by Kelly L. Baldessari, Director of Managed Care Contracting and Quality, Physician Practice Management (PPM), SurgOne, TraumaOne
Featured in the March/April 2019 Colorado Medicine.
The 41 physicians of SurgOne PC, a comprehensive multi-specialty surgical group serving patients from Castle Rock to Lafayette and Aurora to Littleton and Englewood, pride themselves on high quality of care, demonstrated by thorough preoperative and postoperative evaluation and successful surgical outcomes. The patient has always been the center of what we do. Our providers recognized early on that duplicative testing and being out of network did not benefit our patients. That led to another focus: bending the cost curve for the benefit of patients and the system overall.
Consider four actions we have taken to reduce costs over the past few years.
1. Providing self-funded employer group-bundled payment
At SurgOne we started working with self-funded employer groups to allow for bundled payments two years ago. It has been very successful in giving patients an opportunity to get the procedures they need without having to pay any out-of-pocket cost. They continue to keep their traditional employer-paid insurance but can use the surgical rider that the employer purchases for certain surgical procedures. We not only save the patient money but also the employer as these services are provided at a significantly discounted rate because the providers have no administrative cost for providing these services; i.e. no pre-authorizations, referrals or claims challenges. We agree on the bundled amount and get our check seven days after they receive our HCFA reimbursement form. In the last four months I have been in discussions with three more of these types of companies. It’s a simple concept with a huge result in savings.
2. Ensuring an in-network trauma group
In 2014 TraumaOne PLLC, a subsidiary of SurgOne, started one of the first in-network trauma groups to give patients who seek care in the emergency room a guaranteed in-network physician. In most hospitals the emergency department and trauma physicians are out of network after 5 p.m. and use a different tax identification number to bill for their services. Hospital executives have told us that they have no choice but to let these physicians practice in their hospitals or they will lose their elective cases during the day when they do use their commercial contracts and are considered in network.
We use freestanding ambulatory surgery centers (ASCs) whenever possible, which offer significant savings over a hospital setting – creating cost savings for patients and the system. We were able to improve from 65 percent of cases going to the freestanding centers to 85 percent within one year. This allowed us to participate in shared savings opportunities with UnitedHealthcare and Cigna. In just three months we have even moved cases out of certain high-cost freestanding ASCs into a much more cost-effective one. In addition, our physicians are now using conscious sedation instead of Propofol when appropriate so that no bills from anesthesia are generated.
3. Keeping surgical site infections down
The Centers for Disease Control and Prevention estimates that four percent of surgery patients get surgical site infections post-operation. If we take a conservative estimate that we perform approximately 18,000 procedures annually, approximately 720 patients should have surgical site infections. With our rate of 2.3 percent, only 414 patients develop surgical site infections. The average cost of a surgical site infection is $15,000. If you calculate the difference between expected and actual infections and multiply by the cost per infection, our group is saving the system $4.6 million dollars each year.
4. Reducing hospital length of stay
We have impressive data through Intuitive Surgical that proves when certain procedures are done robotically versus laparoscopically or open, it can reduce hospital lengths of stay by 1 to 4 full hospital days. With a group our size, reducing the length of stay by a couple of hundred days a year is a significant cost savings and huge patient satisfaction booster.
Through our affiliation with the Transforming Clinical Practice Initiative (TCPi), a federally funded support network, we teamed up with Radiology Imaging Associates (RIA). In our partnership, RIA shared data with us which showed that SurgOne providers order the right imaging study 99 percent of the time. It is estimated nationwide that 33 percent of tests ordered are unnecessary. That equates to a cost savings of $8 million for our group annually.
Though these cost-saving strategies take time and effort to grow, we continue to identify ways to improve quality and reduce costs. We made a hard push in 2018 to reduce the number of opioids we prescribe after surgery and have already seen a dramatic decrease in the number of pills dispensed. We will continue this effort in 2019. In addition, we plan to launch telemedicine services. We will grow TraumaOne to bring more out-of-network physicians in network and continue to pursue other cost saving opportunities as they arise.