Physicians can only improve the things they measure. From costs to outcomes and supply, spine surgeons discuss how they manage and learn from the data.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: As federal regulations evolve rapidly—especially around quality measures and reimbursement—what strategies or resources are helping you stay ahead in your practice?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, July 22.
Editor’s note: Responses were lightly edited for clarity.
Question: How do you track and analyze cost and outcomes data at your practice? What have you learned?
Andrew Fanous, MD. Inova Alexandria (Va.) Hospital: At our practice, we utilize an integrated electronic health record system combined with a data analytics platform to systematically track both cost and outcomes data. This includes monitoring direct surgical costs, implant usage, length of stay, readmissions, complications and patient-reported outcomes measures (PROMs). We conduct regular multidisciplinary reviews to identify trends and opportunities for improvement. Through this approach, we have learned that standardizing surgical protocols and closely monitoring post-operative care can significantly reduce variability in outcomes and cost. There is no doubt that aligning clinical decisions with data has enhanced our efficiency and increased our patient satisfaction.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I look at my profit and loss forms twice a quarter, and I do my own reconciliation every week. At my office we are always looking to save money on overhead without sacrificing quality and patient satisfaction. The biggest advantage we have over the “big box store” medical practices is agility and high-touch. We use our patient feedback on what works and what is just a drag. Cutting for the sake of cutting is a fool’s errand because no thought is given to what happens after. So, we do things with thoughts of how it affects business three, six and 12 months down the road and see if it’s actually worth getting rid of or not. I have learned if you are cutting for the sake of cutting, it often harms your practice rather than helps it. You have to use your brains before your chainsaws.
Alex Vaccaro, MD, PhD. Rothman Orthopaedics (Philadelphia): From a cost monitoring perspective Rothman Orthopaedics, like similar medical practices, develops an annual budget for the practice, academic department, ambulatory surgical centers and specialty hospitals monitoring medical and administrative supplies usage, staffing, benefit costs, facilities and equipment maintenance and replacement costs. Cost budgets are based on projected patient volumes for all areas. Actual costs vs. budgeted costs are reviewed monthly with variance explanations provided by the department leads. Actual data is then used to prepare subsequent budgets and actual costs.
When it comes to outcome data, outcomes are monitored and reviewed at numerous levels. Patient surgical outcomes are monitored and reported by the facilities where the procedures take place such as an academic hospital, ASC, specialty hospital or office facilities. Rothman has a team of nurse navigators that follow patients from preoperative care, through surgical planning, surgery, and post-surgery care. To optimize patient outcomes communication is key. In the case of a perioperative concern our nurse navigators will assess the patient needs and get them to the appropriate site of care such as the office, urgent care or emergency department. Rothman also tracks outcomes on a longitudinal basis with a very robust research department which monitors patient outcomes to develop improved care protocols for future patient care as well as knowledge dissemination through peer reviewed medical journals, and seminars.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As an employee of a large, national health system, our data collection, analysis and performance metrics are positioned locally, compared nationally and reportable to all insurers and providers alike. Comparisons and correlates of patient outcomes and cost data are matched nationally and within the entire system and become better utilized with a ubiquitous EHR and Healthcare Cost Reporting System.
The inescapable terms of lower reimbursements and both escalating direct and indirect costs have certainly changed the purchasing landscape, adding yet more scrutiny to equipment and technological advancement. The applicable truism of learning is timing and expectation; both being an exercise in patience, diligence and composure.
