For hospitals that can effectively collaborate across service lines to redesign care processes, the perioperative surgical home (PSH) model of care can help lower costs, improve outcomes and enhance patient satisfaction for surgical cases. Persuading hospital administration to commit resources to support new initiatives, however, can prove difficult in today’s health care environment.
At the American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference, Sonya Pease, MD, MBA, outlined a three-pronged strategy to obtain buy-in from community hospitals to implement more integrated forms of care. Dr. Pease is chief medical officer at TeamHealth Anesthesiology, in Palm Beach Gardens, Fla.
What’s in It for Your Hospital?
“You cannot create a PSH program without resources and support from your hospital,” Dr. Pease said. “We, as anesthesiologists in our own silo, will never get anywhere without institutional support, so explaining to the C-suite why they need to buy in is critical.”
While the ER may be the front door to the hospital—most hospitals get between 50% and 68% of hospital admissions through that department—these cases are predominantly medical admissions and unscheduled care, according to Dr. Pease. On the other hand, anesthesiology is the front door that has the biggest effect on the bottom line, as perioperative services drive revenue for the hospital via scheduled care admissions.
“Approximately 70% to 90% of surgical and procedural care is scheduled electively,” she said, “and these episodes of care cost 2.5 times more than the average medical admission.”
While the majority of hospitals spend 50% to 60% of their annual budgets supporting perioperative services, surgery and procedural care drives 70% to 80% of a typical community hospital’s annual profits. A lot of time is spent by hospitals trying to maintain surgical volumes because these are “make or break” for hospitals’ margins, Dr. Pease said. Furthermore, the top 5% of the highest-acuity patients that drive over 50% of the total U.S. health care spend are the patients who anesthesiologists take care of every day.
“I think it’s really important that the hospital understands why anesthesia is so important,” she said. “We are helping to better manage the most expensive patients that come into the hospital and can impact margins most.”
Given the volume of patients being cared for, missed opportunities in the form of increased hospital length of stay, increased complication rates and poor pain management can be costly. Dr. Pease cited a study of multimodal pain approaches that found the average 250-bed hospital pays approximately $7.9 million in costs associated with opioid-related complications postoperatively. Implementing a multimodal approach to pain management, however, has been shown to reduce overall length of stay by 30%.
“If you’re asking for resources to support a surgical home or enhanced recovery initiatives, you can tell the C-suite that just this one initiative alone has a very significant financial benefit to the hospital and to our patients,” Dr. Pease pointed out.
Identifying the Big Gaps
Once a hospital understands more the value to patients and the financial benefits of better-coordinated care, the next step is identifying where to start building a pathway. Dr. Pease recommended becoming familiar with the hospital’s Leapfrog scores to see how it compares with national benchmarks and to find the greatest opportunities for improvement and impact (www.hospitalsafetyscore.org).
“Your hospitals are very sensitive to how they are perceived by the public, and Leapfrog is a direct-to-consumer portal that’s public,” she said. “These are like crash-test ratings but for hospitals, and they may help you determine what pathways need to be implemented first.”
Finally, once the senior executives are committed, it’s important to hit the ground running, according to Dr. Pease.
“Everyone needs to understand that PSH is an integrated coordinated care effort, similar to a stroke center of excellence or an orthopedic center of excellence. Because you’re impacting so many different areas of the hospital, everyone needs to be on board and understand what the end goal is,” she said.
To this end, TeamHealth has built a comprehensive assessment tool to test hospital readiness. According to Dr. Pease, the assessment looks at all aspects of leadership, clinical care, quality assurance, performance improvement and data management throughout the perioperative continuum to determine a hospital’s progress toward becoming a PSH. “This tool serves as a guide for an organization to enhance integration of the physician leaders engaged in all perioperative care and to eventually prepare for the certification process to become a PSH when this accreditation process is fully developed.”
A poster campaign can be effective in educating providers about the essential components of the program. “If you want to change culture and have everybody buy in to what you’re doing, communication is essential. You’re never going to be able to communicate enough to be successful,” Dr. Pease stressed.
Michael C. Lewis, MD, chair of the Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, in Detroit, asked how organizers can navigate variability at individual hospitals, especially when it comes to surgical preferences.
“I think the reason we’ve been so successful,” said Dr. Pease, who also oversees TeamHealth’s Quality Registry, “is that we can examine service and quality metrics along with actual patient outcomes and length of stay for each individual provider. The quality registry enables us to compare our organization against a national level, which helps us support our individual providers, who might be providing great quality but are unable to hit metrics because their hospital partner has not bought into what we’re trying to do.”
Dr. Pease added, “Ultimately, though, we practice patient care, which is going to look different at every institution. We all have our own clinical practices, our own culture and patient population dynamics, so it’s important to be flexible.”