Reducing unnecessary variation in clinical practice and medical device use is a key strategy in optimizing the value of enhanced recovery and perioperative surgical home (PSH) programs, and providers are being encouraged to take an active role in identifying opportunities where value can be created.
“Each step in a value chain should add value,” said Jimmy Y. Chung, MD, FACS, CHCQM, senior director of perioperative services at Providence St. Joseph Health, in Renton, Wash. “If it doesn’t add value, it’s wasteful and should be eliminated or optimized. Redesigning the supply chain is one way to incorporate value optimization into enhanced recovery and surgical home models.”
As Dr. Chung reported at the American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference, there are several opportunities to add value along the perioperative journey by improving quality and outcomes while also reducing cost. In the preoperative period, for example, this can be achieved through better education of patients and family members, use of risk assessments, and prehabilitation. Normothermia, glucose management and pain management are common value-boosting components of enhanced recovery pathways. Pain management continues in the postoperative phase of care, along with a planned diet, appropriate physical activity and infection prevention. Then in the long term, follow-up, rehabilitation and wellness maintenance help to optimize care long after the patient has left the hospital.
Analysis of total direct costs of laparoscopic appendectomy within the Providence St. Joseph Health system, for example, reveals significant variation. Even when limited to average supply cost, individual hospitals and individual surgeons can vary by more than $500 per case. These data can be further dissected to identify the exact supplies consumed.
As Dr. Chung reported, medical product selection should be included in PSH discussions. For new product requests, for example, there is often pressure on hospitals to comply lest the surgeon seek employment elsewhere, but by bringing surgeons together as part of the value component of enhanced recovery or the surgical home model, many unnecessary purchases can be avoided.
In addition, according to Dr. Chung, value optimization of the supply chain means reducing unnecessary variation. “If you have a spine program or orthopedic program, you probably have 30 different vendors in the hospital. If you talk to the surgeons and include them in the value analysis, you can pare that down to four or five vendors.”
Dr. Chung also emphasized strategic collaboration with vendors. “It’s possible to bring vendors to the table to negotiate pricing based on savings or revenue arising from patient outcomes and/or quality improvement.”
He added, “It’s really hard to change physician practice to affect operating room time, so I wouldn’t start with that first. I would start with something easier to change like product choice, which can have a significant impact on the hospital’s bottom line.”