Bariatric Times

Spotlight on Technology December 2014

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C3 [DECEMBER 2014, SUPPLEMENT C] Bariatric Times S POTLIGHT ON TECHNOLOGY Q: How is a surgeon's "value" being measured in today's healthcare environment? A: In today's healthcare environment, a surgeon's value will be measured by looking at the surgeon's outcomes (i.e., the quality of the product they produce, how well the procedure goes, and any potential complications that may occur after the procedure). I believe that cost will play a factor in that as well, but primarily a surgeon's value will be measured by the quality of the surgery and the reduction of any potential complications or outcomes that are undesirable in the long run. How do you see the measurement of a surgeon's "value" changing as we move from "Fee for Service" to a "Pay for Performance" healthcare system? A: In a "Fee for Service" environment, the surgeon's value is measured by the number of procedures that they perform, how much volume they bring to the hospital, their surgical volume, their patient volume, their volume of additional studies, tests, X-rays, and lab tests. In a "Pay for Performance" model, a surgeon's value is measured by outcomes, how the surgeon performs, the quality of those outcomes, the reduction of complications, the reduction of risk, which ultimately results in better outcome for the patient and less cost to the hospital and to the healthcare environment in general. How does GORE ® SEAMGUARD ® Reinforcement affect these values? A: By using GORE ® SEAMGUARD ® Reinforcement, complications are reduced, whether they be bleeding, leaks, strictures, or any variety of other complications. Ultimately, if we are able to reduce complications to the patient, then the surgeon has better outcomes, the patient has a better outcome, and the hospital has less downstream risk. How is the hospital's "value" being measured today? A: I believe the hospital and surgeon are interconnected. Many surgeons are employed by hospitals or hospital systems. That may b e more of the model that we see in the future as we move out of a private practice environment and into more of an employed environment, in which case the hospital and the surgeon then essentially function as one. In my hospital, for instance, the hospital is really an extension of our private practice, so whatever we do as surgeons affects the bottom line of the hospital. The value of the hospital is affected as well. If we can reduce complications, reduce risk, reduce downstream—potential downstream negative outcomes—then we are adding value to the hospital and ultimately to our practice and to the employer. How can a surgeon improve cost-efficiency for the hospital? A: Hospitals look at cost-efficiency. It's been important in the past, and I believe it is going to be a major factor in the future as reimbursement models and reimbursement change. Although there is a small upfront cost to using GORE ® SEAMGUARD ® Reinforcement, the downstream potential risk reduction that can occur from using it is in the best interest of the hospital and, ultimately, in the best interest of the patient. I think hospitals need to begin to look further than what the cost of an actual product is and really look at the cost of the potential risk that the patient may face by choosing or not using a particular product that has been shown to be efficacious in patient care and reduction in risk and complications. How do you change focus from the "Cost of Product" to "Total Cost of Care?" A: The total cost of care is everything that's involved from the minute the patient hits the door of that hospital to the minute that the patient is discharged. From the administrative standpoint, keeping those costs at a minimum is important and, ideally in an environment like today's where we get reimbursed based on a particular diagnosis related group (DRG) for a patient, the lower we can keep our costs, the higher that that margin becomes for the patient's care. It's important, therefore, to look at GORE ® SEAMGUARD ® Reinforcement and say, "That product may increase the cost of caring for that patient by a certain number of dollars; however, that needs to be compared fairly to the total cost of a patient in which we didn't use that particular product." For instance, did that patient's procedure require more clip appliers? Did the patient require a blood transfusion, reoperation, another trip to the operation room or to the endoscopy lab for a procedure, a dilation, or a stent placement? We really need to look Eric S. Bour, MD, MBA, FACS, FASMBS Dr. Bour is President, Hillcrest Memorial Hospital and Simpsonville Medical Campus; Chair, Greenville Health System Quality and Patient Safety Council; and Surgeon, UMG Bariatric and Minimal Access Surgery, Greenville Health System, Greenville, South Carolina T h e h o s p i t a l a d m i n i s t r a t o r

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