BLOG: Surgical Density, part 2: Norms and tracking density over time
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What’s the normal surgical density? The typical figure is +/-25 visits per case, but this can range widely in a general ophthalmology practice, from 5 to 50 patient visits per surgical case.
My most established and surgically assertive clients commonly hit 15 or fewer visits per case. In extremely young and old practices, and in clinically conservative or operationally neglectful settings, the ratio is closer to 50 or even more patient visits for every major surgical case.
Even with the ramp-up in injection visits, retinal practices will commonly have the same surgical density as their anterior segment colleagues, about 25 visits per case. Well-established oculoplastics surgeons typically transit about 10 to 15 visits per case.
Obviously, the greater the diversity of major surgical procedures you offer in your practice, the higher your surgical density is likely to be. Surgical density can be higher or lower within a practice for a number of other reasons:
• In an older, more established practice, the average age of patients is higher, and the cataract yield is thus elevated.
• Practices that actively market nearly always have a superior surgical density.
• Surgeons who actively co-manage patient care with referring optometrists or ophthalmologists always have a higher surgical yield — with as few as three or four patient visits for every surgical case.
• A highly experienced surgeon with a low complications rate will often perform surgery on borderline patients that another, less-experienced surgeon would pass up, refer or delay.
• Some surgeons, for ethical preferences, or due to a lack of confidence in their skills, will only provide surgical care when a patient’s case is well-advanced and other options have been completely exhausted.
For a very revealing look at trends in your individual or group practice, graph the surgical density month-by-month over the past 12 or more months. Here’s an example from one client setting:
In this setting, the surgical density is very favorable, averaging just over 12 visits per case in the last year. (This is a graph where one likes to have the curve heading downward!)
For this rural practice, about half of the surgical cases are generated internally and half are referred by local optometrists. Absent a shift in case selection or a move toward more OD outreach in a wider geographic span, it’s unlikely that surgical densities can be further enhanced here.