The operational ramifications of a vascular surgical fellowship

Shukla, Mrinal; Huynh, Tinh T; Bertges, Daniel J.; Steinthorsson, Georg; Mayhew, Christopher R.; Tsai, Mitchell H.

doi:10.1016/j.pcorm.2019.100077

Cited by 1 publication

(2 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 99%

“…Previously, Silverstein et al showed that both clinical productivity and RVU generation increased after the implementation of a vascular surgery fellowship at the University of Vermont. 30,34 Regarding the revenue/FTE, the monthly variable cost/ FTE increase of $540.20 should be compared against the profitability of an increased caseload/FTE of 1.5 cases per month. The cost frontier in Figure 1 showed increased revenue despite increased diminishing returns due to the increased variable cost of associated after-hours time.…”

Section: Discussionmentioning

confidence: 99%

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Multivariable Cost Frontiers—Qualitative Financial Analyses Using Operational Metrics From the Implementation of a Surgery Fellowship

et al. 2023

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Objective: We expand the application of cost frontiers and introduce a novel approach using qualitative multivariable financial analyses. Summary Background Data: With the creation of a 5 + 2-year fellowship program in July 2016, the Division of Vascular Surgery at the University of Vermont Medical Center altered the underlying operational structure of its inpatient services. Method: Using WiseOR (Palo Alto, CA), a web-based OR management data system, we extracted the operating room metrics before and after August 1, 2016 service for each 4-week period spanning from September 2015 to July 2017. The cost per minute modeled after Childers et al’s inpatient OR cost guidelines was multiplied by the after-hours utilization to determine variable cost. Zones with corresponding cutoffs were used to graphically represent cost efficiency trends. Results: Caseload/FTE for attending surgeons increased from 11.54 cases per month to 13.02 cases per month (P = 0.0771). Monthly variable costs/FTE increased from $540.2 to $1873 (P = 0.0138). Monthly revenue/FTE increased from $61,505 to $70,277 (P = 0.2639). Adjusted monthly reve-nue/FTE increased from $60,965 to $68,403 (P = 0.3374). Average monthly percent of adjusted revenue/FTE lost to variable costs increased from 0.85% to 2.77% (P = 0.0078). Adjusted monthly revenue/case/FTE remained the same from $5309 to $5319 (P = 0.9889). Conclusion: In summary, we demonstrate that multivariable cost (or performance) frontiers can track a net increase in profitability associated with fellowship implementation despite diminishing returns at higher caseloads.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%