OR Manager - April 2020 - 17

OR business
Overcoming common obstacles to implementing
a perioperative surgical home
O
ver the last 5 years, the perioperative
surgical home (PSH)
model has attracted increasing
interest from OR directors, anesthesiologists,
and surgeons. This teambased,
patient-centered approach coordinates
all phases of surgical care,
from preoperative assessment through
intraoperative care and postdischarge
recovery. According to the American
Society of Anesthesiologists, PSH initiatives
have resulted in lower surgical
complication rates, fewer readmissions,
higher patient satisfaction, and
lower episode costs.
Surgical Directions, a Chicago-based
healthcare consulting firm, has seen
similarly positive results from systems
with a PSH in place. Despite growing
interest in this model, however, many
surgery department leaders are unsure
how to launch a PSH, and even those
who have started one tend to face
stumbling blocks.
Pioneering hospitals have encountered
most of these problems and
developed effective solutions. In this
article we present six of the most common
obstacles to implementing a PSH,
along with tested strategies for optimizing
performance.
Lack of support from hospital
executives
The PSH model requires an investment
in staff and process change, and it can
cause disruption for key perioperative
stakeholders. As a result, it can be difficult
to gain agreement from hospital
executives. To overcome this obstacle,
OR leaders should learn how to make
the financial case for a surgical home.
Start by providing the payment analysis.
Under value-based care, hospital
diagnosis related group payments are increasingly
at risk for quality, clinical outcomes,
total cost, and patient satisfaction.
Key drivers of payment risk include:
* high complication rates (1% penalty
under the Hospital-Acquired Condiwww.ormanager.com
A
PSH launch should focus on one wellselected
specialty or procedure.
tion Reduction Program)
* high readmission rates (up to 3%
penalty under the Hospital Readmissions
Reduction Program)
* overall clinical quality, safety, cost
performance, and patient satisfaction
(up to 2% penalty or incentive
payment under the Hospital ValueBased
Purchasing Program).
The potential losses for low-quality
care can be significant. One hospital we
recently visited lost $12.5 million over
6 years because of poor performance
under these three programs alone.
Value-based payment penalties are
tied to hospital results across all departments,
not just surgery. However,
perioperative services drive a significant
share of these results. And considering
that surgery and surgery-related care account
for approximately 60% of hospital
spending, perioperative performance is
a critical element of overall cost control.
With a demonstrated ability to reduce
complications, cut readmissions,
improve patient satisfaction, and control
costs, the PSH model represents
a hospital's best overall opportunity to
achieve several value-based goals with
one comprehensive approach.
From a payment viewpoint, PSH results
can be impressive. A few years
ago, an East Coast hospital was struggling
with Medicare payment penalties
tied to readmissions and other measures.
Perioperative leaders responded
by implementing a surgical home model
for joint arthroplasty. Within 2 years:
* readmissions were cut in half
* surgical complications decreased by
more than one-quarter
* cost per case decreased by more
than $1,700
* patient satisfaction increased to
above the 90th percentile.
These improvements allowed the
hospital to avoid millions of dollars in
value-based payment penalties. They
also helped cut length of stay by more
than one-third, which enabled the hospital
to increase OR volume significantly.
In subsequent years, the hospital rolled
out the surgical home model to multiple
service lines. In 2018, total savings attributed
to the hospital's PSH program
exceeded $10 million.
Uncertainty about where to begin
Leading hospitals have surgical homes
in place for multiple services. Although
this is the ultimate goal, a PSH launch
should focus on one well-selected specialty
or procedure. Here are some key
considerations:
* Which service lines are the focus of
hospital strategy? It will be easier to
gain executive support and physician
buy-in for a PSH initiative that could
help optimize a strategic department
or procedure.
* Do any surgeons already support the
surgical home concept or its components?
A strong surgeon champion
is a critical factor for a successful
PSH initiative. Surgeon leadership
can quickly win executive support
and get staff behind the surgical
home vision.
* Which service lines have a strong
Enhanced Recovery After Surgery
(ERAS) program? Teams that have
already seen solid ERAS results will
understand the value of a protocoldriven
approach to optimizing surgical
care.
* Which services have the biggest
room for improvement? Where performance
is lagging, there is often
a big opportunity to show a gain
Continued on page 18
OR Manager | April 2020
17
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OR Manager - April 2020

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