A lesson learned from a colonoscopy applicable to preventive maintenance
- Andrew Bissot
- Feb 17
- 4 min read
Preventive maintenance (PM) is simply an action aimed at preserving a piece of equipment in a desirable operational condition. This activity increases the probability that the equipment remains effective and prolongs the useful life of the asset. Understandably, not everything requires preventive maintenance. There are some assets where running to failure is more economical. For those assets that require preventive maintenance, failing to do so is a risk of a functional failure or an unexpected failure.
When the PM is conducted, it typically has a known set of instructions and a predefined understanding of what conditions to look for. When something is found, it is either addressed at the moment or captured as follow-up work to be rectified in the future (SMRP 5.4.13 Preventive Maintenance Effectiveness). Here lies a problem. Based upon an interpretation of conditions, what should be addressed in the moment versus the future?
A colonoscopy is simply a PM
Similar to preventive maintenance on a piece of equipment, a preventive colonoscopy is used to look for cancer of the colon or colon polyps, which are growths on the linings of the colon. These polyps can sometimes be cancerous or can grow to become cancerous. In most cases, the existence of a polyp is unknown before the preventive colonoscopy. Rarely, a polyp will be too large to remove during colonoscopy, which means that a polyp(s) is removed during the procedure. For a few extra minutes by the maintenance technician, I mean the Gastroenterologist, the polyp is safely removed, you wake up, and you find something to eat. The duration of the colonoscopy is probably already sandbagged.
This means that over 50% of these cases would need a 15-minute higher allocation for the average allocation time to be about the same as the average actual time. This supports the general statement that the times are often under-allocated. Heechan Kang, Mo Hameed Thoufeeq, describing the time to remove a polyp, National Library of Medicine
I do not think anyone in the right mind wants to be woken up during a colonoscopy to say, “Schedule an appointment in a few weeks, and we will remove the one polyp that we saw.” Additionally, I do not think anyone wants to be woken during a procedure and hear, “Looks like you have a single polyp. So we need your permission. It will only take a few more minutes.” It is obviously unanimous.
The whole point of screening is to see if there is a potentially problematic growth and snip it out for testing to make sure it does not evolve into a cancer. Elizabeth Melville, Heard on All Things Considered https://www.npr.org/transcripts/1101861735
Minor adjustments during a PM versus follow-up work
When completing a PM, if a minor adjustment is found, then it should be completed and noted as a work log. If a problem is too big to address during a PM, a corrective maintenance (CM) work order is created as a follow-up work order to the PM (SMRP 5.4.13 Preventive Maintenance Effectiveness). As follow-up work, the PM created work in the future as a diagnostic follow-up or corrective maintenance. If you find something that is only a minor adjustment, a few extra minutes, or gives you some additional insight into the predictive performance of the asset, take the time to address it. You are already there!
The argument of why a colonoscopy is preventive versus diagnostic
I had my first colonoscopy last year, and my gastroenterologist indicated that they found a single polyp when I woke. As expected, the polyp was found, snared (4 extra minutes), and sent to be tested. A few days later, the results came back to conclude my first colonoscopy was a success. However, the success of the colonoscopy faded when the hospital coded the colonoscopy as diagnostic versus preventive. Their position was that finding and removing a single polyp during a preventive colonoscopy changes the coding to a diagnostic colonoscopy.
My insurance clearly showed that “a polyp found during a preventive colonoscopy is considered preventive.” But the hospital countered. Back and forth, back and forth. For five months, I learned more about the ACA, hospital coding, and insurance declaration than I ever wanted. Eventually, I convinced insurance and the hospital that the polyp removal was part of the preventive colonoscopy (PM) versus diagnostic work (CM). Because there was no follow-up work to the colonoscopy (PM), the additional work performed during the colonoscopy (PM) did not significantly impact its duration. A polypectomy is a minimally invasive procedure, and snaring a polyp during a colonoscopy is simply doing the PM.
Using the example of a colonoscopy and finding a polyp can be used to teach teams to determine what to address at the moment versus in the future. Also, before you get a colonoscopy, ensure that a simple polyp removal is part of the PM and not a CM. If not, you may find yourself with a $5,000 bill.
If the doctor finds a growth in your colon during the test, they can remove it before it even turns into cancer. If you do have colorectal cancer, getting tested regularly can help you find out early — when it may be easier to treat. Michele Andrews, Heard on All Things Considered
Comments