Hospital Group Offers Guarantee on Heart Surgery
Geisinger Health System, a hospital group in central Pennsylvania, is "trying to address what it views as a fundamental flaw in the typical medical reimbursement system" by offering heart bypass surgery patients a "guarantee of its workmanship": 90 days of follow-up treatment at no additional cost, the New York Times reports.
The program, called ProvenCare, uses a 40-step system based on best practices for pre- and post-operative treatment. Geisinger physicians also developed procedures to "ensure the steps would always be followed, regardless of which surgeon or which one of its three hospitals was involved."
When the program began, physicians used all 40 steps in 59% of heart bypass surgeries, but now "an operation is canceled if any of the pre-operative measures have been forgotten," according to the Times. Under a pilot program, the hospital charges an insurer a flat fee for the surgery and half the amount it has determined as "the historical cost of related care for the next 90 days," the Times reports.
The results of the Geisinger experiment, presented last month at a meeting of the American Surgical Association, showed that since the program's inception in February 2006, patients were less likely to return for intensive care, spent fewer days in the hospital and were more likely to go directly home from the hospital rather than to a nursing home.
The Times reports that the approach is "noteworthy as a distinct departure from the typical medical reimbursement system, ... under which doctors and hospitals are paid mainly for delivering more care -- not necessarily better care."
The hospital system currently offers the guarantee only to those covered by its own insurance unit, but it hopes to extend the offer to other insurers and employers. Geisinger CEO Glenn Steele said the challenge now is to determine standards for other types of care, such as hip replacement, that have less agreement on best practices.
Insurers and employers have indicated that the hospital system would have to offer the guarantee for five to 10 other procedures before they would buy in to the program.
In addition, the Times reports that although the results of the program seem promising, the model might be difficult to replicate.
According to the Times, "in contrast to most hospital systems," Geisinger directly employs the majority of its doctors. In hospitals where doctors typically act as independent contractors, it could be more difficult "to coax them toward a uniform set of procedures," and it is often "unclear who is responsible for follow-up care," the Times reports (Abelson, New York Times, 5/17).