charge. It was first implemented for coronary artery bypass surgeries,
but has since expanded to include 7 other surgeries, including total hip
replacements, total knee replacements and lumbar spine surgeries.
The results? "Patients had better outcomes clinically from what was
already a very, very good program with outcomes that were better
than national averages," says Dr. Casale. "So from an already high bar,
we improved clinical outcomes." Geisinger also lowered its costs
through the program by eliminating unwarranted variation.
"But the real moment the hair stood up on our necks and we real-
ized we had something was when we looked at the total cost of what
our insurance company was spending on these patients over a 90-day
period, and it was dramatically lower than when you look at the exact
same patient and run the bill to figure out what you'd pay in the old
system," says Dr. Casale. "It was a 25% difference."
Although the idea of surgical warranties is still emerging in the
healthcare space, implementing one in your facility could save you —
and your patients — unnecessary time and money. Here's what to
know about the game behind guarantees.
How it pays off
Even if your facility has incredible outcomes and the idea of implanti-
ng a warranty program appeals to you, figuring out the fiscal logistics
could be daunting. That's where insurance companies come in. For
them, there's a huge appeal in a warranty program: predictable out-
comes.
When Dr. Casale went to Geisinger's insurance team, that was his
main selling point. "They said, 'What my accountants and actuaries
tell me is driving them crazy is that I can send a clone of the same
patient 10 times to 10 different facilities with the same problem and
get 10 completely different bills with 10 completely different things
Business Advisor
BA
2 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A n U A R Y 2 0 1 8
