The Affortable Care Act has brought significant change in the health care world including high deductibles, consolidation of health systems,
innovative payment models. It is clear that these changes are impacting surgery and the surgeon practice but how will this impact our patients. Currently, hospital revenue is driven by volume, i.e. number of procedures. Generally, surgeons provide the largest volume of procedures and the most “profitable” business. Doing more cases makes the hospital happy. However, surgery is transitioning from revenue center to cost center.
Today, surgeons are focused on providing the highest quality of care for their patients. This means a safe operation that results in limited morbidity and mortality. We want minimal pain, rapid recovery, and no complications. Recent innovation in surgery has focused on improving clinical outcomes. Doing more surgery to help the hospital bottom line is not the focus of modern surgical research and innovation.
As hospitals transition away from volume-based reimbursement (surgery as a revenue center), we will see more and more focus on providing high quality care to patients who will benefit most from surgical intervention. From a business prospective, hospitals will be payed not for an individual procedure/operation but for the global care of a population. To increase profitability, hospitals will see surgery as a source of money loss (cost center) and attempt to limit procedures.
In this new model, surgeons and their patients will need to be focused on the overall cost benefit of an operation. For example, a palliative operation that might not prolong someones life might improve someones quality of life and decrease readmissions. Given our position as institution and community leaders, surgeons need to represent our patient’s best interest in this transition of care delivery and reimbursement.