How Site of Care Impacts Surgical Outcomes—And What That Means for Employers

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Traditional Center of Excellence (COE) programs often require employees to travel long distances for care. This means more time off work, more time away from their families, and may be the determining factor for whether employees even get needed care.

While there is no national standard for what defines a COE, they have typically been designated at the facility level. But for many procedures, excellent care can be delivered wherever excellent surgeons operate.

In any community, there’s a wide range of skill sets, operating site quality, bedside manner, and best practice program models,” said Alan Davis, MD, an orthopedic surgeon and Emeritus Staff at the Cleveland Clinic. “At EDH, we look at the surgeon and their entire surgery program, not just the facility, so we can find the best providers for our members. The best surgeons create the best centers, not the other way around.”

Because Employer Direct Healthcare’s SurgeryPlus network vets at the surgeon level, members can see their surgeon wherever they operate, including doctors who operate in Ambulatory Surgery Centers (ASCs). ASCs are dedicated to same-day surgical care, and for the right patients, they deliver better outcomes than hospitals. For example, they offer:

  • 75% lower readmission rates than hospitals
  • 10x lower revision rates for total joint replacements, according to American Academy of Orthopedic Surgeons research
  • 6x lower infection rates than hospital outpatient surgeries

Working with a COE solution that includes access to ASCs means more employees can get high-quality care locally, rather than traveling to large facilities.

The Evolution of Healthcare

The technology and techniques for many surgeries have evolved, meaning patients don’t need the level of inpatient care they did even a decade ago.

For example, a knee replacement surgery required a 5- to 7-day hospital stay when Dr. Davis trained in the ‘80s.

“The patient would be on intravenous morphine and receive all their initial physical therapy in the hospital,” Davis says. “We’ve evolved to doing a huge number of total knee replacements as outpatient with appropriate pain management blocks, no opioids, and physical therapy set up ahead of time to do at home. We’ve taken a long stay in the hospital that’s costly and used too many drugs and turned it into an outpatient procedure with better results. ASCs are getting less complication rates, less revision rates and less infections.”

And while hospitals have outpatient departments, they still face scheduling delays and limited operating room availability.

“A hospital outpatient procedure conducted in the main operating room is no different than having surgery as an inpatient. The problem in the hospital is that you don’t necessarily have a dedicated team,” Davis says. “The nurses and techs have to be jacks of all trades. You have many more rooms around with emergencies coming in and patients with higher acuity ratings and infections. So, you’re in a setting that is going to give you higher complication rates regardless.”

ASCs provide a more focused option.

“The entire operating room environment is more efficient and less stressful, including for the patient,” Davis says. “In an ASC, the equipment is dedicated to you, you have a dedicated team the surgeon is more comfortable with, and the overall environment is more comfortable for the patient and their family. If you have the opportunity for a patient to have elective surgery in an outpatient setting, you’re going to have more satisfied patients, lower complication rates and better outcomes.”

Key Takeaways for Employers

At the end of the day, employers just want what’s best for their employees. Optimizing site of care offers the following benefits:

Better health outcomes: The primary benefit of utilizing an ASC is a better outcome. Employer Direct Healthcare steers toward ASCs when appropriate, and 2022 data shows 61% of SurgeryPlus surgeries were performed at ASCs, compared to only 10% nationally. That means more people can access high-quality, local care with fewer complications.

Improved patient experience: Beyond the health outcome, an ASC just provides a better patient experience. They’re typically smaller and less complicated facilities, which eases anxiety for patients and their families. Patients receive more personalized care, creative pain management strategies, an easier scheduling experience and fewer delays.

Increased access: ASCs increase access to care, which benefits employers and employees. The SurgeryPlus network is five times larger than the nearest peer competitor. This places 98% of SurgeryPlus members within driving distance for more than 1,500 covered procedures. The ease of access leads to a 5x utilization rate compared to facility-based COEs.

“In the end, every episode of care between a patient and physician is a relationship,” Davis says. “You want to engage with physicians who can make you feel comfortable with whatever elective surgery you’re going to have.”

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