OR Manager - November 2019 - 18

Enhanced Recovery After Surgery
SPECIAL SERIES
Maximizing the beneficial impact of Enhanced Recovery
After Surgery (ERAS) on patient outcomes is heavily reliant
on high-functioning team-based care. This approach ensures
that all members of the care team are working to the
top of their license, performing standard work that is foundational
to the surgery care process, and maintaining clear
lines of communication along the care continuum among
the care team, the patient, and the patient's family.
A well-implemented ERAS program results in several
clinical and financial benefits. In the current healthcare
landscape, where opportunities for improvement in our delivery
systems abound and the appetite for change is great,
now is the time to transform care.
In this article, we'll examine some of the benefits of
ERAS and provide a roadmap for integrating it into surgical
patient care.
The role of the OR in ERAS pathway implementation
he US has been on a journey for
the last several years to reduce
the cost of healthcare. In 2017,
the percent of gross domestic product
attributed to healthcare goods and services
was at 17.9%. This is expected
to reach as much as 19.4% by the year
2027.1 Factors contributing to this include
an increase in healthcare goods
and services prices of 2.5% versus the
1.1% during 2014 to 2017.2 The average
annual spend growth for healthcare
is estimated at 5.5% for the years 2017
to 2027, and for Medicare specifically,
an average annual spend growth of
7.4% is anticipated during the same
period 1, 2 (Figure 1 below).
T
Surgery and OR utilization continue
to grow to meet the increased demand
for elective surgical services even as
the aging population is leading to an
increase in two of the major common
emergency surgical procedures-fractured
neck of femur and emergency
laparotomy. Hospital expenditures are
projected to grow by 5.7% per year,
mostly because the shortage of physicians
is expected to drive an increase in
their compensation.1
In 2015, the Department of Health
and Human Services announced goals
to increase the percentage of valuebased
payments under the Affordable
Care Act over a 3-year period so that,
by 2018, 90% of Medicare payments
would be tied to quality and value. Additionally,
alternative payment models
were to account for 30% of Medicare
reimbursements by 2016 and 50%
by 2018.3 Although progress is being
made, the programs continue to fall
short of these goals.
The Healthcare Payment Learning in
Action Network reports the actual percentage
of Medicare payments linked to
quality for calendar years 2015 through
2017: 38%, 57%, and 59%, respectively.
Other markets continue to lag behind,
with commercial payers at 43.5%
of payments linked to quality in 2017
and Medicaid at only 32.2%. For alternative
payment models, the Medicare
percent increased from 23% in 2015 to
34% in 2017.4
These quality links to payments are
driven through programs such as the
Hospital Inpatient Quality Reporting
Program (IQR). Data collected as a
part of IQR are available to the public
on the Hospital Compare website
and affect annual payment rates to
hospitals as well as hospital star ratings.
Some of these data overlap with
Figure 1. Source: Paula Spencer, MSHA, PMP, CPHIMS. All figures used with permission.
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OR Manager | November 2019
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OR Manager - November 2019

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