Web Extra: A Scorecard to Facilitate Dialogue
Scorecards such as the sample primary joint replacement scorecard discussed below provide an opportunity for both surgeons and executives to negotiate what is important to them.
The executive wants to see results such as low expense per case and short length of stay. In exchange for providing an efficient workshop, the hospital executive expects the surgeon's output will be of high quality and at low cost.
The surgeon wants faster turnover time between cases, high flexion on discharge, low pain scores on discharge, etc. Some of the indicators relate to the surgeon's income, some to the amount of hassle (or not) in working with a particular hospital.
The scorecard allows each party to hold the other accountable. It is presented in the familiar stop light colors: green for good and red for needs improvement. The benchmarks can be negotiated at any time.
The scorecard presented here ( see exhibit) is an example of one used by a hospital system that has taken some pains to develop accurate data collection as well as strong, respectful, and professional bonds with its surgeons. Because all parties know the information reflects the current realities, it is a useful tool for discussions and for accountability-for all parties. These areas are mutually agreed to be significant measures of efficiency and cost-consciousness that also ensure quality outcomes for patients.
The "traffic light" colors in the two columns on the right are in a universally recognized shorthand:
- Red = stop/needs improvement
- Yellow = warning/area of concern
- Green = good to go.
The Indicators column is color-cued to demonstrate the key participant for each indicator:
- Purple = executives
- White = both surgeons and executives
- Blue = surgeons
It is important point to note, however, that each party should be closely monitoring all areas to understand how one depends on another, and each party contributes to the desired outcome.
Although most or all of the measures in this scorecard are likely to be familiar to CFOs, the following notes are provided to clarify or expand on the scorecard categories:
- % Knees-This measure refers to the knee portion of the total of hips and knees indicated by the MS-DRG 469/470.
- % Abx Cement-This one refers to the use of more costly antibiotic cement versus standard cement.
- % Blood Transfusion-Because it is ideally a bloodless surgery, a lower number of cases using transfusions is optimal.
- % Discharge to Home-An optimal reading of this measure will show more patients discharged to home than to rehab or a nursing home.
- LOS-A shorter hospital stay is optimal.
- % Pre-Education Classes-All parties benefit when hospitals optimally provide education/classes for patients by setting realistic expectations prior to admission.
- % Medicare-A lower Medicare number suggests a higher proportion of private payers.
- % Volume/Budget-Because the implant expense is significant, changes in volume (up or down) can have a dramatic effect on the hospital's budget and the surgeon's income.
- % Surgical Site Infection-Patently, the lowest possible percentage is optimal for all.
- Average Turnover Time-This is an efficiency measure of the minutes from the end of one case to the completion of operating room prep for next case.
- Average Procedure Time-This is an efficiency measure of the minutes required by the surgeon to complete the specific procedure; those with more experience are likely to work more quickly.
- Pain Score, Day 2-The lowest possible score is optimal.
- Ambulation Distance-This is a measure in feet of the distance the patient is able to travel at discharge.
- Flexion at Discharge-Measured in degrees, the angle of motion for total knee replacement patients is critical to get to a standing position from a seated one.
Publication Date: Monday, March 01, 2010