On November 16, 2015, CMS released a final rule that implements changes to Medicare that will require roughly 800 hospitals across the country to be financially responsible for all of the inpatient and postoperative care of patients undergoing total knee or hip replacements from admission until 90 days after discharge.
The perioperative surgical home (PSH) is seen as a solution to help these hospitals control costs and maintain margins as they address this new requirement. The PSH is a patient-centered and physician-led multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience. Coordination is often lacking in the surgical care process; the PSH provides a model to address this lack of coordination, leading to better clinical outcomes and lower surgical costs. The continuum can be achieved by having a single perioperative team headed by a director of perioperative services who coordinates and manages all aspects of care from the minute the surgeon decides to operate until 30 days post-discharge.
Here are the top 10 things hospital executives should know about establishing PSHs.
1. Education. Provide plenty of education on the components of the PSH, examples of institutions that have successfully implemented a PSH and expectations of results to the physicians, C-level executive suite, and clinical and administrative support staff. Be prepared to present studies, share articles, hold meetings, and schedule informal and formal discussions.
2. Leadership. Ensure the PSH development program has leadership from a surgeon and anesthesiologist. These individuals must carry the banner, ensure the program stays on target and hold others accountable.
3. Key performance indicators (KPIs). You will need to show the value of the PSH to C-level executives of the hospital in terms of saving costs, reducing readmissions, length of stay, complications, delays in the operating room and patient satisfaction.
4. Change management. A significant part of implementing a PSH is understanding change management, which requires individuals to acknowledge there is a problem, focusing on the issues, creating teams, holding people accountable and knowing your goals.
5. Team formation. You will need to assemble a steering committee team and work groups. The steering committees oversees the entire process, working to ensure buy-in from the hospital executives and reviewing results. The work groups determine and map out the processes and work with departments to streamline operations. Team building is vital for a successful PSH.
6. Communication. Constant communication is needed. People need to be reminded and re-educated on the PSH as well as progress as it is made. There will be times when people may want to take a step back and ask why the hospital is pursuing this model. Prevent this from occurring by constantly communicating.
7. Time. It takes a good amount of time to put together a PSH — in some cases, it may require a year to create a successful program. Communicate this aspect of the development, and remind those involved that the PSH is not intended as a quick fix.
8. Start small. Do not take on a large department or many surgeons for your initial PSH system development. Start with one or two surgeons and their patients. The larger the group, the more difficult is to organize and come to consensus, which means there is a greater chance for divisiveness. Start small, get a success under your belt and then replicate the process as others see the success you achieve.
9. Incorporate all departments. Be sure to include all departments involved in patient care. It may seem like a lot of people, but identify all of the stakeholders and keep them involved. In one of our PSH development projects, we involved the heads of pharmacy, physical therapy, occupational therapy, ambulatory nursing, information technology, dietary and many other leaders to help ensure success.
10. Reinforce and emulate. A PSH does not end. It is a continuous work in progress. The individuals involved in the PSH development and execution processes must work to continuously improve upon the processes and be diligent to ensure these processes are not abandoned, which will lead to a return to historical performance levels. Once one PSH is completed, the organization should have blueprints for the next procedures, episodic care or specialty to implement a PSH.
Following these 10 steps will serve as a good beginning guide if you are thinking of implementing a successful PSH to address value-based payment methodologies.
Jonathan Friedman, MBA, CPC, is principal and CEO of PRN Advisors, a global company that provides pragmatic solutions for the most critical, strategic challenges facing healthcare practices and systems in an ever-challenging environment. Service lines include revenue cycle management, HIPAA and IT services, operations management and expense reduction.
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