Strategies for Surgical Service Line Success Under Accountable Care

In a Feb. 28 webinar hosted by Becker's Healthcare, Jeff Peters, president and CEO of Surgical Directions, shared tips on how to ensure profitability from surgery departments under accountable care and value-based purchasing.

Surgical departments are beginning to be judged on different metrics due to the rise of accountable care and value-based purchasing. For example, many payors are placing a higher proportion of payment on patient satisfaction and clinical outcomes than they have in the past. That necessitates somewhat of a change in how surgical service departments are operated in order to be successful and profitable.

Along with sharing specific case studies of hospitals' success, Mr. Peters presented some tips to help hospitals and health systems create a competitive market advantage and keep costs in check in order to be profitable in the new era of healthcare.

Work well with surgeons

To have successful surgery service lines under accountable care and value-based purchasing, working with surgeons in different ways to widen the hospital's surgical case load and keep costs under control becomes important.

First, hospitals need to make their operating rooms attractive to great local surgeons, and they can do this by providing great service to surgeons. According to Mr. Peters, that involves having efficient operating rooms that surgeons are excited about operating in. "[The] ability to run…ORs well is going to dictate our ability to recruit and retain surgeons," he said, and quality surgeons are more likely to meet the performance metrics put in place under accountable care.

While attracting surgeons will help a hospital's bottom line, hospitals and health systems also need to identify which surgeons they want to work with — the surgeons who are at the median or low end on the cost spectrum and meet the necessary quality outcomes.

Additionally, it is important to identify outlier surgeons and communicate with them. According to Mr. Peters, a good way to communicate with the outliers and try to get their costs into the normal range is by presenting them with robust, transparent data. For example, if a surgeon's case time is higher than his colleagues, present him with data comparing his case time to others in the organization. "Just point out the data…that alone has been highly effective in changing behavior," Mr. Peters said.

Many hospitals have started presenting monthly report cards to surgeons — including data on their patients' length of stay, discharges and how the surgeons are performing on value-based purchasing and accountable care metrics — as a way of making them aware of how they're performing and helping them to identify any problem areas in order to lower overall costs.

Change the governance structure

Creating a collaborative governing structure for surgical services is a great way to align incentives and establish a strategic plan for surgical services and the rules and controls to make sure it works. "Increasingly, how organizations are succeeding in perioperative services are, they're really identifying a governance model…to drive the transformation and to meet the value-based purchasing and accountable care goals," Mr. Peters said.

One such structure is a surgical services executive committee, made up of surgical, OR nursing, anesthesia and senior hospital leaders. The SSEC would address things such as the surgeons' block schedule and how to improve case efficiency and minimize turnovers in order to make their OR more efficient.

Implement a daily huddle

Having a daily huddle with surgical service staff can drive operating room performance improvement. During the huddle, the OR director, anesthesia director, nurses and pre-anesthesia testing, central sterile supply and scheduling review the OR schedule for the next three days.

The huddle can then determine the sequence of patients, staff assignments and make sure all of the equipment is scheduled properly. According to Mr. Peters, having a daily huddle can improve on-time starts and minimize daily cancellations, among other benefits.

Improve pre-anesthesia testing

Finally, streamlining and improving the pre-anesthesia testing program helps make ORs run smoothly and improves patient outcomes.

The PAT program should utilize a telephone questionnaire with patients in order to identify patients that need to be seen prior to surgery or can be given instructions over the phone. The questionnaire can also be used to identify risks, such as patients with diabetes or those on many medications, who may need extra treatments prior to surgery. Having a great PAT program can help hospitals improve patient outcomes and lower length-of-stay by ensuring proper management of at-risk patients before, during and after surgery.

Overall, following the tips provided by Mr. Peters can help improve patient outcomes and increase market share while lowering costs — all necessities for surgical service success under accountable care and value-based purchasing.

Download a copy of the presentation by clicking here (pdf).

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