Just seven procedures account for most of the costs and complications of emergency surgeries in the U.S. each year, according to a study in The Journal of the American Medical Association April 27.
UConn Health’s surgeon-in-chief Dr. David McFadden is not surprised. These seven procedures are some of the most common, including gallbladder and appendix removal, and it makes sense that the most common surgeries are also responsible for most of the costs. And since UConn Health is on a constant quest to provide the best care possible, the surgery department was already working on some of the issues discussed in the study.
For example, UConn Health participates in the National Surgical Quality Improvement Project (NSQIP), a service that tracks surgical complications such as infections, strokes and heart attacks, and alerts the surgeons to patterns. Catheter-associated urinary tract infections are one such common complication that happens in hospitals across the country. UConn Health surgeons decided that they would no longer accept that.
“We have started a focused, all-out war on catheter-associated urinary tract infections,” says Dr. Stephen Lahey, chief of the Department of Cardiothoracic Surgery and vice chair of quality improvement in the Department of Surgery. The NSQIP data has shown that there are subsets of patients who are much more likely to get urinary tract infections. The surgery department now focuses on those patients and has significantly reduced this type of infection. Reducing post-operative pneumonia in vulnerable populations is the department’s next project, Lahey says.
UConn Health’s work in this area is part of a national focus on improved population health care that stems from the passage of the Affordable Care Act, commonly known as Obamacare. Medicare has begun listing surgical complications that should happen rarely or never, and will lower or deny reimbursement to hospitals where they commonly occur. Private insurers are following suit. This can be a potent incentive for hospitals to support what medical personnel want to do anyway: find and reduce or eliminate the sources of complications.
“While lowering or denying reimbursement for certain patient events such as hospital readmission is a powerful incentive for hospitals to minimize their occurrence, we must never lose sight of the primary reason we do this — providing the best and most appropriate care to our patients,” Lahey says.
The main goal, he says, is “to alleviate suffering and improve the health of the population we serve. If we do that well, the finances will take care of themselves.”