4 Tips on Implementing a Surgicalist Program at Your Hospital

As patient loads and provider shortages increase, many hospitals are implementing surgicalist programs to accompany the hospitalist programs that came into vogue several years ago. Here, two hospital executives who have been through a surgicalist program implementation with physician staffing company Delphi Healthcare Partners offer four tips on building a surgicalist program that will benefit your patients, physicians and bottom line.

1. Assess the impact of your current surgeons. Donald Avery, president and CEO of Fairview Park Hospital in Dublin, Ga., says Fairview Park chose to implement a surgicalist program in part because of a critical need of general surgeons. "We have three general surgeons on staff, all local and board-certified, and two of them are 55 [years of age] or older," he says. The hospital's medical staff bylaws say surgeons over 55 can no longer take ER call, meaning that of the hospital's three surgeons, only one could take call — and he was only doing it for eight or ten nights per month. In addition to the general surgeon shortage, the hospital had two GI physicians on staff, only one of whom was taking GI call. "In those two specialties, we were transferring 20-30 patients a month to other hospitals and not able to receive transfers from other hospitals in those areas," he says.

In order to implement a successful program, Fairview Park needed to recruit general surgeons dual-qualified in GI. Mr. Avery says because of this unique need, it was essential for the hospital to set high standards and not compromise. "One of the general surgeons we interviewed really didn't do GI procedures, and we weren't going to compromise on that," he says. "We said we just won't compromise on quality or on the capabilities of the surgeon."

Ronald May, MD, vice president of medical affairs for New Bern, N.C.-based CarolinaEast Health System, says his system implemented an orthopedic surgicalist program for similar reasons. "We had a number of orthopedic surgeons who decided they couldn’t take call in the ER any longer, and those who continued to take call said, 'We're not going to take all the calls,'" he says. "That meant we were going to have gaps in the schedule, which was not okay for the community." The health system wasn't enthusiastic about paying for call, so they considered the potential "win-win" situation of implementing surgicalists to take ER call, do inpatient consults and take care of the patient through the outpatient visit. "We thought that might free up the orthopedic surgeons taking call to take other patients and therefore benefit the hospital and community," he says.

2. Work with existing physicians to eliminate resistance. Mr. Avery said the surgicalist program at Fairview Park Hospital initially met some resistance from local physicians who worried the surgicalists would compete with physicians for patient volumes. "Some physicians asked, 'What if a patient comes to the ER and wants to see their doctor? Will they have to see the surgicalist?'" he says. "We listened to them, and they said they wanted to get the call if a patient asked for it." Interestingly enough, once the period of resistance passed, most physicians were glad to pass their patients over to the surgicalist — excepting cases when the patient was a close personal friend. The set-up allowed physicians to spend more time in their offices and eliminated the time spend commuting back and forth from the hospital to see patients at the last minute.

Dr. May says the main causes for resistance at CarolinaEast were the concerns about surgicalist qualifications and the possibility of competition. "Some physicians said, 'Who are these people? Are they qualified to do what they're going to do?'" He says luckily, the hospital worked to eliminate resistance by involving existing surgeons in the decisions about the program. "The issues were put to rest very quickly, and the surgicalists actually brought new skills," he says.

Mr. Avery says one of the most important things a hospital can do to implement a successful surgicalist program is to talk to existing physicians about how the program will work. In the case of Fairview Park Hospital, the surgicalists provided by Delphi were very willing to work with physicians to develop good relationships. Mr. Avery says some surgicalists have even developed great friendships with members of the hospital staff and become an integral part of the community. "They have been accepted very, very well," he says. "They've developed great relationships with the doctors, and they've been very willing to combat resistance by talking over misunderstandings of who should deal with a patient."

3. Communicate your new surgeon availability to referring providers and hospitals.
According to Mr. Avery, one of the main reasons to implement a surgicalist program at Fairview Park was the hospital's status as a regional referral center. As the largest hospital between Savannah and Macon, two Georgia cities that sit about 200 miles apart, Fairview Park has services that half a dozen nearby critical access hospitals can't provide. Because of this, the hospital needed to provide enough surgeons to handle unpredictable regional referrals.

Since the program's inception, Mr. Avery says Fairview Park has communicated the hospital's increased surgical services to county EMS ambulance services and regional hospitals. He says the hospital can measure the program's success in very tangible numbers: since it began, two lives have been saved. "We've had two people that, without a surgicalist program, would have died," he says. "They would not have survived a transfer. That trumps any other thing I can say, and that's very rewarding to me." He says the surgicalist program also helps families in the Fairview Park community because surgeries no longer have to be transferred elsewhere when the hospital cannot provide enough surgeons. "It means the family of a patient doesn't have to drive an hour to see them," he says.

4. Consider the eventual financial benefits as well as the up-front cost.
Mr. Avery says that within the next five years, he expects surgicalist programs to become "more the rule than the exception" — possibly even more so than hospitalist programs. He says many hospitals probably don't consider surgicalists because the up-front cost can be overwhelming. "Typically, you have more admits in the medical arena than you do in the surgical arena, and people figure they don't need to be that concerned about ER call," he says.

He says that despite the initial cost of implementing a surgical program, Fairview Park has experienced tremendous financial benefits since the program's inception. "We transfer fewer patients, which has resulted in jobs and the reopening of our surgery floor," he says. "We're doing more surgery cases with a pretty good payor mix, and we're currently on track to do 400 cases annually." He says the surgicalist program has increased admissions, revenue and net income, and the hospital anticipates — based on the first quarter — that the program will have a "seven figure positive impact" on earnings.

Dr. May says even if your hospital does not see immediate financial benefits, the hospital will benefit from eliminating gaps in coverage. "The program has generated an increased volume of surgery, and there are no longer patients that need to be taken care of that are stuck waiting for service," he says. "Because there are two or three doctors here on a regular basis, patients get to learn who they are and develop really good relationships with them."

Learn more about Delphi Healthcare Partners.

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