Increasing surgical supply cost transparency using a balanced scorecard

Background

Nearly half of hospitalization costs for patients undergoing surgery are attributed to operating room expenses. Surgical supplies that include consumables and implantable devices account for the bulk of surgical spending. Surgeons heavily influence surgical supply selection; however, few can estimate pricing for routinely used items correctly. The lack of cost transparency can contribute to higher costs without improved patient outcomes. The Balanced Scorecard (BSC) is a cost feedback tool that can increase surgeon cost awareness and empower them to achieve significant cost savings while maintaining positive patient outcomes.

Methods

Six months of retrospective data collection was completed to establish baselines for surgeon median surgical supply costs, patient disposition, 30-day readmissions, and surgical time from cut-to-close, for surgeons (n = 6) performing single-level transforaminal lumbar interbody fusions (TLIF). During the eight weeks of the implementation phase, each surgeon received customized, biweekly BSC reports displaying their median surgical supply costs, the group's median surgical supply costs, the group best, and a list of the five items that mostly contributed to costs. Additionally, surgeons received a dashboard exhibiting anonymous median surgical supply costs for all participants to encourage peer comparison and stimulate practice change. The primary outcome was decreased surgical supply costs. Patient outcomes were measured to evaluate the initiative's impact on quality and safety. Surgeons completed pre- and post-intervention surveys used to calculate the BSC's influence on surgical supply selection, the value of the initiative, and their interest in expanding this practice.

Results

Surgeons (n = 6) from the orthopedic spine and neurosurgery specialties performed eight single-level TLIF procedures. The group's median surgical supply costs decreased by $2,767.73, representing a 9.8 % reduction. A 7.75-min decrease in surgical time from cut-to-close and a 0.57-day reduction in patient length of hospital stay was identified. There were no reports of 30-day readmissions. Sixty seven percent of participating surgeons completed pre- and post-intervention surveys. Survey results revealed that 83 % of surgeons agreed the BSC has value in reducing surgical costs, and 100 % agreed that lower-cost alternatives do not increase the risk for poor patient outcomes. Over 80 % of surgeons were interested in supporting future BSC initiatives.

Conclusion

The surgeon's lack of surgical supply cost awareness can limit their ability to reduce spending. The BSC can increase cost transparency and inspire performance improvement to deliver value-based care with favorable patient outcomes.