OR Manager - October 2020 - 21
OR business
The PSHSC should also establish
metrics for monitoring surgical home
processes and outcomes.
Although it may seem as though the
surgical services executive committee
(SSEC) could take charge of a PSH,
launching a surgical home is a big project
that requires a separate committee.
A surgical home also requires involvement
from stakeholders who are not
part of a traditional SSEC (eg, pharmacy).
We recommend launching a PSH
with just one service, so putting it under
the charge of a multiservice SSEC can
lead to confusion. In short, the PSHSC
can report to the SSEC, but it should
always be a separate entity.
Uncertainty about rolling out the
model
In some hospitals, the prevailing
change management culture favors
large-scale rollouts. For a complex surgical
home initiative, however, a largescale
" go live " is not advisable. The
PSH model is a very hands-on approach
to patient care that requires a lot of
flexibility. Initiatives that start small and
scale slowly have the best chance of
success.
We recommend a " rule of one " approach.
After PSH clinical protocols
have been established, test the model
with one surgeon and one patient, and
review the results. Data from even a
single patient will show how the pathway
works in real life and will generate
insights on how to improve the model.
Continue to test, review, and iterate
with successive patients. Once the
model is working successfully for one
surgeon's practice, expand it to other
members of the surgeon's staff.
Difficulty with getting surgeons'
buy-in
A surgical home initiative will usually
require some changes in clinical practice
and patient time commitment, so
surgeons may resist participating in the
model.
www.ormanager.com
One solution is peer education, especially
from the surgeon champion who
is spearheading the surgical home initiative.
If coaching fails to persuade a
surgeon to adopt a key protocol, the
issue may need to be escalated to the
SSEC. Ultimately, however, surgeon
buy-in will stand or fall based on clinical
results. As a surgical home begins
to deliver better outcomes and prevent
complications, even skeptical surgeons
will willingly adopt new protocols.
Another solution is to establish a
comanagement agreement. Comanagement
can be complex, but it is essentially
a contract that allows physicians
to be rewarded for improving patient
care and reducing costs.
One component of a comanagement
agreement would be hourly compensation
for taking part in PSH management
activities, such as planning protocols,
reviewing performance, and working on
continuous improvement. (Hourly compensation
is based on independently
determined fair market value for physician
work input.) The other component
would be a performance incentive tied
to improvement on baseline metrics for
quality, outcomes, and costs.
A comanagement agreement is a
flexible way to align physicians with the
PSH model. Performance metrics can
be customized to the particular goals
of the surgical home. Quality and cost
metrics can change yearly to ensure
physicians are always engaged with new
performance targets. In addition, PSH
comanagement contracts can eventually
be expanded to include other programs
and/or bundled payment agreements.
Strong
foundation
There are several obstacles to implementing
the surgical home model, but
overcoming the barriers is well worth
the effort. ORs that adopt a PSH successfully
are able to establish a strong
foundation for high performance under
value-based care. ✥
Barbara
McClenathan
Barbara McClenathan, MBA-HCM, BSN,
RN, CNOR (left), is director of perioperative
nursing, and Lisa Branding, MHSA,
is director of strategy and value-based
care at Surgical Directions in Chicago.
References
Altarum. Health Sector Economic Indicators-June
2020 Spending Brief.
https://altarum.org/sites/default/
files/uploaded-publication-files/
SHSS-Spending-Brief_June_2020.pdf.
American Hospital Association. Hospitals
and Health Systems Face
Unprecedented Financial Pressures
Due to COVID-19. https://
www.aha.org/system/files/media/
file/2020/05/aha-covid19-financial-impact-0520-FINAL.pdf.
American
Society of Anesthesiologists.
Perioperative surgical home (PSH).
https://www.asahq.org/psh.
Ellison A. 29 Hospital Bankruptcies
in 2020. Becker's Hospital
Review. June 3, 2020. https://
www.beckershospitalreview.com/
finance/29-hospital-bankruptciesin-2020.html#:~:text=At%20
least%2029%20hospitals%20
across,many%20hospitals%20
across%20the%20nation.
Ellison
A, Masson G, Anderson M. 110
Hospital Benchmarks | 2020. Becker's
Hospital Review. February 24,
2020. https://www.beckershospitalreview.com/lists/110-hospitalbenchmarks-2020.html.
Macario
A, Vitez T S, Dunn B, et
al. Where are the costs in perioperative
care? Anesthesiology.
1995;83(6):1138-1144. https://
anesthesiology.pubs.asahq.org/article.aspx?articleid=2323555.
OR
Manager | October/November 2020 21
Lisa Branding
https://www.altarum.org/sites/default/
http://https://
http://www.aha.org/system/files/media/
https://www.asahq.org/psh
http://https://
http://www.beckershospitalreview.com/
https://www.beckershospi
http://www.talreview.com/lists/110-hospital
http://https://
http://anesthesiology.pubs.asahq.org/ar
http://www.ormanager.com
OR Manager - October 2020
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