As little as one extra MRI per day can generate more than an additional $200,000 in incremental revenue annually. But most imaging centers use crude scheduling systems that do not accurately present a center’s potential throughput. David A. Dierolf, director of performance improvement, Outpatient Imaging Affiliates (OIA), Nashville, Tenn, outlined a handy method for understanding the potential of your schedule to enable maximum throughput for an audience gathered at the May meeting of the Radiology Business Management Association in St Louis, Mo.
Hired by OIA in advance of the Deficit Reduction Act to improve efficiency throughout the company’s imaging center holdings, Dierolf, an IT expert, shared two case studies with the audience that revealed his techniques and yielded significant additional incremental revenue at the centers. OIA specializes in establishing joint ventures with local health care providers and operating those centers for its partners. Attributing OIA executive VP, operations, Kelly Gill, as the inspiration for his talk, Dierolf said: “One of the first things he told me was nothing is worse than unsubstantiated success. I am going to build my talk around that.”
University of Virginia Imaging
This very busy freestanding imaging center in Charlottesville, Va, offers full diagnostic services, adding up to 6,500 exams per month. A partnership between OIA and the University of Virginia, the center operates four very busy MRs and is already working towards a fifth. “Enhancing utilization is important when your schedule is full,” noted Dierolf. “If you are only using half of your slots, there’s not a lot of reasons to spend a lot of time trying to get one more procedure through unless you are going to send you techs home halfway through the day.”
The center’s third available appointment was 8 or 9 days out in the fall of 2005 when Dierolf entered the picture. Dierolf was charged with developing a method to assess whether the scanners were running at maximum capability and also to develop a better method to decide when a new scanner should be purchased.
Dierolf had to determine the following measures:
Throughput, or how many exams were done in a specified time period, one week in this case.
The number of appointment slots, defined as a unit of time reserved for a patient or an exam.
Because the existing scheduling system dated back to 1970, there was not a lot of flexibility. “Back then we were scheduling everyone into 45 minute time slots,” noted Dierolf. “There was no ability to do some at 30 and some at 45. When scheduling and deciding what is the next available appointment, you looked at 4 different screens. There were three high field magnets and we kept those open in 19 slots a day, M-F, and 12 on Saturday. We also had one open system. The protocols were longer and the scanners were slower, so we scheduled those at 60 minutes.”
Dierolf counted 371 total appointment slots per week, but still did not know how many exams could be done in a week. “That question was difficult to answer,” said Dierolf. “We knew how many patients we saw and how many exams we did, and we even tracked the number of no-shows and last minute fill-ins. But we couldn’t figure out how many slots we did we not use. It was the number we needed to know in order to find out how many exams we could do.”
Calculating Theoretical Maximum Throughput
To answer that question, Dierolf had to do two things: figure out how many exams were done in a specified number of appointment slots so he could calculate how many slots the center wasn’t using: “It was interesting that we really couldn’t figure that out.” Dierolf undertook the painful method of going to the logs of each machine and poring over the notes that the technologist kept on the schedule: did not show, or “x” for cancel. He transferred those notes to a spreadsheet. “Today we actually have an online system where they can go on and say here is the schedule and here is what happened and it makes it fairly easy to count, “ he noted.
He performed the task for the month of October and went back and did it again in December in his effort to determine how many exams he could get into each appointment slot. Because MR of the brain and MRA of the head could be performed in one 45-minute slot, knowing the patient number was not enough because sometimes two procedures took one slot and sometimes two procedures took two slots.
“This notion of coming back and evaluating the procedure