Opportunities to improve the value of outpatient surgical care.
OBJECTIVE
Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing.


METHODS
Evidence-based care delivery composite.


METHODS
We synthesized peer-reviewed publications describing efforts to improve the value of outpatient surgical care, interviewed patients and clinicians to understand their most deeply felt discontents, reviewed potentially relevant emerging science and technology, and observed surgeries at healthcare organizations nominated by researchers as exemplars of efficiency and effectiveness. Primed by this information, we iterated potential new designs utilizing criticism from practicing clinicians, health services researchers, and healthcare managers.


RESULTS
We found that 3 opportunities are most likely to improve value: 1) maximizing the appropriate use of surgeries via decision aids, clinical decision support, and a remote surgical coach for physicians considering a surgical referral; 2) safely shifting surgeries from HOPDs to high-volume, multi-specialty ASCs where costs are much lower; and 3) standardizing processes in ASCs from referral to recovery.


CONCLUSIONS
Extrapolation based on published studies of the effects of each component suggests that the proposed 3-part composite may lower annual national outpatient surgical spending by as much as one-fifth, while maintaining or improving outcomes and the care experience for patients and clinicians. Pilot testing and evaluation will allow refinement of this composite.
Judge Business School, University of Cambridge, Trumpington S, Cambridge CB2 1AG, UK. E-mail: f.erhun@jbs.cam.ac.uk.
Feryal
F
Erhun
Elizabeth
E
Malcolm
Maziyar
M
Kalani
Kimberly
K
Brayton
Christine
C
Nguyen
Steven M
SM
Asch
Terry
T
Platchek
Arnold
A
Milstein
D000556:Ambulatory Surgical Procedures / Q000191:economics; D020000:Decision Support Systems, Clinical; D006801:Humans; D058996:Quality Improvement; D012017:Referral and Consultation / Q000592:standards; D013531:Surgicenters; D014481:United States