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The Otology Group of Vanderbilt
Emerging Issue #4 Cochlear Implant Practice Management
David S Haynes, MD, FACS, MMHC Meredith Holcomb, Au.D.
Holly Teagle, Au.D.
Brendan O’Connell, MD Mark Syms, MD
Jacques Herzog, MD Charles Syms, III, MD, FACS
Loren Bartels, MD
Emerging Issue #4 Cochlear Implant Practice Management
Operational Improvement Coding Efficiency
Industry PartnershipsYield Loss Management Operational Efficiency
Telehealth Outreach
Cochlear Implantation Using Process Analysis to Improve the Delivery Model
0
50
100
150
200
250
300
2012 2013 2014 2015 2016 2017
CochlearImplantVolume
287236
165 162181 190
ExpectCon5nuedGrowthallofusseekgrowthyetIfweareat6%penetranceandatresourcelimita5ons.Whatistheanswer?
1streferral:Call
oremail
Fax/MailsPacket
Pa5ents
Fax/MailPacketsback
AudiologyScreen(2)
SurgeryEvalua5on
7
AllTes5ng(MRIandCT)
CICandidacyTes5ng
8
Surgeryscheduling
wait
wait wait
waitCI
Coordinator(1)
wait
wait
WaitOR/SurgAvail.
surgery
2
SurgeryPostop
7
AudiologyAc5va5on
8
AudiologyMapping1month
wait
AudiologyMapping3month
AudiologyMapping6month
AudiologyMapping12month
Insurancepre-DleYer
Deviceordered
5minutesintake
Audio2hoursPSR7min
2hourssurgeon/anesthteam1.5hourspreop2hourspostop
1day
2weeks
15minutesreview3days
3hours
2hours
ReceiveInfo/verify/uploadsInfotoEMR45minutes
10minutes–fax3days-mail
2hours-4weeks-fax/mail
Completespackagesandschedulespreopappointments
45minutes
7weeksRange6-8weeks
10minutes
Ifbusy,accesscenteruploadsinfotoEMR-15minutes(15%)
Yieldloss5%
Surgeon30minutesMedicalassistant7minutes
Nursing7minutesPSR15minutes
Surgeryscheduler10minSupplychain30minAudtech15min
Audiology20minCoordinator50min
Allpost-opappointsscheduled
CIcoordinator35minutes
Audio2hoursPSR15
Nurse/MA10minSurgeon15min
Audio2hoursPSR7min
Audio2hoursPSR15min
Surgeon30minPSR15minNurse10minMA10min
Audio2hourseachdayfor2daysPSR15min
4weeksRange2-6weeks
Yieldloss5%
nowait(85%)
Yield loss 17%
wait
4weeksforapprovalRange2-12weeks
CICoordinator
(1)
CICoordinator
(1)
ProcessmapDay1to12monthspost-ac;va;on
1streferral:Call
oremail
Fax/MailsPacket
Pa5ents
Fax/MailPacketsback
AudiologyScreen(2)
SurgeryEvalua5on
7
AllTes5ng(MRIandCT)
CICandidacyTes5ng
8
Surgeryscheduling
wait
wait wait
waitCI
Coordinator(1)
wait
wait
WaitOR/SurgAvail.
surgery
2
SurgeryPostop
7
AudiologyAc5va5on
8
AudiologyMapping1month
wait
AudiologyMapping3month
AudiologyMapping6month
AudiologyMapping12month
Insurancepre-DleYer
Deviceordered
5minutesintake
Audio2hoursPSR7min
2hourssurgeon/anesthteam1.5hourspreop2hourspostop
1day
2weeks
15minutesreview3days
3hours
2hours
ReceiveInfo/verify/uploadsInfotoEMR45minutes
10minutes–fax3days-mail
2hours-4weeks-fax/mail
Completespackagesandschedulespreopappointments
45minutes
7weeksRange6-8weeks
10minutes
Ifbusy,accesscenteruploadsinfotoEMR-15minutes(15%)
Yieldloss5%
Surgeon30minutesMedicalassistant7minutes
Nursing7minutesPSR15minutes
Surgeryscheduler10minSupplychain30minAudtech15min
Audiology20minCoordinator50min
Allpost-opappointsscheduled
CIcoordinator35minutes
Audio2hoursPSR15
Nurse/MA10minSurgeon15min
Audio2hoursPSR7min
Audio2hoursPSR15min
Surgeon30minPSR15minNurse10minMA10min
Audio2hourseachdayfor2daysPSR15min
4weeksRange2-6weeks
Yieldloss5%
nowait(85%)
Yield loss 17%
wait
4weeksforapprovalRange2-12weeks
CICoordinator
(1)
CICoordinator
(1)
AudiologyResourceCapacityIssuesCurrent
1streferral:Call
oremail
Fax/MailsPacket
Pa5ents
Fax/MailPacketsback
AudiologyScreen(2)
SurgeryEvalua5on
7
AllTes5ng(MRIandCT)
CICandidacyTes5ng
8
Surgeryscheduling
wait
wait wait
waitCI
Coordinator(1)
wait
wait
WaitOR/SurgAvail.
Surgery7
2
SurgeryPostop
7
AudiologyAc5va5on
8
AudiologyMapping1month
wait
AudiologyMapping3month
AudiologyMapping6month
AudiologyMapping12month
Insurancepre-DleYer
Deviceordered
5minutesintake
Audio2hoursPSR7min
2hourssurgeon/anesthteam1.5hourspreop2hourspostop
1day
2weeks
15minutesreview3days
3hours
2hours
ReceiveInfo/verify/uploadsInfotoEMR45minutes
10minutes–fax3days-mail
2hours-4weeks-fax/mail
Completespackagesandschedulespreopappointments
45minutes
7weeksRange6-8weeks
10minutes
Ifbusy,accesscenteruploadsinfotoEMR-15minutes(15%)
Yieldloss5%
Surgeon30minutesMedicalassistant7minutes
Nursing7minutesPSR15minutes
Surgeryscheduler10minSupplychain30minAudtech15min
Audiology20minCoordinator50min
Allpost-opappointsscheduled
CIcoordinator35minutes
Audio2hoursPSR15
Nurse/MA10minSurgeon15min
Audio2hoursPSR7min
Audio2hoursPSR15min
Surgeon30minPSR15minNurse10minMA10min
Audio2hourseachdayfor2daysPSR15min
4weeksRange2-6weeks
Yieldloss5%
nowait(85%)
Yield loss 17%
wait
4weeksforapprovalRange2-12weeks
CICoordinator
(1)
CICoordinator
(1)
ResourceCapacityissue:CICoordinator300*14=4,200 Waits/yieldlossmanagement/opportuni5es
Audience Response Question
If your center was asked to perform 50 more cochlear implants next year, what resources would you need to add? 1. None 2. Implant audiologist 3. Non Implant audiologist 4. Surgeon 5. CI coordinator 6. Administrative assistant
