Becker's Clinical Quality & Infection Control

9 Executive Briefing: Surgical Homes Most hospital surgery departments have taken steps in recent years to boost quality. Unfortunately, their good efforts may not be enough to keep up with rapidly increasing penalties for operating room quality shortfalls. Consider the payment changes that will roll out in just a few months: The VBP program will add new surgical quality measures. The Medicare Hospital Value-Based Purchasing program will add several surgical outcome measures. To maintain CMS rev- enue, hospital ORs must minimize post-operative blood clots, blood infections, surgical wound rupture and hip fractures. In fis- cal year 2014, 1.25 percent of DRG payments to eligible hospi- tals will be withheld to provide the estimated $963 million neces- sary for VBP program incentives. More than half of all hospitals within the program will lose some portion of their Medicare reim- bursements. VBP withholdings will rise by steps to a maximum 2 percent in 2017. Medicare HAC penalties will begin. October will also see the launch of Medicare penalties for hospital-acquired conditions such as orthopedic pulmonary embolisms and deep vein throm- bosis, surgical site infections and retained objects. ORs in the lowest-quality quartile for these complications will be penalized 1 percent. Readmissions penalties are ramping up. CMS will add coro- nary artery bypass graft to the readmission reduction program in just two years. The program is sure to target other surgical pro- cedures in the near future. Penalties will increase to 3 percent in fiscal year 2015. Costs are coming under increasing pressure. Also in the new fiscal year, the VBP program will begin tracking hospital spending efficiency. Separately, the Medicare bundled payment initiative is rapidly developing a reimbursement model that will penalize hos- pitals for high costs. The bottom line is that quality and cost expectations are ramping up faster than most hospital ORs can respond. Traditional ap- proaches to OR quality improvement are no longer adequate in today's rapidly evolving payment environment. To maintain revenue, hospital ORs must adopt a comprehensive approach to improving surgical quality while minimizing costs. Many organizations have achieved promising results through a new clinical model — the perioperative surgical home. Leading ORs nationwide have used the surgical home model to increase quality, reduce complications, optimize patient outcomes and control the cost of care. Two stubborn problems The surgical home concept addresses two problems in surgical care today: 1. Lack of coordination. A single surgical procedure involves dozens of clinicians and support personnel, both inside and outside the hospital. In most organizations, the services provided by these individuals are only loosely coordinated. The results are often miscommunication and waste. 2. Lack of standardization. Surgeons, anesthesiologists, nurses and other clinicians often make practice decisions based on personal experience and individual preference. Differences in perioperative care lead to wide variation in quality and outcomes. In addition, lack of standardization makes it difficult to evaluate current performance and strat- egize process improvements. Overall, poorly coordinated and non-standardized surgical care leads to uneven quality, costly inefficiencies, a higher risk of error and mixed patient outcomes. The surgical home is designed to address these underlying problems by providing fully coordinated, evidence-based surgical care. A comprehensive solution The surgical home concept was proposed by the American So- ciety of Anesthesiologists in 2012. Under the ASA model, anes- thesiologists use their unique expertise to optimize perioperative care. Surgical home initiatives have also been led by surgeons and hospitalists. All versions of the model share a handful of com- mon characteristics. • Evidence-based care pathways (standardized services and care plans for specific procedures) • Standard protocols for managing specific patient conditions (such as diabetes or anemia) • Coordination of services across pre-operative, intraoperative and post-operative care • Proactive discharge planning, including rehabilitation and home recovery • The use of care coordinators to orchestrate all patient ser- vices What does the model look like in practice? Here's a snapshot one possible approach to a surgical home program for knee replacement: The 'Surgical Home' Solution Facing Increasing Penalties, ORs Seek a Comprehensive Approach to Quality Improvement By Jeffry Peters, President and CEO, and Barbara McClenathan, Senor Nurse Executive, Surgical Directions Sponsored by: perioperative & anesthesia assessment · interim management 312.870.5600 www.surgicaldirections.com discuss your specific issues within Perioperative Services as well as tell you about strategies used by other organizations to address similar situations. Contact us to schedule obligation conference call to review your situation and design a path to operational excellence! active consultants help you enhance your bottom line through improved quality outcomes, perioperative process and overall operational improvement.

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