Improving the Patient Experience: Best Practices for Pre-Assessment Workflows

Ep. 125: Improving the Patient Experience: Best Practices for Patient Pre-Assessment Workflows

Here’s what to expect on this week’s episode. 🎙️

Pre-assessments make — or break — your day, and with an industry case cancellation rate of about 21%, ASCs have room to tighten this key step in the patient’s surgical journey. In this episode, Grant Duncan and Marta Shultz join the show to share what actually works: 

• Outreach cadence: why ASCs should start 4–6 weeks pre-op, with reminders at 2 weeks & 10 days and prep texts 8 days & 1 day before. 
• Frictionless UX: secure no-login links (with simple DOB verify) + two-way texting. 
• Smart forms: short with branching logic; reuse data for repeat patients; capture allergies and meds (GLP-1s, anticoagulants), key history, preferred name; offer multi-language support. 
• Safety nets: auto-flag risks to clinical queues/dashboards with clear owners. 
• Fewer calls: free nurses from phone tag and save on overtime. 

And KPIs to track: 

• % completing forms before day-of & days-to-complete 
• # of flagged issues & time-to-follow-up 
• Cancellation rate due to missing info 

Listen to the full discussion on your favorite podcast platform or watch on YouTube for even more even more strategies and considerations for reimagining your patient pre-assessment workflow.

Episode Transcript

Alex Larralde: All right. Welcome back to This Week in Surgery Centers. Today we are continuing our conversation on the patient experience and digging into a topic that directly affects both patient outcomes and operational efficiency. And that is pre-assessment workflows. Pre-assessments are one of the very first touch points that a patient has with your ASC, and when they’re done well, they ensure that the patient arrives prepared. The care team has all of the information that they need, and your schedule runs smoothly.

But when they’re done poorly. That leads to confusion, cancellations, and a whole lot of stress on both sides. So, to help us unpack what good looks like and how centers can optimize this part of the surgical journey, I’m joined by two of my fantastic colleagues from HST Pathways.

Grant’s a familiar face, and he’ll introduce himself as well, but Marta, you’re new here. Tell us a little bit about what you do at HST.

Marta Shultz: Hi. Well, thanks for having me. My name is Marta, and I’ve been at HST three years. I’ve worked in implementation and training, but now I help out our sales team as a clinical sales engineer.

Alex Larralde: Yeah. Thanks for joining us. And Grant, if you could remind everybody what your role is, that’d be awesome.

Grant Duncan: Yeah. Hey there. I co-host this podcast and lead marketing and sales development at HST.

I enjoy working at the intersection of healthcare and technology and ultimately for us, helping ASCs become more proactive in their operations. We have a fun vantage point of being able to advise and learn from our 1700 plus customers, and so we can cross-pollinate those learnings across centers.

Alex Larralde: Well, I’m so grateful to you both for being here and joining me in this discussion. Making sure that the patient experience is dialed in is super important, especially as the industry is poising for so much growth, hopefully over the next few years with these big CMS changes coming out.

So let’s jump in and I would love to know from both of you. Why do you believe that pre-assessments play such an important role in shaping that patient experience? And maybe Grant, we can start with you.

Grant Duncan: Yeah. The first experience a patient has with your ASC is probably a text, an email, or a phone call from the ASC.

And that text or call is probably for a pre-assessment or asking them to pay their estimate upfront for their surgical procedure. And we all know first impressions matter. So having an easy-to-use process for the pre-assessment is important. On the flip side, you know, if it’s hard to fill out the pre-assessment, the patient’s probably going to get annoyed at the ASC, and you might even see that reflected later in your OAS CAHPS results.

Last thing I’ll mention is the pre-assessment is also going to ensure that the patient arrives fully prepared for surgery. And if they do that, it’s going to reduce case cancellations as well.

Marta Shultz: I always like to look at things from that patient experience, and nobody likes to answer those same questions over and over again.

It makes patients especially question your competency. If you ask them those same questions again and again. In many ASCs we see repeat patients. If you do a cataract in one eye, you’re most likely doing a cataract in the other eye. Pain patients can come back, every couple weeks, GI patients can be frequent visitors as well. And especially if their experience is positive. If it’s not positive, they may not be repeat, and that’s even worse. So, we want the patients who complete a pre-assessment to see that that information was incorporated into their visit when they arrive. And it can be as simple as asking what they prefer to be called.

So that they know when they walk in, if they prefer to be called Keith instead of Martin, they get called Keith from the time that they hit your door. We’re not having to review a long surgical history or list all their medications again and again, which can kind of make them feel not only a little intimidated, maybe even a little sad, and definitely not heard.

Alex Larralde: That makes sense. And so, sticking with you, Marta, you have a lot of experience working directly with centers and seeing firsthand what their existing processes look like when we come in to improve things. So, what happens when this process isn’t smooth, or you are asking repeat information?

Marta Shultz: I think we have to remember, especially from a healthcare perspective, we work there every day. It’s not nerve wracking for us to walk in, but if you’re a patient, it is, they’re stressed, they may be confused. But if there’s missing documentation, if there’s unflagged comorbidities, it can cause a delay in the procedure, it stresses the patient more. It causes staff burnout because they’re playing catch up with the phone calls or incomplete forms instead of paying attention to the patient, which is what everybody went to school for not to worry about their documentation.

I mean, I’ve seen cases where every nurse has to stay late to get the pre-op calls in for the next couple days, and I can’t even imagine what that costs in overtime. Most of that could have been handled by a patient with a text message and a link to a survey to complete it. Their convenience. I’ve seen patients where I’m asking them what their meds are and they forget important meds, and with the rising use of these GLP medications for weight loss, if a patient forgets to disclose that and they show up day of.

Most often that case is canceled. And so that leads to frustration on the patient’s part, loss of revenue, et cetera. Because there are other patient comorbidities that can influence or deny that scheduled procedure. And then there’s just comfort measures there as well. Making a diabetic patient remain, NPO all day isn’t practical, but knowing a week or more in advance that they’re diabetic may actually have you change that schedule. And so having that information can make everything run smoother and definitely decrease delays.

Grant Duncan: That’s such a great point. Especially if the block is within the same surgeon, that’s way easier to just move the case.

Marta Shultz: Yes.

Grant Duncan: If you’re able to see that in the pre-assessment early enough.

Marta Shultz: I haven’t seen anybody put hangry on there, but I wish they would.

Grant Duncan: Yeah, that’s funny. Alex, what’s your take on how strong pre-assessment workflows support the broader operational success at an ASC?

Alex Larralde: Yeah, that’s a great question. I think there are a lot of implications for all metrics within an ASC if you’re not nailing this process. One of the biggest ones is probably, case cancellations like Marta mentioned.

When people are showing up and you don’t have complete information, that puts your schedule in jeopardy. We found in our last state of the industry report actually that the ASC industry case cancellation is about 21%. And so, a good analogy here would be, you know, not getting your every fifth paycheck.

And that would not be great. So, I think, when you have cancellations that are related to patient info, that’s really easy to rectify. Implement a really strong process here to make sure that you’re at least not losing out on revenue because you didn’t clarify medications or get this information in advance.

Grant Duncan: I like that analogy of missing every fifth paycheck. But what probably makes the analogy even worse is it’s unexpected.

It’s not like you can plan, okay, this 21% that going to no show, it’s this paycheck and it’s this paycheck instead. You have no idea, and it’s just going to be a random one.

Alex Larralde: Absolutely. I just think about all of the staff, the nurses, all of your people there, ready to perform a surgery and we didn’t know they were on GLP-1s, right. And so now all of that money wasted if they can’t work.

So, Grant, back to you, actually.

When we’re thinking about digital tools and how we reduce the phone calls, because nurses did not usually go into healthcare to make phone calls. At least I haven’t talked to any that have.

What does a really strong pre-assessment workflow look like? What are some of the best practices that we’ve seen work well?

Grant Duncan: Yeah. So, I’ll share what we’ve seen in talking with hundreds of ASCs about this. The first step in the workflow that we see is to first choose a secure platform for pre-assessment surveys that can send texts and emails and integrates with your EHR.

Then once you’ve got that tool, then design a comprehensive pre-assessment form. They’ve got form builders usually and make it so that it can capture all the necessary patient details and ideally use an elegant user interface so that it doesn’t look like it’s too old.

Once you have that pre-assessment survey built, test it internally, grab a couple colleagues, ask to send it to their phone number and see how it shows up, and then when it’s good to go, maybe you’ve made some changes after that.

Then you can start sending the electronic preassessment. Form link to the patient either via email or text. We’ve seen that it works better for surgery centers to send this in text format because people respond more quickly and more often through text. But either can be options. Now in your backend setup on your side of the tool, we also suggest setting up reminder messages to go out to encourage the form submissions. So, if no response, then follow up with another text. If still no survey completion, then follow up again.

And as the forms are submitted by the patients, have your clinical staff review them for completeness and accuracy. Just like you would have the nurse review them if this was over a call. You want to still have them review it from the submission.

But of course, it’s going to be a lot less time for them to scan through the digital submission rather than have to go back and forth live on a call. And if they do find discrepancies or maybe there’s additional clarifications needed. In their review, then we suggest reaching out to the patient directly.

You could do that through two-way texting, which is built into most pre-assessment survey tools, or you could just call them directly. What we see a lot of centers doing is calling to get that clarification so that they can get the nuance if there is any.

Another workflow setup item that we’d suggest is configuring automatic flagging so that certain form submissions or text responses flag the appropriate clinical or business office staff. That way, those really important allergies or other things that you want to make sure people see, it’ll automatically pop up into a queue and get a flag, so, you know, these are high priority ones to, to look further into.

So, these would be what I’d say would be the most essential items to include in your pre-assessment workflow.

Alex Larralde: That makes sense. That’s great. Thank you.

Marta. Is there anything you would add here? Any, any other things you would throw on that list?

And then my second question would be, as you’re talking to ASCs, what are you looking for to help them configure this setup and strategize what their approach is going to be?

Marta Shultz: Yeah, that’s such a good question because I often start with two things I’ll ask especially when I was in the implementations, I’ll ask, what are you asking patients now? So, I’ll start with their form. What do you have on that form? Let’s take a look at what you’re asking. I’ll also ask about, if they know reasons for cancellation currently. Because, you know, GLP medications two years ago was not really much of a factor, but they certainly are now.

So, we start with the form, and we ask them, are we asking those right questions? But I like to make sure that we don’t overwhelm the patient. Nobody wants to fill out a 50-question survey. So, what’s more important, and then I move to the automation. Are the reminders spaced out? Are keywords being flagged for risks, so that you know that you’re catching those when you’re reviewing them and getting that information?

And then, even though we’re talking about automation, it’s very important to ensure that those follow-up tasks are assigned to specific staff, so nothing falls through the crack. It doesn’t help if every patient fills it out, but nobody looks at the information. Those are some areas I like to start with.

Alex Larralde: That makes sense.

Grant Duncan: Alex, question for you. Do you think it matters if patients have to log in to access the pre-assessment form, or do you have different takes?

Alex Larralde: I actually have a pretty strong opinion here as a user of technology and a patient who has had surgery. I do think that like many centers and customers that we’ve spoken to, it is a barrier to have to log in.

It’s a barrier to have to log in to just about anything, but especially something that you only use once or twice in your lifetime. It’s a challenge for people to remember, passwords, to go back and complete information. They get discouraged by the reset workflow.

So truly the best approach here to try to get people to actually fill it out and complete the form would be to send some sort of secure link or have them provide simple verification information like a date of birth. We’re meeting HIPAA standards, but it’s not burdensome for the patient, and you’re increasing the likelihood that they do what you want them to do and they’re not dropping out of that process.

But I’m curious from Marta’s point of view, what kind of questions should we put on this form? We don’t want to make it too long, right? We don’t want to make it so oppressive that people just opt out. But what’s that balance and what do you think we should prioritize?

Marta Shultz: I mean, there’s certain things that definitely impact your visit, and so there’s critical medical information that you want to have.

Allergies. You want to make sure that you know that patient’s allergies. Last thing you want to do is give them something they’re allergic to. Then you know their medications. Because the GLP, but there’s other medications, anticoagulants, et cetera, that could impact whether you have a procedure when you should stop taking them, which might prompt a anesthesiologist or a nurse to call and let you know when to stop taking that. There’s a very delicate balance with blood thinners, et cetera. So those are some areas that I definitely want to see significant surgical history. It could be helpful. Do I need to know you had your tonsils out at five? Maybe not, but I may need to know that if you had a very bad reaction to the anesthesia.

Those are the type of things that I want to ask, and I think it’s important to be able to mark some questions required. So that, you know you’re getting that pertinent information. And then I also love the idea when you answer a question a certain way, if it triggers you for a question, because that trigger can make you not feel like, oh, there’s this huge list.

Because, if you never drink alcohol, I don’t need to know how often, how many and what kind, right? Or if you don’t smoke, I don’t need to know what it is. But if you do smoke and then you tell me you have COPD, somebody needs to talk to you before you come in for a general anesthetic.

Alex Larralde: Mm-hmm.

Marta Shultz: Those are, those are the kind of things that I like to look for and how I like to use technology to trim that list.

Grant Duncan: Marta, I’m curious, you’ve worked in multiple healthcare settings in the past. I believe one of them was in quality and risk for a hospital, what were some elements you saw there that are pertinent?

Marta Shultz: I love that question. And Grant, I’m going to use myself on the patient side and the quality and risk side for that one because, allergies — when I keep mentioning that. People can have a very long list of allergies, they may not think to mention all of them. When you’re asking them on the spot, but if you give me time to fill out a form, I’m going to make sure that I have them all listed.

And sometimes people don’t think, if it’s not a medication, it’s not pertinent, or if it’s this type of medication, maybe it’s not pertinent. But they’re all important. And from a risk management standpoint, you never want an adverse outcome for a patient. Obviously, you know, from litigious purposes, but mostly because everybody comes to work wanting patients to go home safe from an ASC.

But if somebody has an allergy, and they forgot to mention it, and you end up giving a medication that you might have picked up had you known that? I just don’t understand why somebody wouldn’t be asking that and giving the patient time and comfort to answer that versus on the spot when they’re already nervous in your facility.

 I’ve been that patient. I’ve received a drug I was allergic to. I’m happy to say that I’m still here to talk about it, but it just seems like a no-brainer and yet it’s still a problem in healthcare across the world.

Alex Larralde: Yeah. I have to say, when I had surgery, Marta, I was so much more nervous than I thought I would be. I couldn’t think straight. I was so glad I had somebody there to help me organize things. That’s a great point. People are not thinking about those things. They’re thinking, am I going to wake up from anesthesia? What’s going to happen? Where am I going to go? You know?

Marta Shultz: I joke that it smells different when you walk in as a patient, versus when you walk in as an employee. It does, and I think it’s the smell of fear.

Yeah. We want people to be comfortable, and part of that comfort is having that assessment already woven in, so you feel seen and heard when you walk in that door.

Alex Larralde: Yep.

Grant Duncan: Very true.

Alex, what’s your view should texting be one way or two-way texting?

Alex Larralde: I really think that it needs to be two-way. I think that if you’re opening up a channel to somebody and saying, I’m going to communicate with you in this channel, then the expectation is that they can communicate back to you. So I think nothing’s more frustrating than getting like an email from a no-reply email address, but you really need to reply, and you don’t now know how to do that.

I think texting is the same way. It’s important to have that option, but additionally, you need to really think about who’s going to be reviewing those communications and responding to them if you open up that capability. So, I think it’s all part of the consideration of your strategy.

What channels are we going to facilitate? Can we commit to have that be a two-way communication channel? Can we provide the resources needed to actually respond to those patients in a meaningful way?

But I think you can take a cue out of any consumer marketing playbook, right? Like, we really want to make it easy, remove barriers, ensure that people are calling, texting, whatever, so that we don’t have to cancel cases at the end of the day.

Marta, back to you as we’re talking about patient responses. So, people are filling out the pre-assessment form. They’re getting this data back to the ASC. What should the staff be flagging and looking for in those patient responses?

Marta Shultz: That’s great because there’s definitely some things that everybody’s going to flag… shortness of breath, right? If somebody reports that they’re short of breath, I don’t care what type of anesthesia you’re going to have or if you’re not having anesthesia, we want to do that. And I was thinking about this as we’re talking about, it’s not just about cancellation of cases, it’s patient safety.

We cancel cases to keep them safe. And so, shortness of breath, chest pain. Some should be specific depending on the ASC specialty, for they have latex allergy, be another one, uncontrolled diabetes. Risk of infection goes way up with that, if it’s not controlled.

Those are some things that I would flag. And again, having that ability to create custom flags depending on your specialty, what procedures, what type of anesthesia, is really important.

Alex Larralde: So, when those do come in, there’s some follow up that needs to happen.

Marta Shultz: Right.

Alex Larralde: How do you notify the right staff that something was flagged? What does that look like?

Marta Shultz: Ideally, right, the system needs to route those alerts into clinical cues or dashboards.

And this is where we go back to technology does not replace clinical assessment. And so, it’s very important to assign that ownership. If we have a flagged bleeding risk that somebody’s on an anticoagulant, that needs to notify a pre-op nurse and a clinical lead and potentially anesthesia, so that that’s there, so that that can be assessed, we could communicate with the patient about when to stop taking those anticoagulants, or even if they can. So those daily checks to make sure follow up is happening in real time. It’s critical that has to happen. But it also needs to make sure that clinicians following up with the complex patients do not burn out, taking shortcuts when talking with patients.

And unfortunately, I’ve seen that in a few facilities, where they’ll have the right questions, but they’ll ask something and just move on without taking time for each of those. That’s where having those flags so that when you’re calling and you’re looking into, patients that it’s critical for their safety, that makes a better experience for both the patient and for the clinical staff.

Alex Larralde: That’s great. So, Grant what’s your opinion on the best timing for this outreach to take place? When should ASCs start talking to their patients?

Grant Duncan: What we see as best practice across centers, is to start outreach ideally four to six weeks before surgery. If it’s scheduled sooner than that, then of course just send it right away. This gives time to find issues if there are, and then if it’s incomplete, then send follow-up reminders. I’d suggest at least two. One about two weeks out, another about 10 days prior. If it’s still incomplete, then escalate to a phone call.

That way you can try to really get them on the line before. They have to come in. And I’d also suggest sending texts about how to prepare for the surgery eight days before and one day before, that they prepare properly. For some medications now, you have to stop taking them a week prior. So that’s why the eight days is one of the reminders and beneficial more than just doing the one day before.

Most pre-assessment survey tools allow you to send texts, not just with a survey link, but also reminders like that. So, those would be the general guidelines for what we see as best practice for timing.

Alex Larralde: And I guess these questions are really for both of you to jump in, but I’m curious, should in your opinion, a center stick to one form, a universal form, should they create multiple? What should that look like?

Marta Shultz: I think, you know, a lot of facilities, could benefit from just using a universal pre-assessment form, especially if you have a lot of smart branching logic, meaning depending on the response, it triggers a second question.

But there are unique cases where you are going to need an additional form. Pediatric patients. If the age is than 12, very different considerations sometimes for those patients than for adults. High risk specialties. We’re seeing a lot of cardiovascular, where you’re going to see a lot more patients on anticoagulants than you might in some other areas. That would be helpful to break those out.

But again, you want to keep it streamlined. So, I’d much rather have a second form that I could trigger based on the patient population or the procedure, than to just have a very lengthy form that’s not relevant to everybody.

Alex Larralde: That makes sense. Yeah. Because you have one form and you’re multi-specialty, there’s just potentially lots of questions patients are trying to skip or not sure if they should answer.

Grant Duncan: Another piece that I’d add to that is that you should also think about how to handle language, because you’re not always going to have patients that only speak English. So, I’d suggest choosing a tool that auto translates the pre-assessment form into multiple languages. Many of them can do dozens and dozens of languages just automatically, so that way the patient can read it in whatever language is relevant to them.

Marta Shultz: That’s so important. From a regulatory perspective having somebody on your staff that speaks the language but not listed as a valid translator isn’t always acceptable. Because translating medical terminology is very different from talking to your Nana in Spanish.

And so that’s why it’s often required by regulatory bodies that you have a translation service. So having those pre-assessments, having them answered, then converting them back to English for those poor souls like myself, who only speak one language, is really helpful.

Alex Larralde: Yeah, absolutely. This has been awesome but I want to talk about, where the rubber meets the road, the next steps for somebody who recognizes this is a gap, I really need to streamline what I’m doing here.

Grant, if a center wants to improve their workflow, what do you recommend is the first thing they do?

Grant Duncan: The first suggestion I would have is. Take a current state assessment. Just evaluate, ‘hey, where are we today?’ If you don’t have a tool to do these pre-assessments via text or email and you’re doing all calling, then I would suggest your first step be evaluating a few pre-assessment tools.

The main ones you want to look at that are ASC-focused. Are us at HST One Mnet Health, and SIS, if you do already have a tool, then I’d suggest appointing someone to evaluate your workflow against some of the items we talked about today, such as the automatic flagging, the sending schedule, if you’re doing one-way versus two-way, the follow up, et cetera. Just think back to what we talked about and say, okay, let’s evaluate some of those. And identify, where is the friction, where could we improve? And then you have a roadmap to make changes. Marta, would you add anything to that?

Marta Shultz: I’d love that. And I think one of the things when you said evaluate your current state, I think so often people start with a form.

And years later, nobody’s looked at it to see if it’s still relevant and everybody’s just skipping a certain question. A good example lately has been, it’s not that COVID has gone away, we still ask if you’ve been sick in the last five days, but we don’t get as specific, very few centers are asking about COVID, vaccinations, et cetera, anymore with their patients.

So, take a look at those forms, see if they’re still relevant and update, based on what’s happening in your facility today.

Alex Larralde: What performance indicators should they be tracking as they’re thinking about measuring improvement, for implementing this process, what would you recommend, Marta?

Marta Shultz: Because I come from a quality and risk management background, all of them. But no, I would say, not all of them, but there are some, that I would love.

I’d like to know the percentage of patients who complete the form before the day of, and how far out they’re completing that, because that may change how often I send it. The average time from when that form is sent to when we get it back, do patients need just a day or is it taking them a couple days to get it back? The number of flagged issues because that’s going to probably assign how many people, I’m looking at following up and calling. The time to follow up on those flagged responses. If somebody sends me something that flags, I need time to evaluate that and not frustrate them with the day-before cancellation. And then, last but never least, is that cancellation rate related to missing information. How often do they fill it out? But we get there and there’s something that’s said, that maybe changes what happens for that procedure that we could have captured in that form. And that goes back to evaluating how long has it been since you looked at your form.

So those are just a couple. But I love data. I could add tons more to that.

Alex Larralde: That’s great. Those are super helpful KPIs, and I hope everybody listening wrote them down because that’s a great list to start with.

Grant Duncan: Alex, I mentioned a couple of suggestions, and Marta did as well. What would you add, let’s say if a center is still doing their pre-assessments all via phone calls?

Alex Larralde: If you want to take your efficiency from zero to 60, eliminating those phone calls is a huge step. It’s so time-consuming. Honestly, people don’t really answer their phones so you’re going to voicemail now you’re playing phone tag. That’s not what nurses want to be doing. If you’re looking to free up nurse time, streamline some of your operational metrics, get better data… there’s just so many upsides to switching to a digital process here.

Marta Shultz: I think that’s absolutely true. And one of the things that I would maybe say, if you’re not doing it, ask three or four of your patients when they come in, would you have preferred to do this over text?

When you’re calling them, would you have answered this over text or email and see, because I’m willing to bet the majority of patients would’ve answered yes to that. That they would’ve said, yeah, I’d like to do that. And then ask, go ahead and ask your staff. How many of you would prefer to only call patients with a problem versus every single patient?

Grant Duncan: Sometimes ASCs who serve populations of patients that skew older are concerned thinking, well, they’re not going to text. But I know a lot of elderly people who actually do communicate with their grandchildren over texts and email. So, sure, maybe the percentage is a little lower than someone in their forties, but there’s still going to be a high percentage that are going to be willing to do it.

Marta Shultz: Grant, I always use my cousin as an example. She would not text, she didn’t want any part of it. And then she got a grandchild. And she wanted those pictures over the phone. And now, that woman texts me almost every day. So, absolutely. And I’m probably in that population you’re thinking about, and even I can text with my thumbs now, so we…

Alex Larralde: Digital adoption is here. I think we’ll find that more and more that, that’s less of a concern for sure.

Marta Shultz: Very different answer. Five years ago, very different than there would be today.

Alex Larralde: There’s one thing that we do every week on the podcast and I’m going to ask you both and then I’ll answer it myself.

But what’s one thing that listeners can do this week to improve their surgery centers? Marta, I’ll start with you.

Marta Shultz: I’m going to repeat an answer only because I think asking your staff and asking your patients, first of all, everybody feels important when you ask for their opinion. Getting their opinion about this or anything else, and then using data to either, find out if that’s valid or not, is probably the best way you can start improving your ASC.

Alex Larralde: Get some data. I love that. What about you, Grant?

Grant Duncan: I would say choose one of the metrics we discussed today related to pre-assessment surveys and make that metric your next QAPI study.

You can work to improve it, and then you get a two for one.

Marta Shultz: Yes!

Grant Duncan: When you improve the workflow and get a QAPI study out of it.

Marta Shultz: Cancellations would be perfect, right? I mean, everybody looks at them, but how often do you look and, and categorize them versus saying other. Anytime other is more than 10% of your answers, you need to break that out, right?

I’d love that for a QAPI study.

Grant Duncan: Yeah.

How about you, Alex?

Alex Larralde: Everybody who heard this episode and thought I need to do this. Go schedule some demos for some pre-assessment tools and start seeing what’s out there and seeing what these capabilities are.

If you haven’t explored digital solutions, go learn about them and start gathering information. Schedule some calls.

This has been awesome.

Grant, Marta, really grateful you could join.

Alex Larralde: This week, let’s take a closer look at Gynecology ASCs. We analyzed more than 33,000 cases across 99 centers, and the story the data tells is one of progress in some areas, but pressure in others.

So let’s start in the OR. In 2023, gynecology centers were using 51% of their block time. Fast forward to 2024, and that number has to 41%.

That means that nearly six out of every 10 minutes of allocated block time is going unused. And for ASCs, this isn’t just about numbers, it’s really about missed opportunities. More than anything, this reflects a breakdown in coordination. Too often, scheduling is handled with phone calls and faxes, which causes delays. But the centers that are using technology to broadcast OR availability and automate scheduling are the ones getting closer to that gold standard of 70% utilization.

Now let’s shift to the front end of the revenue cycle and talk about pre-authorization. Here, the rate climbed from 10% to 13%. That’s more patients requiring payer approval before their surgery. On the surface, that might seem like a burden, but it can actually prevent last minute cancellations and denials because it forces confirmation upfront.

The challenge for ASCs is not assuming that the physician’s office has it handled. Centers that verify authorizations themselves and use integrated payer technology are the ones who avoid operational hiccups and financial surprises.

But verification, that’s where the story stalls. Insurance verification rates held steady at 56% year over year, and that is well below the multi-specialty average. Without strong verification, centers risk cancellations, delayed billing, and denied claims. The best approach is simple. Double check coverage when you schedule the case, and then again, on the morning of surgery. Then run monthly sweeps to catch any lapses. Automating these checks makes it painless and ensures smoother patient care.

And speaking of cancellations, the rate climbed slightly from 15.2% to 15.9%, and when we look deeper, it looks like the majority are patient-driven or provider-driven.

That means that many of these cancellations could have probably been avoided with better processes. A missed lab, a scheduling error, simply poor communication with patients, maybe the lack of a pre-assessment workflow… all of these add up to wasted block time. Centers that are proactive with patient outreach and use a centralized system to keep all of their care teams aligned, are the ones without these disruptions.

Patient deposit collection stayed steady at 67%, which is encouraging. And billing got faster. Average days to bill dropped from 7.4 to 6.7.

That means money is coming in sooner and with less administrative lag. Add to that, the fact that reimbursement per case is climbing from about $2,900 to $3,447, and the revenue side is looking strong.

But those claim denials are creeping up from 6% to 7%, and that small increase can eat away at those revenue gains pretty quickly. It’s a reminder that efficiency on the clinical side only pays off when it’s matched by discipline on the billing side.

So what’s the big picture? This is really a story of two trajectories, financial performance moving up, but operational efficiency pulling down, and the centers that thrive are the ones who can bridge that gap.

And that wraps up today’s episode. Thanks again to Grant and Marta for joining me this week and thank you to every single one of you taking a few minutes of your day to spend some time with us. If you enjoy our podcast, please be sure to leave us a rating or review on your favorite platform and join us next time.

We’ll see you again soon.