Quality Vascular Surgical Care
Quality Vascular Surgical Care
Background: Reductions in vascular surgery reimbursement emphasize the need to decrease cost while maintaining quality. Hospital solvency is essential if we are to preserve acceptable levels of nursing/support personnel and acquire new diagnostic and treatment programs.
Methods: Care processes for patients undergoing carotid, aortic, or dialysis access surgery were retrospectively analyzed and new quality- and cost-oriented treatment algorithms and clinical pathways were developed and implemented using case management principles. Preoperative risk stratification, length of stay, costs, complications, outcomes, and patient satisfaction were compared before and after these revisions in the care process. Statistical analyses were done using the Wilcoxon Rank sum test and Fisher exact test.
Results: Significant reductions in length of stay, intensive care use, and cost of treatment and diagnosis were achieved without adversely affecting morbidity, mortality, or patient satisfaction.
Conclusion: Use of algorithm, clinical pathway, and case management principles resulted in a marked improvement in the "bottom line" for vascular surgical procedures in our academic medical center.
Previous and planned reductions in the Medicare DRG payments for vascular surgical procedures continues to have a negative impact on hospital revenue. This coupled with increased costs for new technologies and the economic constraints imposed by managed care have resulted in an ever-shrinking number of dollars available to meet health care costs. The delivery of health care must be accomplished by the most efficient means possible to ensure that reimbursement covers the cost of the care. If we are to maintain satisfactory levels of nursing and other support personnel and state-of-the-art diagnostic and treatment capabilities, we must strive to keep our hospitals profitable. To meet this challenge as it applies to vascular surgery, the care processes for three of our most frequently performed surgical procedures were analyzed and reengineered. This effort resulted in substantial decreases in treatment-related costs without compromising quality of care.
Background: Reductions in vascular surgery reimbursement emphasize the need to decrease cost while maintaining quality. Hospital solvency is essential if we are to preserve acceptable levels of nursing/support personnel and acquire new diagnostic and treatment programs.
Methods: Care processes for patients undergoing carotid, aortic, or dialysis access surgery were retrospectively analyzed and new quality- and cost-oriented treatment algorithms and clinical pathways were developed and implemented using case management principles. Preoperative risk stratification, length of stay, costs, complications, outcomes, and patient satisfaction were compared before and after these revisions in the care process. Statistical analyses were done using the Wilcoxon Rank sum test and Fisher exact test.
Results: Significant reductions in length of stay, intensive care use, and cost of treatment and diagnosis were achieved without adversely affecting morbidity, mortality, or patient satisfaction.
Conclusion: Use of algorithm, clinical pathway, and case management principles resulted in a marked improvement in the "bottom line" for vascular surgical procedures in our academic medical center.
Previous and planned reductions in the Medicare DRG payments for vascular surgical procedures continues to have a negative impact on hospital revenue. This coupled with increased costs for new technologies and the economic constraints imposed by managed care have resulted in an ever-shrinking number of dollars available to meet health care costs. The delivery of health care must be accomplished by the most efficient means possible to ensure that reimbursement covers the cost of the care. If we are to maintain satisfactory levels of nursing and other support personnel and state-of-the-art diagnostic and treatment capabilities, we must strive to keep our hospitals profitable. To meet this challenge as it applies to vascular surgery, the care processes for three of our most frequently performed surgical procedures were analyzed and reengineered. This effort resulted in substantial decreases in treatment-related costs without compromising quality of care.
