What is the secret to improved financial performance for hospitals in the age of healthcare reform? Understand and manage the convergence of quality, outcomes, patient experience, reimbursements and costs. And there's no better place to start than with the hospital's number one expense - the operating room.
If a hospital's financial goals are to achieve better, more sustainable and more predictable financial results, the hospital needs to achieve three objectives: build a perioperative superstructure; reduce costs and drive efficiencies; and increase revenues.
The Perioperative Superstructure
To thrive in the age of healthcare reform, hospitals need to forge a foundation that includes an end-to-end perioperative super structure at every patient touch point, from the time the surgeon and patient decide on surgery to the pre-op visit, the surgery itself, discharge and everything in between.
In this new paradigm of care, the goal is having one physician leader overseeing the process and accountable for the entire patient experience and results. Since the hospital-based anesthesia group touches every area surrounding surgery, it makes sense for an anesthesiologist from the hospital team to lead and monitor the entire perioperative process.
Reduce Costs and Drive Efficiencies
Run a Better OR: With a perioperative superstructure in place, a hospital can improve on-time surgical starts, minimize delays between surgeries, and decrease cancellations. For instance, there was a hospital with excessive delays between surgeries that meant paying expensive surgical staff to wait around for an available OR. The perioperative team analyzed the situation and discovered only two housekeepers on duty who were unable to clean the OR fast enough, so the hospital hired more housekeepers at a significant savings and improved its surgical turn over times.
Streamline Processes: The perioperative super structure corrals the disparate moving parts of the pre-operative phase: booking surgery; customizing a patient-specific plan that includes appropriate testing; meeting administrative requirements; providing the patient with information that mitigates anxiety; and avoiding last minute cancellations. Post-op, the team seamlessly coordinates care from the OR to the recovery room and onto the floor, maximizing pain control, assuring compliance and minimizing unexpected disruptions.
Decrease Earnings Drags: By leveraging an existing function - anesthesia - to drive the perioperative team, the hospital can reduce or eliminate subsidies as a result of increased revenues. The implementation of a perioperative superstructure can also reduce length of stay, and decrease or even eliminate non-reimbursable Never Events thanks to lower mortality, reduced readmissions and better Surgical Care Improvement Project (SCIP) scores; as well as attention being keenly focused on Value Based Purchasing metrics and "Hospital Consumer Assessment of Healthcare Providers and Systems" (HCAHPS) scores.
Improve Purchasing: The perioperative team works directly with the purchasing department to identify and negotiate for the most cost-effective supplies for the end-to-end surgical experience. In one documented instance in a 350-bed hospital, the perioperative team was able to save $1 million in disposable and non-disposable costs.
Effective Reporting and Analytics: The organized nature of the perioperative superstructures lends itself to data collection on everything touching the patient experience. Robust data provides comparative benchmarking on performance, and feeds the best possible scores into required external reporting tools, which ultimately improves reimbursement.
Increase Quality: Hospitals need to create a comprehensive list of key quality measurements and implement the best ways to manage each touch point. For example, two small changes that can improve SCIP scores are having the perioperative team ensure the right antibiotic pre-surgery and a beta-blocker pre- and post-surgery. These are things traditionally left solely to the surgeon, now being tasked to the entire team.
Strategies for Increased Revenue
Increase Caseload: A good perioperative team is cognizant of OR usage and staffing, and is a proactive partner in maximizing the number of surgeries performed. Whether bringing in more surgeons or pain doctors to perform more procedures, the perioperative team should serve as a recruitment arm for the hospital to maximize valid utilization.
Improve Surgeon Satisfaction: The perioperative approach creates a professional, on-time atmosphere of respect and teamwork for busy surgeons who have a choice of where to operate. Happy surgeons generate more revenue for hospitals through increased caseload and more efficient throughput.
Improve Patient Satisfaction: With patient satisfaction tied to reimbursement, hospitals need a perioperative team that owns the total patient experience. Patients increasingly are empowered consumers, armed with tools and information that help them choose the best hospitals and surgeons - and to report dissatisfaction.
The perioperative superstructure provides hospitals with a seamless accountable care model that can manage tactically at every patient touch point and strategically as an invaluable partner to hospitals, leading to lower costs and increased revenue for a truly transformed OR in the age of healthcare reform.