Facility saves with checklist of best practices
System offers price guarantee for some patients
(In this first part of a two-part series on innovative care and pricing plans being used for outpatient surgery, we tell you how Geisinger Health System has used a checklist of best practices to save money, plus implemented a price guarantee for members of its health plan. Next month, we'll tell you how another facility has used a price guarantee effectively.)
Reduce your length of stay and reduce readmissions, and you'll save money. Sounds simple, but how do you do it?
Geisinger Health System in Danville, PA, has implemented an approach it calls ProvenCare that uses a checklist of best practices for certain surgical procedures. If a step is left out of the checklist, the surgery is canceled. Patients who are insured through Geisinger's insurance unit are charged a set price for preoperative care, surgery, and postoperative care. Because the set price covers most postoperative complications for 90 days, it acts as a sort of "90-day guarantee." If a patient experiences an avoidable complication within 90 days of the procedure, Geisinger covers the entire cost of any follow-up care provided by a Geisinger clinician or at a Geisinger facility. The health system is seeking to expand the price guarantee to other insurers.
ProvenCare started out as a program solely for coronary artery bypass graft (CABG) surgery. When Geisinger started its CABG program, 60% of patients received every step of the checklist. Now they all do. Rehospitalizations for complications dropped 40%. Patients recovered faster, and the hospital and its health plan saved thousands, according to Alfred Casale, MD, associate chief medical officer and chief of cardiothoracic surgery. Since that time, the program has been expanded to percutaneous coronary intervention (PCI)/angioplasty, cataracts, bariatrics, hip replacement, perinatal care, low back pain, and erythropoietin management. (Editor's note: For information on ProvenCare for elective percutaneous angioplasty, including the checklist, go to www.geisinger.org/provencare/pci.html.)
At health care facilities across the country, only about half of the care steps for a procedure generally are performed, he says. Before the checklists at Geisinger, some items were not being documented, he says. Examples of items left off the documentation included comprehensive discussions about procedure risks and the time IV antibiotics are started.
To implement a program such as ProvenCare, you need to have staff at the table when the evidence-based guidelines are developed "so they have a stake in its success," Casale says. Geisinger included physicians, nurses, physician assistants, pharmacists, and others in its guideline development and the implementation process. "They received weekly evals on that week's procedures," he says.
Also, checklists are easier to implement if they are done on an electronic health record, which ensures the items are documented and cross- referenced.
(In this first part of a two-part series on innovative care and pricing plans being used for outpatient surgery, we tell you how Geisinger Health System has used a checklist of best practices to save money, plus implemented a price guarantee for members of its health plan. Next month, we'll tell you how another facility has used a price guarantee effectively.)You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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