Even as the U.S. emerges from the COVID-19 pandemic, emergency department (ED) patient volumes are still predicted to be inconsistent throughout 2021. Last year, ED visits were down 16.2% compared with 2019 and 22.6% year-over-year in December 2020. A recent TransUnion report also projected that ED volumes will likely remain at the pandemic-era baseline in Q2 2021 because of COVID-19 impacts which include continued safety concerns, and patients gravitating toward other immediate care options such as virtual visits, convenient urgent care/walk-in clinics, etc. However, the same report did foresee visits increasing if vaccinations continue to become more widespread and patients feel more comfortable returning to hospitals.
With so much uncertainty still in play, emergency physician groups are faced with the challenge of scheduling adequate physician coverage at the sites they serve and doing this in a way that is cost effective and provides the best level of care to the patient. Coverage schedules are typically planned based on volume and averaged over large periods of time since most emergency physician groups don’t have access to real-time data or technology that can take variability/market changes into account. This often creates situations where there is either excessive coverage which can result in substantial financial loss or insufficient coverage which leads to longer wait times and higher walk-out rates.
Provider schedules need to be optimized in a systematic way that reflects the realities of the ED and what physicians are experiencing on a day-to-day or hourly basis. Many emergency physician groups are partnering with R1 to utilize the robust analytics tools needed to make informed scheduling decisions that allow them to achieve overall cost savings and deliver better care to patients. This blog will cover how R1’s Tool for Optimizing Provider Schedules (TOPS) works, and why it is such an important resource to have while managing considerable fluctuations in patient volume.
Before TOPS can be explained, it is important to recognize how data serves as the foundation for the platform. Traditional approaches to coverage planning have heavily relied on average or aggregated data, which prevents an ED medical director from evaluating the detailed information needed to address specific patient nuances. With patient-level, granular data such as billing records, staff schedules, hospital registration and patient arrival information, certain patient acuities that impact scheduling can be addressed head on. For example, older, sicker patients tend to arrive during the morning hours, with lower acuity, while trauma patients with higher acuity usually frequent the ED on Fridays.
While it is impossible to know exactly what type of patient is going to come into an ED at any given time, granular data allows schedulers to understand, on average, what is typically seen and ensure the right physicians are scheduled at the right time to process these incoming patients. While data is a crucial component, it can only serve as a reference point without insight into the most ideal coverage and resource distribution. To truly optimize scheduling, a medical director must be able to load this granular data into a platform like TOPS, evaluate their current schedules and apply “what if” scenarios to evaluate what potential output will look like. Some of these “what if scenarios” include, “What if I start this physician’s shift an hour earlier on Friday?” “What will happen if volume increases by 5% on a certain day?” “How much could we save by cutting a double coverage shift?”
Through intuitive dashboards, productivity profiles, and data-driven demand models, R1’s TOPS platform analyzes the effect various scenarios have on overall ED coverage and allows ED medical directors to align provider capacity with patient demand to define optimal staffing. Once historical data and current schedule definitions are loaded to TOPS for reference, ED medical directors can set certain time parameters, anticipated volume changes or add, change, or remove shifts. These data, parameter, and schedule changes are immediately reflected in the heat map view that is displayed side by side with the controls (see visual below).
This heat map gives ED medical directors immediate insight into the effects the proposed changes will have, by hour of day, day of week, and week of year. In turn, the heat map also shows where areas of concern are within the current schedule, giving ED medical directors the opportunity to work with the controls and identify where improvements can be made, e.g., moving a high performing physician to a different time of day, adding an extra shift, etc. Proposed schedules can be saved off and referenced later, as well as shared with other users within the same practice. Costs associated with each schedule change are also displayed right on the screen for quick comparison, so financial impacts can always be taken into consideration.
For TOPS to be effective, each ED medical director needs to set their ideal peak capacity percentage which will display on the heat graph where areas for improvement are needed. Peak capacity is truly defined by physician productivity – how many relative value units (RVUs) ED physicians should be held accountable for during their assigned shift. When thinking about the ED as an assembly line – patients arrive as inputs, physicians process the inputs to produce an output – the operator (ED medical director) needs to know each assembly line member’s peak capacity to determine how to achieve consistent, strong performance at any given time.
Another key component of planning is interpreting arrival patterns. TOPS has an arrivals section that can be adjusted when unexpected market changes occur; the prime example being COVID-19. With trying to plan schedules post-pandemic, emergency physician groups can use the arrivals tab to evaluate what patient volume looked like before the pandemic, what their current schedule is, and then apply necessary reductions to create a more accurate schedule. For example, when planning coverage for this upcoming summer, data could be pulled from 2019, pre-COVID, current volume reductions could be applied (say the ED is now at a 20% reduction) and then TOPS would show what an ED’s arrivals distribution would look like based on these factors. This helps ED medical directors design a schedule that takes pre-COVID volume numbers into account while still factoring in the overall reduction your ED is currently experiencing.
Having this kind of data-driven, integrated approach to practice management is an essential strategy for physicians in the unpredictable world of healthcare. Emergency physician groups need to be nimble and rapidly adjust their schedules as conditions change, eliminating any guesswork that could result in higher overall costs. In addition to coverage planning, a partner like R1 provides revenue cycle and practice management services that create the automated workflows and necessary system integration needed to drive enhancements in patient satisfaction, quality and performance, while also enabling emergency physician groups to gain better visibility into the financial, clinical and operational sides of their businesses. Leveraging technology in a way that enhances patient quality care – right staff at the right time for the right patient – and balances physician workload/overall costs is a significant value add that emergency physician groups can no longer afford to go without.
Steve Queen is Vice President, Hospital-Based Physicians at R1.