Start with simple steps to cut procedure costs
Tourniquet, disposable stirrup strap not needed
El Camino Surgery Center in Mountain View, CA, always has scored high in all the categories of the study on Knee Arthroscopy with Meniscectomy benchmark study by the Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement. However, a review of their 2004 results showed that the center’s cost per case was high, reports Lisa Cooper, RN, CNOR, clinical director for the surgery center and a speaker at the most recent annual meeting of the Federated Ambulatory Surgery Association.
"We were surprised that we were one of the highest cost study participants, and we decided to put together a cost study team to look at the reasons for our high costs," she says.
The team included representatives from the administrative, clinical, and financial departments. "In addition to evaluating a cost analysis for all knee arthroscopies, the team looked at costs by physician," says Cooper. There was a difference from physician to physician in operating room time and supply cost per case, she adds.
The data were necessary to present the findings to the physicians, says Cooper. "We did not identify individual physicians, but we showed the differences in costs related to supplies and operating room time and explained how we were a high-cost provider in a national benchmark study."
"Although a thorough cost analysis includes supplies, operating room time, allocation of salary and benefit costs, allocation of monthly overhead charges such as rent, and allocation of indirect costs such as equipment, when we presented the information to the physicians, we focused on costs over which they have control," says R. Craig Lind, managing director of Lind/ Fitzsimons, a Greenbrae, CA-based management consulting firm and a member of the El Camino cost study team.
"These costs included their operating room times as compared to other physicians and their average operating room costs based on the actual supplies used and marked on the preference cards," he explains. They also were careful to include only cases with the same CPT code, in this case CPT 29881, he adds.
It is critical to break down costs by physician because it gives you an opportunity to pinpoint where changes are taking place once you initiate cost savings measures, says Lind. "Our analysis by physician helped put the spotlight on what was a surprisingly wide range of performance statistics," he says. "There was a threefold difference in supply costs between the average for the lowest physician and the average for the highest."
By investigating the cause of the wide range of costs, some very specific initial changes that could decrease costs were identified, Lind adds.
Team members knew they couldn’t overwhelm the physicians with a list of changes to supplies and or changes in scheduling, so they picked two items that were noncontroversial that they could change to start cutting costs, says Cooper. "We noticed that in 90% of our knee arthroscopies surgeons were using a precautionary tourniquet’ that was never needed," she says. "There is not enough bleeding in a knee arthroscopy to require a precautionary tourniquet, so by eliminating this one supply, we saved $4 per case."
A disposable stirrup strap used to prep the leg also was adding $4 per case, Cooper says. "We had no problem getting the surgeons to agree that purchasing a nondisposable leg holder for $100 that could be used in place of the disposable strap made more sense."
In addition to getting buy-in from the physicians, she says nursing staff members also were asked for feedback before changing the tourniquet requirement and the disposable stirrup straps. "It is important to get buy-in from everyone and make sure all staff members understand that these cost savings won’t affect patient care."
Cooper’s cost study team also noticed that more operating room time was needed when physicians draped their own patients. Physicians were late getting into the operating room if they were talking to family members, and then the procedure would start even later as the surgeon draped the patient. "We pointed out to the surgeons that they could spend more time with the patient’s family while we draped the patient," she says. "We also developed a competency tool for draping so that the physicians are confident that nurses will drape the patient appropriately."
Cooper admits that the steps her staff members have taken to reduce costs are simple and may not represent a huge savings at this time. "The ultimate goal of our cost savings program is to standardize more of their disposable items so that purchasing contracts with good discounts can be negotiated," she says.
However, the first step they wanted to take was to make everyone aware of the need to save money, Cooper notes. "We knew we had to do this in a way that didn’t overwhelm anyone and that would give us an opportunity to present other suggestions for change."
El Camino Surgery Center in Mountain View, CA, always has scored high in all the categories of the study on Knee Arthroscopy with Meniscectomy benchmark study by the Accreditation Association for Ambulatory Health Cares Institute for Quality Improvement.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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