A review of iVantage Clinical Benchmark data highlighted the need for one midwestern academic medical center to focus their efforts on DRG 456-460 (Spinal Fusion) ... these surgeries were too costly for the hospital.
What did they do in response? Formed a team including neurosurgeons, orthopedic spine surgeons, administrators/COO, implant coordinator, nursing unit managers, ambulatory nurse managers, case managers, pharmacists, and OR RNs. Data analysts and finance team members were also included in the process. The team developed several goals associated with these surgeries:
- Improve Surgery Cost per Case: Their target was to decrease the cost/case by 5%. They met with providers and presented detailed data with individual case details. They evaluated provider individual productivity, utilization, lab and supply usage, and supply waste. Transparency was vital with the data so providers could see how they compared among one another. In addition, to decrease waste, each surgeon reviewed their preference list. This lead to fewer unused items being opened during the case.
- Reduce Biologics Usage: Their target was a 50% reduction. The Implant Coordinator reviewed each surgeons' data to see if there were any windows of opportunity to decrease cost. Leadership monitored cost data for individual surgeons, and the team worked with surgeons to consider the use of different biologics and vendors.
- Reduce Intraoperative Monitoring Usage: Their target was an 11% decrease. They evaluated how frequently monitoring was done and if the procedure was eligible for monitoring. They shared the Intraoperative Guidelines from the American Academy of Neurology with the surgeons to educate them on cases for which monitoring is recommended. They also reviewed how insurers see/interpret these recommendations.
- Reduce LOS: The team tracked avoidable days to see why these days occurred. Now, before the surgery, patients attend a Spine School. Education on the procedure, the pre-op evaluation and labs are completed at this time. The team added an Ambulatory Pre-Op Assessment to screen for the need for a Case Manager upfront and to evaluate discharge needs.
- Reduce Lab & Pharmacy Costs: The hospital started a Choosing Wisely Campaign, which demonstrates waste with lab and diagnostics. According to a literature review, 30% of tests are unnecessary -- physicians were given corresponding education. Order sets underwent review to ensure that repeated lab tests or xrays were not ordered without an associated stop date.
Did these methods work? This hospital saw a $2700 decrease in cost/case! They also decreased their LOS by nearly 9%.
See all the details about this hospital and their work with spinal fusion surgery improvements on our KnowledgeWeb: 5 Steps to Cut Spinal Fusion Surgical Costs! Contact us if you'd like to join in.
How are Spinal Fusion surgeries impacting your hospital? See the iVantage Performance Manager Clinical Benchmark to find out.