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ECONOMICS, EDUCATION, AND POLICY

Case Scheduling Preferences of One Surgeon's Cataract Surgery Patients

Franklin Dexter, MD, PhD^*, Lee Birchansky, MD, James M. Bernstein, PhD, and Ruth E. Wachtel, PhD, MBA

From the *Division of Management Consulting, Departments of Anesthesia and Health Management and Policy, University of Iowa; Fox Eye, Cedar Rapids; Frank N. Magid Associates, Inc., Marion; and Department of Anesthesia, University of Iowa, Iowa.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu or web site www.FranklinDexter.net.

Abstract

BACKGROUND: The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility.

METHODS: Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery."

RESULTS: The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound 52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon.

CONCLUSIONS: The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.

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