title: Association Between Surgeon Scorecard Use and Operating Room Costs.
abstract: Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs.
  
  
  
  To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room.
  
  
  
  The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186).
  
  
  
  From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal.
  
  
  
  The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey.
  
  
  
  The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls.
  
  
  
  Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco2UCSF Center for Healthcare Value, University of California, San Francisco.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Department of Internal Medicine, Dell Medical School at The University of Texas at Austin.
authors.forename: Victoria
authors.initials: V
authors.lastname: Valencia
authors.affiliation: UCSF Center for Healthcare Value, University of California, San Francisco3Department of Internal Medicine, Dell Medical School at The University of Texas at Austin.
authors.forename: Christopher
authors.initials: C
authors.lastname: Moriates
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Christy K
authors.initials: CK
authors.lastname: Boscardin
authors.affiliation: Department of Medicine, University of California, San Francisco5Department of Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Sereina
authors.initials: S
authors.lastname: Catschegn
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Alvin
authors.initials: A
authors.lastname: Rajkomar
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin7Department of Orthopedic Surgery, University of California, San Francisco.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.affiliation: Healthcare Technology Assessment Program, University of California, San Francisco.
authors.forename: Kent
authors.initials: K
authors.lastname: Soo Hoo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Goldberg
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Pitts
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
authors.affiliation: UCSF Center for Healthcare Value, University of California, San Francisco4Department of Medicine, University of California, San Francisco10Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.affiliation: UCSF Center for Healthcare Value, University of California, San Francisco4Department of Medicine, University of California, San Francisco11Continuous Process Improvement, UCSF Health, University of California, San Francisco.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D001364:Awareness; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D004865:Equipment and Supplies, Hospital / Q000191:economics*; D005246:Feedback; D005260:Female; D006786:Hospitals, Urban / Q000191:economics*; D006801:Humans; D008297:Male; D009873:Operating Rooms / Q000191:economics*; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000191:economics* / Q000706:statistics & numerical data; D066231:Surgeons / Q000523:psychology*; D013503:Surgery Department, Hospital / Q000191:economics; D016896:Treatment Outcome