Using data to influence decisions, behaviors, and outcomes is as essential to improving
healthcare delivery at Intermountain as it will be to transforming healthcare globally.
Intermountain’s Surgical Services ProComp initiative employs resources to provide
surgeons transparent access to meaningful costs and outcomes data related to procedure
comparisons, provider comparisons, patient-reported outcomes comparisons, and
supply comparisons. It also provides a forum to discuss those results.
The Surgical Services Clinical Program has been working with physicians, using
ProComp, to improve the value of healthcare in three specific clinical areas related
to surgery: appendectomies, blood utilization, and tonsillectomies. Using ProComp
cohorts and targeted data, physician-led collaborations have found practical solutions
to reduce variation in care and ultimately make high-quality care more affordable.
Pediatric general surgeons at Primary Children’s Hospital discovered
significant variation in supply costs for a laparoscopic appendectomy,
with the average supply cost per case landing around $840 per surgery.
Within one year of reviewing data and collaborating on best practice,
our experts agreed on a standardized approach to the surgery and
brought the supply costs down to $275 per case with no negative
impact to quality outcomes for patients. This 67 percent decrease in
supply costs has supported a 35 percent decrease in direct costs, an 18
percent decrease in total costs, a 16 percent decrease in total charges,
a 23 percent decrease in insurance payments, and a 17.9 percent
decrease in other payments. Following successful standardization
at Primary Children’s Hospital, the physicians shared the practice
changes in forums where surgeons across the system learned about
opportunities to improve care in other areas.
The Surgical Services Clinical Program analyzed data that showed patients
who received blood at Intermountain received two units 50 percent of
the time, whether they needed two units or not. Although ordering two
units of blood for every transfusion has historically been a practice taught
in medical schools, it’s not an evidence-based practice.
The Surgical Services Clinical Program implemented evidence-based
transfusion protocols, and physicians across the system championed
protocol education to other clinicians. Since 2012, the project has
decreased the number of transfusions by more than 12,000, eliminating
$3 million in costs. Blood utilization continues to be a measure that
the Surgical Services Clinical Program keeps in front of physicians. A
customized report is sent to all providers whose patients have received
blood during their care. By reviewing the reports, our physicians can
track their orders for one or two units of blood and make more informed
decisions going forward.
A physician-led case study reviewed the variation of costs and outcomes
associated with the different devices used during a tonsillectomy.
The average supply costs for various tools to perform this same procedure
had a wide range:
- $46 for electrocautery
- $254 for coblation
- $202 for a microdebrider
- $346 for a Harmonic scalpel
- $40 for a basic steel knife blade
Basic outcomes data—consisting of surgery time, PACU time,
complications, and hemorrhage statistics—indicated there was no
difference in the complication rate based on the device used.
To prepare meaningful data that would be compelling enough to change
the practice of providers, the Surgical Services Clinical Program began
work on collecting patient-reported outcomes as well: 672 parent
responses were voluntarily offered from the 1,444 patients included in
the tonsillectomy study. Parents reported outcomes for the child’s pain
score on day 2, 3, 7, and 14; the number of days until the child returned
to normal activity; the number of days until the child resumed a normal
diet; the number of days the child no longer needed any pain medication;
and the number of days until the child stopped taking narcotics. These
outcomes again indicated no statistical difference between the devices
used during the procedure.
Educating physicians about this data through a customized report has
led to more physicians reconsidering the devices they use during a
tonsillectomy, and ultimately, will lead to consistent high-quality care at
more affordable costs for patients.