In 2016, the Advisory Board, an international consulting and membership organization focusing on management “best practices” for health care organizations, issued a paper which said, essentially, that hospitals and ambulatory surgery centers (ASCs) must bring surgeons, management, and time-and-materials stopwatch people together to cut their costs for total knee arthroplasty (TKA)—or lose calamitous amounts of money under the bundled payment system the federal government had imposed for Medicare-covered TKAs.
Flash forward to October 2018—Ochsner Health System (OHS) of Louisiana, which won national attention earlier this year by implementing artificial intelligence in its Epic Healthcare clinical information system, took heed.
In a white paper of its own, “Ochsner Health System Redesigns the Surgical Process and Transforms Orthopedic Surgery to Improve Efficiencies and Decrease Costs,” an OHS efficiency expert said that it had cut the cost of TKA procedures an astonishing 29% by combining teamwork between physicians and efficiency experts, using new, surgical-suite-specific software.
The software, called SIGHT, from a Louisiana company called SIGHT Medical, helps OHS to both anticipate surgical-suite needs at the individual patient level and control surgical-supply ordering.
Many of the key steps and results described in the OHS paper are similar to those described in a May 4, 2018 study by Premier, Inc., a consulting firm, titled, “How Variation in Total Joint Replacements Affects Quality and Costs,” and also in an August 21, 2018 article in the Wall Street Journal titled, “What Does Knee Surgery Cost? Few Know, and That’s a Problem” (see more on both reports below).
OHS seems to be unique so far in its use of software designed specifically to control surgical costs.
| Average Projected Savings From New Process, New Software | ||
| National average for surgeons direct cost per case | $12,700 | |
| Number of cases in studied group | 270 | |
| Average savings per case | $3,696 | |
| Total Savings | $998,025 | |
Source: Ochsner White Paper
The OHS study was done with a group of orthopedic surgeons who were already achieving the hospital organization’s lowest costs in TKA procedures.
Its efficiency people followed these surgeons and other medical personnel around, timing all their work activities. They also did “voice of the customer (VOC) with surgeons” and management (which apparently means, “listening to them”), as well as “current state and future state analysis, process maps.” Also, they spied on surgical supply orders, how surgical suites were scheduled, what everything cost, who decided what to buy, how surgical supplies were brought in and stored, and measures of surgical quality.
As an orthopedic implant representative for better than 30 years, I feel it necessary to reply to the above study, specifically; The Cost of Chewing the Fat with Sales People. After listing all the many functions the company representative performs, and then attempting to eliminate that one person, to me makes no sense. What appears to be completely ignored, is; most, if not all company reps are well trained professionals, providing an invaluable service to not only the surgeon, but also the hospital staff, whether it be in the operating room, central sterile supply, or wherever they are needed. Its then stated that the surgical techs, whom I’ve found to be excellent, are assigned some of the reps tasks. Its important to know; what training, and by whom? Most likely, not the in depth training provided by the implant companies to their reps, but I could be wrong, I believe this to be a serious omission. Now, I’m fully aware of the need to look at all costs associated with joint replacement, however in my opinion,value needs to be part of the equation also.