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Simpler Surgeries, Complex Market

Elyas Bakhtiari, for HealthLeaders Magazine, May 11, 2009
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Technological advances have impact beyond the OR, affecting market trends and hospital-physician alignment.

It wasn't so long ago that, in order to remove a gallbladder, a surgeon would have to make a roughly seven-inch incision in the abdomen to access the organ, and after the operation the patient would stay in the hospital overnight, taking an additional few weeks to fully recover.

Like a lot of surgical procedures, cholecystectomies have been revolutionized by technological developments that allow minimally invasive alternatives to once complicated surgeries. Nearly 80% of today's gallbladder removals are done laproscopically, and the single seven-inch cut has been replaced with several much smaller incisions—a few millimeters in length—that allow for the insertion of a small camera and surgical instruments. No abdominal muscles are severed, and patients can be released the same day, often recovering within a week.

The shift toward microsurgery and noninvasive procedures has been under way for a while, but it is far from over and continues to reshape the market for surgical services. Surgeons are now experimenting with removing gallbladders through natural orifices, doing away with visible incisions altogether, and every day, procedural developments are changing how surgeons operate—in both a clinical and financial sense.

Robert Sewell, MD, president of the American Society of General Surgeons, compares minimally invasive technologies to the development of antibiotics in terms of their impact on how healthcare is delivered. They are cutting down on length of stay and reducing risk for the patient, and growth in surgical volume has subsequently moved from inpatient to outpatient settings as once-complicated surgeries can now be performed requiring fewer hospital resources.

The result is a much more complex and competitive market that centers less on the hospital, even though surgical services are the leading revenue generator for many hospitals. More than half of all surgeries performed today are minimally invasive, and in some areas, ambulatory surgery centers, surgical hospitals, and physicians operating out of their offices have eaten away at inpatient hospital market share.

The demand for shorter stays combined with the financial realities of the market has pushed providers—both inpatient and outpatient—to focus on efficiency and quality in the operating room. Robots, cameras, and other high-tech devices are becoming the modus operandi, and day by day, new technologies and techniques add momentum to the transformation.

Yet, as with most service lines these days, there are short-term market realities that override the long-term trends. Elective surgical procedures are one of the areas of healthcare hit hardest by the economic recession, as patients put off vanity surgeries or decide to delay a needed, but not necessary, procedure like a knee operation.

"The market is different right now than it has been because of the overall economy," says Jan DeHaan, hospital administrator and operational vice president for Gunderson Lutheran health system in La Crosse, WI. "Some organizations are experiencing a downturn in surgical volume because, if something is elective, people are waiting longer to wait and see."

The challenge for leaders is to deal with this hopefully short-term hiccup in the market without losing sight of their long-term plan for success. Patients are placing more value in convenience and quality, and physician-hospital financial relationships are more complex—and often more competitive—than ever. The hospitals and physicians that can deal with these problems will stand out from their competitors, even in these tough times.

Service Line Success Key No. 1: Evaluate how services are organized
Surgery isn't always thought of as a traditional service line. Instead, it's often considered a functional department or viewed from the perspective of the many surgical subspecialties. But the multidisciplinary nature of surgical services and the need for a consolidated management structure make it a prime candidate for a service line management approach, says Kevin Kennedy, principal with ECG Management Consultants.

Organizations need to constantly reevaluate how their surgical services are organized in order to improve operational efficiencies and meet strategic goals.

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