Association Between Surgeon Scorecard Use and Operating Room Costs
Authors: Corinna C. Zygourakis, Victoria Valencia, Christopher Moriates, Christy K. Boscardin, Sereina Catschegn, Alvin Rajkomar, Kevin J. Bozic, Kent Soo Hoo, Andrew N. Goldberg, Lawrence Pitts, Michael T. Lawton, R. Adams Dudley, Ralph Gonzales
Journal: JAMA Surgery (2016)

<h3>Importance</h3> Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. <h3>Objective</h3> To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. <h3>Design, Setting, and Participants</h3> 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). <h3>Interventions</h3> 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. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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%;<i>P</i> = .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. <h3>Conclusions and Relevance</h3> Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.