The request was an attention-getter. The regional leadership in the Northwest wanted the Vancouver General Surgery department to reduce use of a non-Kaiser facility—which would mean a 20-mile drive to the Sunnyside campus.

There was instant pushback. The questions flew: What about our patients? Wouldn't they prefer to have their procedure performed closer to their home? What about the doctors? They like performing surgeries at the SW Washington Medical Center, which is close to the Vancouver office and to their homes. How would this affect staff members? Would they have to deal with the brunt of the upset patients and doctors trying to explain this change to them?

One by one, the department's unit-based team worked through the questions and embarked on a performance improvement project, using the Plan, Do, Study Act cycle, to bring down the cost of using an outside medical facility.

Background

At a time when membership is down, services are being brought in-house and the biggest expansion the region has seen at the hospital is under way, reining in outside medical costs has captured a great deal of attention. It helps keep care affordable, as the savings can be significant—and it means that our members are cared for by KP employees throughout their entire experience.

The region opened up a new medical office with a state-of-the-art outpatient surgery center in 2007. One year later, the facility had open surgical blocks—times when surgeries could be performed but surgery bays remained empty for lack of cases. At the same time, surgeons across town in Vancouver were continuing to book surgeries for their patients at the nearby contracted hospital, SW Washington, a past practice that yielded safe results and ensured quality for our patients.

This was a costly gap—a double whammy, since KP was paying to use an outside source while its own resource was going unused.

According to Farah Pakseresht, director of surgical services for the Northwest region, "We save on average about $1,000 per case by performing the surgery at Sunnybrook (Medical Office, which is on the Sunnyside campus) rather than at an outside contracted facility."

The unit-based team took a hard look at the situation and identified three metrics that would help measure the success of their improvement project:

• The total number of surgeries done in the department;
• The number of surgeries that could be performed at Sunnybrook; and
• The number of surgeries actually done at Sunnybrook.

In working out the metrics, the team realized that some of the more complex cases should continue to be performed at SW Washington Medical Center. That realization led the team to create a list of which types of surgeries were appropriate for each location. That helped staff members determine when a patient's surgery could be scheduled at Sunnybrook.

Out-of-pocket expenses for our members are much less expensive if they are seen at Sunnybrook.

Ebony Sage, RN

The first test

Working with schedulers at Sunnybrook, Vancouver General Surgery was allotted one half-day a week of surgical block time, enough for about three to four surgical procedures. Concerned about the reactions from patients about having their surgeries across town, staff members developed scripting to use with patients to educate them around having their surgeries at Sunnybrook instead of SW Washington Medical Center.

Staff were surprised to find they didn't receive the pushback they expected from members. "We thought patients would not be happy having surgeries at Sunnybrook, since it's a longer drive for most of them, but we found that our patients don't mind," explained Ebony Sage RN, the UBT co-lead. "We developed a script to use with the member that explains our preference to use Sunnybrook and why we prefer our patients experience the full KP experience."

There was an unexpected benefit for patients, too: It saves many of them money.

"For some members with deductible plans, it's an office visit co-pay, versus an outside facility office co-pay," Sage said. "Out-of-pocket expenses for our members are much less expensive if they are seen at Sunnybrook. It's about being better stewards of our members' money—it helps control rate increases."

Did it work?

Vancouver General Surgery began this project in March 2008. From March through July, the number of surgeries performed at Sunnybrook has increased from 25 percent of the possible surgeries to more than 50 percent of possible surgeries. This has resulted in savings during the five months of about $94,000, or about $18,800 per month in outside costs.

The block time allotted has increased to three half-days a week at Sunnybrook, and schedulers from Vancouver are asking for additional time.

And how do doctors view the change? According to Robert Douglass MD, the UBT physician co-lead, "it's been nice to see staff we haven't seen in years—it's like coming home again."