Surgery is an expensive aspect of healthcare. For perspective, an office visit is about $100. Inpatient surgery without complication averages $20,000; with complications, surgical care becomes 2 to 3 times more expensive. 1 Annually in the US, 45 million inpatient surgeries are performed, and 1 in 5 involves a complication. While many important surgical outcomes-based quality improvement programs exist, there is need to expand these efforts to focus on appropriateness of surgery and directly motivate patients to modify their risk factors to optimize outcomes.
The Michigan Surgical and Health Optimization Program (MSHOP), a recipient of the CMS Health Care Innovation Award (HCIA), was developed to mitigate these opportunities and aims to reduce healthcare expenditures while improving health and outcomes. The program is centered on two key service offerings for high-risk patients having major inpatient abdominal surgery: 1) real time risk stratification and 2) prehabilitation.
- Risk Stratification via the Risk Assessment Tool
Leveraging currently available clinical data, a bedside risk assessment tool has been designed to identify remediable risk factors prior to major surgery and provides real time pre-operative risk assessment for surgeons and patients. This tool helps facilitate patient education as they learn about their procedure and what they can do to improve their outcomes by participating in their own care. Secondly, the tool facilitates shared and improved clinical decision-making. For example, a surgeon may determine that a specific procedure is too high risk and, in discussion with the patient, may prescribe a lower risk course of therapy.
- The Prehabilitation Program
Much as an athlete trains for competition, patients should train for surgery. Unlike other factors associated with pre-operative risk such as medical comorbidities, overall physiologic status can be improved prior to major surgery. As part of prehab, MSHOP patients are provided a pedometer and incentive spirometer to facilitate walking and breathing exercises. Their progress is tracked and uploaded to online server, supporting a cycle of self-regulation by providing a complete, detailed assessment of step counts, individualized goals, and individualized motivational messages. In addition, participants receive nutrition education and smoking cessation resources as well as task-training and stress reduction techniques.
After successful implementation of the program at the University of Michigan Health System (UMHS), MSHOP pilot studies noted a reduction in hospital costs by $2,308, a reduction in insurer payments to UMHS by $2,518, and a reduction in length of stay by a mean of 2.3 days. The HCIA award will enable implementation of MSHOP across 40 surgical clinics in the state of Michigan over the course of 3 years.
If you are interested in learning more about MSHOP or incorporating the program into your surgical practice please email Brooke Kenney for additional information.
1Vaughan-Sarrazin M, Bayman L, Rosenthal G, Henderson W, Hendricks A, Cullen JJ. The business case for the reduction of surgical complications in VA hospitals. Surgery. Apr 2011;149(4):474-483
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