Cory M Resnick1, Kimberly M Daniels2, Susan J Flath-Sporn3, Michael Doyle4, Ronald Heald5, Bonnie L Padwa6. 1. Instructor, Harvard School of Dental Medicine; Attending Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: Cory.Resnick@childrens.harvard.edu. 2. Research Data Manager, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. 3. Quality Improvement Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. 4. Research Study Assistant, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. 5. Department Director, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. 6. Associate Professor, Harvard School of Dental Medicine; Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Abstract
PURPOSE: To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice. MATERIALS AND METHODS: This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P < .05. RESULTS: The total process time did not differ significantly between groups, but the average total procedure cost decreased by $75.08 after the introduction of PAs (P < .001). The time that the oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P < .001). No significant differences in postoperative complications were found. CONCLUSIONS: The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue.
PURPOSE: To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice. MATERIALS AND METHODS: This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P < .05. RESULTS: The total process time did not differ significantly between groups, but the average total procedure cost decreased by $75.08 after the introduction of PAs (P < .001). The time that the oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P < .001). No significant differences in postoperative complications were found. CONCLUSIONS: The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue.
Authors: Jonathan Cho; Karl Sanchez; Oren Ganor; Salim Afshar; Alex Ruditsky; Alex Bierman; Amir H Taghinia Journal: Plast Reconstr Surg Glob Open Date: 2019-10-21