero backlogged and new demand volumes. This is due to the lower bed capacity contribution across outpatient cases compared to inpatient services, which makes rescheduling outpatient procedures imperative to reduce volume losses.

      Second, a handful of inpatient services rose to the top in our exercise due to their relatively high demand and low required capacity per case. We recommend members consider these inpatient services as top priorities following outpatient subservices. In our model, as we aimed to reschedule all backlogged and new demand cases for each service, we hit maximum capacity when trying to clear joint replacement surgeries:

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    In summary, scheduled surgeries can comprise over half of a hospital's annual revenue, but some hospitals have had to cancel months of these procedures. These realities are beyond control, but health system leaders can mitigate the impact of these cancellations by strategically prioritizing key services.

    Tara Viviani contributed to this post.

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