How community hospitals can introduce the surgical home model

With the shift to value-based care already sending ripples throughout the healthcare industry, physicians and hospitals alike recognize the need to institute new delivery models to ensure the quality of care patients receive continues to improve.

Sonya Pease, MD, CMO at Knoxville, Tenn.-based TeamHealth Anesthesia and Mary Ouimet, vice president of patient care and CNO at St. Louis-based Ascension Health, discussed how hospitals and health systems can begin to implement the surgical home model in their practices at Becker's Hospital Review's 5th Annual CEO + CFO Roundtable Nov. 7.

Dr. Pease recognized that the widely accepted patient care models utilized today all aim to increase the level of care physicians are able to provide patients, lower rates of infection, lower total spending and improve patient satisfaction and engagement. Because the current models are so well received, hospitals are much more hesitant in implementing new models because they are perceived to be much more risky.

However, the current industrywide transition to value-based care,Dr. Pease argues, is exactly why health centers should look to implement new models now, particularly the surgical home health model. The surgical home model constitutes a new way for physicians and other medical personnel to simplify not only the procedures themselves, but the entire process from before the surgery to recovery and discharge.

"Where we can make the most value, where the surgical home makes the most difference is during those transitions of care. Because if you don't have a global approach…and if you don't reach those transitions in care, then you're really not going to see what [is possible] with a surgical home. So addressing those gaps is really, really important," says Dr. Pease.

Those gaps lead to a number of missed opportunities hospitals have in getting surgical patients into the operating room. Missing those opportunities can prove to be very costly, resulting in delays in surgery, increased costs, lower HCAHPS scores and increased complication rates, among other issues, according to Dr. Pease.

Providers can use the surgical home model to focus on specific types of care, Ms. Ouimet says,. That's exactly what Ascension Health proceeded to do after implementing the surgical home model at the Ascension All Saints Hospital in Racine, Wis.

Prior to implementing the model, Ms. Ouimet said surgical volume at the hospital had declined and patient satisfaction had reached a low of 15 percent. Hospital officials utilized the model to construct case-specific protocols, specifically programs to treat hip fractures and total joint issues.

But to implement the model, officials had to find a way to engage clinicians and get them on board with the change.

"Implementing [surgical home model] is a culture change…[it's] asking physicians to change the way they operate," Ms. Ouimet says. "[We had to] engage clinicians through physician tool kits, smarter technology that enabled the implementation of care pathways and [accounting for those changes through] actionable metrics and dashboards."

Their work paid off. According to Ms. Ouimet, the hospital saw a 77 percent reduction in pain medication administration and a 51 percent reduction in patients' average postoperative pain scores within the first 12 hours after surgery in cases of rapid hip injuries. Ms. Ouimet also noted that after applying certain enhanced recovery protocols, officials saw "a reduction in the average length of stay by roughly four-fifths of a day, a 375 percent decrease in opioid doses administered postoperatively and a 25 percent increase in doses of non-narcotic pain medication administered."

Both Ms. Ouimet and Dr. Pease acknowledged the importance of C-suite support and technology in introducing the surgical care model for the first time. Young physicians, according to Dr. Pease, see technology as a way to ease their workload, allowing them to focus on their patients.

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