The Financial Health of Providers: Impact of Spine Patient Satisfaction & Pain Management

Spinal Tech

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a data collection initiative to measure patients' perspectives on hospital care.

The standardized survey contains 21 patient perspectives items, including communication with physicians and nurses, hospital staff responsiveness, discharge information, communication on medication, quietness of the hospital, transition of care and pain management.


"By increasing transparency and allowing for a comparison of institutions nationwide, these results are intended to help consumers make informed medical decisions and to provide incentives for both hospitals and physicians to administer higher-quality care," says Peter Whang, MD, FACS, an Associate Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine in New Haven, Conn. "Similarly, outcomes in accountable care reflect the greater emphasis on value-based, patient-centered care driven by evidence-based therapeutic guidelines."


Patient satisfaction
Hospitals and physicians are vying for increased patient satisfaction scores and recent studies show the facility's financial health is tied to both patient satisfaction and the impact of inadequate postsurgical pain relief. Findings from a 2011 Frost & Sullivan Survey include:


•    82 percent of hospitals had programs focused on improving patient satisfaction
•    92 percent of hospitals stated patient satisfaction was very important to their facility's financial health
•    29 percent of for-profit community hospitals said inadequate postoperative pain relief had a significant negative impact on the hospital's finances; another 59 percent reported a moderately negative financial impact
•    21 percent of not-for-profit community hospitals said inadequate postoperative pain management had a significant negative financial impact; 43 percent said it had a minor negative financial impact


"It has previously been shown that there is often a disconnect between the perceptions of surgeons and patients after operative procedures so maintaining open lines of communication can help to avoid any ongoing confusion and optimize the delivery of their care which not only should lead to improvements in their outcomes but also hopefully translate into cost savings and societal benefits," says Dr. Whang.


But improving pain management won't fix everything.


"While certain facets of the hospital experience are affected by other factors, practitioners can certainly influence these findings in both positive and negative ways; aside from providing safe and effective treatment for spine disorders, we also have to be cognizant of the fact that we have to be better at the customer service aspects of the evolving healthcare market," says Dr. Whang. "I think the relationship between the surgeon and patient takes on even greater significance as we continue to focus more and more on objectively assessing clinical outcomes and establishing the cost-effectiveness of spinal interventions."


Patient selection
Faheem Sandhu, MD, a spine surgeon at Georgetown University in Washington, D.C., has seen the impact of EXPAREL on his patients. He uses it in both open and minimally invasive spine procedures. For patient selection, he generally would use it with any patient unless the patient has medication sensitivities to local anesthetic or carriers.


"I've noticed consistently those patients who receive EXPAREL are more comfortable being discharged and they are done on an outpatient basis," he says. "It's helpful for them to control their pain as they get home and minimize their need for postoperative narcotics. It's one more agent we can use to help control the pain and get patients comfortable and mobile faster, which I think are important parts of the recovery process. There is very little downside to using it. There is an associated cost, but if the patient is able to go home sooner instead of staying in the hospital, it more than makes up for its utility."


It was easy for Dr. Sandhu to incorporate EXPAREL into his practice and he feels more surgeons will begin to use it when they see how positively patients react. "We are working on conducting some of the studies on the efficacy of EXPAREL in minimally invasive procedures, and I'll be interested in seeing the outcomes," he says. "I have used it successfully in broad categories of applications."


Outpatient spine surgery
William Tally, MD, Assistant Professor of Orthopedic Spine Surgery at the University of Georgia, also uses EXPAREL in both minimally invasive and open surgeries, and using the EXPAREL has allowed him to take cases into the outpatient surgery center. "I try to get procedures out of the hospital, and having EXPAREL is an advantage that could make this pain more mainstream," he says. "It's one arm of the pain control that I use in my practice."


He speaks with his patients preoperatively about what type of pain to expect after the procedure and gives them pain medication before surgery. During the initial part of the procedure, he activates the regular marcaine in the wound and then injects the EXPAREL into the area surrounding the surgical bed to block the nerve fibers going in and out of the muscle bed. He also puts a small amount of EXPAREL into the muscle bed, but is careful not to damage the nerves or dura. Then he works with the patient on postoperative pain care.


"The first narcotic administration in the PACU is unchanged with EXPAREL, but the time we have patients take the narcotic at home has shifted 20 percent," says Dr. Tally. "We don't have them take it as soon as they get home. They have some time before they'll need it. We tell the families there is a time-release on these medications and the patient shouldn't panic if they feel some pain; they can take the pain meds if they need them."


When the appropriate patients receive the best treatment possible, experience less pain and are able to return to their daily activities more quickly, they will report better satisfaction with their care. In the Frost & Sullivan survey, 98 percent of respondents said pain relief was very important in predicting patient satisfaction with their overall experience, and 78 percent said their hospital had new guidelines and policies to improve postsurgical pain management.


Pain management can also impact the hospital's finances; 28 percent of the survey respondents said inadequate postsurgical pain relief had a significant or severe negative financial impact on their hospitals. New innovations in pain management that can improve HCAHPS may also improve the institution's financial future.


More Articles on Spine Surgery:
Is XLIF for Spine Surgery Effective? 6 New Findings
Spine Surgery in ASCs: 6 Burning Questions About Future Feasibility
8 Core Concepts for Cutting-Edge Comprehensive Spine Practices Today

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