Issue link: https://beckershealthcare.uberflip.com/i/674245
76 Executive Briefing Taking the Wheel: Transforming the Hospital OR to Drive Value I t has been well-established that value is now "driving health- care," but this industry platitude leaves many hospital and health system executives wondering how they can take control of the wheel and ensure they are optimizing value and all that it entails. The operating room, as well as the entire perioperative service line, is an essential area in which executives should focus their attention if they want to boost clinical outcomes and financial results and, ultimately, maximize value. In the surgery sector, the focus on value is causing the move- ment toward bundled payments, according to Jeff Peters, CEO of the specialty healthcare consulting firm Surgical Directions. One such bundle, the Comprehensive Care for Joint Replace- ment Model, demonstrates CMS' commitment to emphasize value, as it is the first bundle of its kind to be mandatory in the roughly 800 hospitals across 67 markets in which it applies. "Under the [Comprehensive Care for Joint Replacement Model], joint procedures are going to be paid by bundled payments in multiple markets. Clearly, the CJR is a test for how surgery is go- ing to be paid," said Mr. Peters. The CJR bundled payment covers all the patients' testing for 72 hours prior to surgery; the surgical episode, including the hospi- tal costs, surgeon costs and anesthesia; and the costs following discharge for 90 days. According to Mr. Peters, hospital leaders need to make several changes in the OR to reflect shifting payment models. There are several major aspects involved in transforming the OR that exec- utives must tackle to improve value. Here, Mr. Peters explains in his own words the five areas of the OR healthcare leaders should transform. Education and Quantification For long-lasting transformation, physicians need to understand why change is necessary. The physician champion or depart- ment chairman leading the OR transformation effort must im- press upon clinicians that change is not an option — not only is the hospital's reimbursement dependent on change, the sur- geons' compensation will also be affected. Hospitals' new job is to prove their value to patients and payers. Educational opportunities should be made on a monthly basis and include both town hall-style meetings with all the hospital's sur- geons, as well as individual sit downs with each physician. During these one-on-one meetings, those overseeing the transformation efforts should quantify and compare surgeon performance. Some individual, regional and national metrics to quantify for sur- geons include cost per procedure, patient satisfaction and clinical outcomes such as 30-day readmission rates, surgical site infections and discharges to a rehabilitation hospital or skilled nursing facility. Physician Leadership A huge part of building physician commitment to an OR trans- formation, and eventually picking a physician leader, is assess- ing the opportunities to improve clinical outcomes, patient sat- isfaction and financial profitability. One of the easiest ways to foster support among surgeons is to quantify these outcomes. This is because physicians are compet- itive by nature — no one likes to be seen as a weak link. If a physi- cian's clinical outcomes are lower than his or her peers or external benchmarks, the physician will be motivated to improve. Addi- tionally, physicians whose outcomes are higher than their peers may be chosen by executives to champion transformation efforts. Getting surgeons on-board with initiatives regarding the OR may become easier as their compensation is increasingly based on clinical outcomes. Once a hospital engages its surgeons, leaders will quickly realize how suited these physicians are to Sponsored by: Value = Clinical Outcomes/Cost "The way ASCs operate is the way hospitals are going to need to operate their ORs in the future. In this regard, trying to stick with tradition won't help a hospital survive." — Jeff Peters, CEO of Surgical Directions