Introduction: Surgical costs are very high, but most surgeons have little knowledge of their OR costs. A recent study of orthopedic surgeons found that their cost estimates for commonly used orthopedic devices ranged from 1.8% to 24.6 times the actual price (1). The goal of OR SCORE is to determine whether a price transparency initiative will reduce costs in the surgical departments at UCSF.
Methods: We first surveyed all attending, resident surgeons, and OR nurses regarding attitudes towards cost/value (n=219 responses). We then used EPIC data to analyze the time and cost of all surgical procedures at UCSF from 2012-2014. We created standardized “surgeon snapshots”, allowing each surgeon to visualize how they compare to their peers on 3 metrics (surgical preparation time, surgical time, surgical supply costs). From January through December 2015, all neurosurgery, orthopedic surgery, urology, and ENT surgeons are receiving these monthly snapshots. Each surgical department is eligible for a $50,000 financial incentive if they meet a 5% target cost reduction goal in 2015.
Results: In our initial survey, >95% of residents and nurses agreed that surgeons have the capacity to control costs, but only 56% were aware of alternatives to lower cost. Only 12% of attendings knew how much their procedures cost in comparison to others.
While it is early to report on direct supply cost trends, Neurosurgery Spine had a 6.6% decrease in supply costs from December 2014 to January 2015. Other services remained at similar supply costs or increased slightly during this time. By the time of the CNS meeting, we will have direct supply cost trends from the first 9 months of OR SCORE.
Conclusions: To the best of our knowledge, there are no publications demonstrating cost reduction through a price transparency initiative directed at surgeons, and our work represents one of the first attempts to do this.
Patient Care: The goal of OR SCORE is to allow surgeons to provide more cost-conscious care to their patients by providing them with direct cost information about all their cases and allowing them to make independent choices about what items they'd like to use in the OR.
Learning Objectives: By the conclusion of the session, participants should be able to:
1) Describe how to develop and implement a hospital-wide program to lower surgical costs
2) Identify some of the barriers to surgical cost reduction at the systems level
3) Evaluate whether price transparency information helps surgeons make more cost-effective choices in the OR
References: 1) Okike et al, Survey Finds Few Orthopedic Surgeons Know The Costs of the Devices They Implant, Health Affairs, Jan 2014, 33:1103-109.