Improving Quality and Reducing Cost: See Something, Say Something, Do Something!

From the 2019 HVPAA National Conference

Dr. Patricia Ayoung-Chee (NYU Langone Health), Dr. Nicole Adler (NYU Langone Health), Dr. Frank Volpicelli (NYU Langone Health), Dr. Jonathan Austrian (NYU Langone Health), Mr. Steven Chatfield (NYU Langone Health), Dr. Paresh Shah (NYU Langone Health)

Background

As the landscape for healthcare reimbursements continues to change, our institution noted an increase in Medicare losses. At the same time, there was a general awareness of increased variability, waste and poor compliance with evidence-based practices.

Objective

Reduce variability and improve quality across all surgical services.

Methods

The Value Based Medicine (VBM) Surgical Committee was created with members from General Surgery and Surgical subspecialties, Internal Medicine and Finance. The goal was to drive quality, process improvement and cost-reduction initiatives across all surgical areas. Projects have involved multiple departments (including the Department of Medicine, Orthopedic Surgery, Obstetrics and Gynecology and Surgery), hospital operations (including information technology, central processing, purchasing, environmental) and specialists (including medical doctors, nurses, residents and analysts).

Results

Since inception in May, 2015, we have initiated 23 VBM Surgical Projects (10 in 2015, 3 in 2016, 6 in 2017 and 4 in 2018), across all surgical sites, including ambulatory locations. Projects have included implementation of clinical care pathways (laparoscopic sleeve and colon), introduction of new healthcare services (hospitalist co-management) and improvements in current practices (clinical documentation, supply chain variability and evaluation/editing of surgical preference cards). With these initiatives, we have been able to improve care standardization and use our electronic medical records system to help enhance the care we provide and results we achieved. Together, these projects have helped us realise an 8.2% reduction in length of stay, 7.5% reduction in mortality and 7.7% reduction in 30-day readmissions. More importantly, we have noted a subtle shift in culture, with more emphasis on efficiency, accountability and transparency. 39% of projects were initiated and lead by individual providers, who were not initially members of the VBM Surgical Committee.

Conclusions

Engaging key stakeholders in a mutli-disciplinary and multi-modality approach to surgical care can result in widespread implementation of value-based initiatives, resulting in improved patient care and cost savings.

Clinical Implications

The Implementation of a Value Based Surgical Committee resulted in the implementation of surgical team led projects that led to reduced admission, rates, lower lengths of stay and improvements in efficiency.

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