Surgeons may reduce OR costs with feedback, incentives

Surgeons are more likely to use supplies sparingly when they receive monthly reports on the costs of their operating rooms, a new study found.

The research, published in JAMA Surgery, divided surgeons at an urban academic hospital into two groups, where 63 received the monthly feedback and 186 did not between Jan. 1, 2015 and Dec. 31, 2015. The surgeons who were informed on their operating room costs reduced costs by more than 6% over the course of 2015 compared to the year before, according to the study, while those in the other group increased costs by more than 7%.

The study team, lead by Corinna C. Zygourakis, M.D., a resident in the department of neurosurgery at the University of California, San Francisco, concluded that cost feedback and financial incentives can reduce surgical costs without a negative impact to patient outcomes.

Some surgical departments fared better than others, according to the study. For example, obstetrics and gynecology reduced costs despite not receiving feedback, while neurology failed to decrease costs even with the intervention of the scorecards.

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Other cost-cutting strategies for surgical centers include clear negotiations with surgeons about the costs upfront—which has been shown to reduce costs for outpatient spine procedures—and improved wound care techniques that can reduce length of stay after a procedure.

Meanwhile, procedures performed at high-quality hospitals are likely to cost less, as patients typically don't need as much post-acute care. Costly procedures like knee replacements are less expensive at high-volume hospitals, and procedures at ambulatory centers may be cheaper, too.

In a commentary accompanying the study, Andrew M. Ibrahim, M.D., and Justin B. Dimick, M.D., both professors in the Department of Surgery at the University of Michigan, agreed with researchers’ assessment.

“This study significantly builds on previous smaller reports demonstrating that, when given the right information, surgeons can be key players in reducing healthcare costs,” they wrote.

But they also noted that organizations should be aware of certain nuances if they plan to implement a scorecard like the one used in the study. Surgeons can reduce costs in two ways, they wrote: By simply changing supplies, or by making changes to their surgical approach.

The latter option requires significantly more investment, they wrote, as surgeons would have to be trained on new skills and techniques. That means healthcare leaders must consider strategies for reducing surgical costs.