Hard Times – Hard Costs – Hard Labor


Dr.Fisher with his surgical assistant, anesthetist Sarah Collins, C.R.N.A.

Many surgical centers are closing their doors during these hard times. You may ask why – are the doctors not rich enough? Some are and do operate at a loss, hoping for better times to come. Others, usually smaller and less successful outpatient centers are left with no choice vis-à-vis the dearth of patients – in the world of ever-rising expenses.

Operating room (OR) charges are perhaps the most important singular charge any hospital has to consider. In larger hospitals, it is scheduled into “blocks” to be used by particular surgeons and their teams. Larger hospitals also have so-called “overflow” block time for a surgical group’s cases that cannot be completed in the regular block time allocated to each surgeon in the surgical group. Having such overflow block time increases OR utilization. The optimal way to schedule patients into a surgical group’s overflow block time is unknown. Hospitals constantly strive to maximize the efficiency. Current strategy focuses on: (i) 2 week advance scheduling into any overflow block; (ii) a “first case of the day” start time and priority; (iii) maximum scheduling not exceeding 4 weeks; and (iv) encouraging the surgeons to perform the cases on the earliest possible date(s). This can be difficult because the whole surgical team must be in place on scheduled time.

 In a smaller hospital, such as the Surgery and Laser Center at Center Court Drive, scheduling surgery is very similar. Although we do not perform as many surgeries as larger hospitals, our OR expenses are equal, if not greater, because we provide equal care and conditions, which means not only the necessary scheduling, staffing, pre- and post-operative care, but also the supplies and maintenance, which the patients do not see. These entail not only running costs for anesthesia equipment, vital signs monitors, vaporizers, respiratory aids and ventilators, electrocautery, medical warmers, infusion pumps, surgical lights with special halogen lights etc. but also simple replacement of oxygen tanks, sterilization of instruments, light handles, machines, disposal of medical refuse, as well as cleaning of the room pre- and post-surgery can be extremely costly. Naturally, labor time for highly-skilled and well-trained staff is comparably high. Even the most economical OR cannot be operated at less than $1,500/hour – plus labor time for the surgeon, anesthetist, 1-2 skilled surgical assistants, and a scrub tech…

Thus, it is usually more economical on the part of the patients to opt for several procedures at the same time, such as liposuction and breast augmentation, because this reduces the maintenance costs for the above-stated backup and equipment: where the performance of liposuction on one patient, and breast augmentation on a different patient would require post- and pre-operative maintenance, this gap-time is eliminated if the patient chooses to undergo several procedures.

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