As our nation moves forward with a new administration come 2017, healthcare's future remains uncertain. However, healthcare's focus on providing value at lower costs will continue to be a priority amongst all facets of the industry.
"No matter what goes on in the administration or with healthcare policy, as providers, we constantly have to look at value and I don't think that will change," said Jeff Peters, president of Chicago-based Surgical Directions. "Value is not measured by standardized outcomes but by patient satisfaction, function and complications."
During the Becker's Hospital Review 5th Annual CEO + CFO Roundtable on Nov. 9 in Chicago, Mr. Peters delved into how providers can use bundled payments to improve outcomes while lowering costs and why coordination amongst team members is key in a presentation titled "Preparing Your Hospital's Perioperative Service Line for Bundled Payment — Success Stories and Lessons Learned."
In a bundled payment initiative, hospitals and providers are charged with a patient's outcomes up to 90 days or 120 days following their discharge. To get all staff members on board, Mr. Peter said hospitals should participate in a gainsharing initiative.
"The idea of gainsharing and aligning incentives are key to get physicians and the whole surgical staff to move the continuum of care," he added. "In most organizations, part of the issue is the mentality about why should I change my behavior unless I share in it. This is why gainsharing is important."
Mr. Peters advised those facilities interested in increasing their surgical market share and volume to use process improvement measures including surgeon education, physician leadership, anesthesia, clinical pathways and case time. Educating surgeons about ways to decrease costs and using benchmarks that compare surgeons to others in the hospital may spur competition amongst surgeons.
"What you will find is if you have 10 orthopedic surgeons, eight are very close to the median and you will likely have two outliers in terms of costs and quality. These outliers are what affects overall institutional drive," Mr. Peters said.
Hospitals can form a leadership structure that motivates all staff members to work toward improving their outcomes and either meeting or exceeding the median. Successful organizations will work to get their nurses, anesthesiologists and surgeons on leadership teams and function as a board of directors in the operating room who decide on a strategic vision, assess what needs to change and look at the process improvements that will drive change.
"What is increasingly obvious to payers and the government is the hospital personnel are the best people to coordinate the entire surgical episode," Mr. Peters said. "The idea of discharging patients to skilled nursing facilities and home and saying we are not responsible for their outcome; that is not what the payer wants. Our role as perioperative leaders is to manage the post-acute episode."
To manage the episode, hospitals can conduct pre-anesthesia testing to identify a patient's comorbidities. The anesthesia provider has an important role to play and their role extends the procedure room.
"Hospitals should have a daily huddle where nurse and anesthesia personnel come together to look at their patients and what is going on with them clinically to understand what they need to do to optimize them clinically and manage them," Mr. Peters said.
Healthcare's movement toward focusing on value presents an opportunity for hospitals to improve the patient experience as well as an opportunity to lower the cost of care.
"There is a change we are about to experience that is much more dramatic than some of us realize. It is our responsibility as healthcare leaders to look at how we can manage change in such a way that we are providing value to our customers, surgeons and third party payers by focusing on how we can improve clinical outcomes," Mr. Peters said.