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Original Investigation
December 07, 2016

Association Between Surgeon Scorecard Use and Operating Room Costs

Author Affiliations
  • 1Department of Neurological Surgery, University of California, San Francisco
  • 2UCSF Center for Healthcare Value, University of California, San Francisco
  • 3Department of Internal Medicine, Dell Medical School at The University of Texas at Austin
  • 4Department of Medicine, University of California, San Francisco
  • 5Department of Medicine, University Hospital Zurich, Zurich, Switzerland
  • 6Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin
  • 7Department of Orthopedic Surgery, University of California, San Francisco
  • 8Healthcare Technology Assessment Program, University of California, San Francisco
  • 9Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
  • 10Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
  • 11Continuous Process Improvement, UCSF Health, University of California, San Francisco
JAMA Surg. Published online December 7, 2016. doi:10.1001/jamasurg.2016.4674
Key Points

Question  What is the association between providing surgeons with individualized cost feedback and surgical supply costs?

Findings  In this case-control study, surgeons in the intervention group received cost feedback scorecards during the study period, while those in the control group did not. The median surgical supply direct costs per case decreased 6.54% in the intervention group compared with a 7.42% increase in the control group.

Meaning  Cost feedback to surgeons was associated with significantly reduced surgical supply costs.

Abstract

Importance  Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs.

Objective  To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room.

Design, Setting, and Participants  The OR Surgical Cost Reduction (OR SCORE) project was a single–health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology–head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186).

Interventions  From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon’s baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal.

Main Outcomes and Measures  The primary outcome was each group’s median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index–adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey.

Results  The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls.

Conclusions and Relevance  Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

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