'Pre-hab' Speeds Discharges Among Elective Surgery Patients
A home-based pre-operative program to improve the physical conditioning of patients will require surgeons to work out "a lot of complex finances and politics between the various parties involved," says a surgeon who champions the idea.
Physicians in the Michigan Surgical Home and Optimizing Program believe that the preoperative training program they've developed for elective surgery patients will someday become a standard of care in hospitals across the country.
So far, however, the adoption process has been slow.
A University of Michigan study shows that elective surgery patients were discharged sooner and were more engaged in their care if they took part in a home-based pre-operative training program to improve their physical condition in the weeks before their surgery.
Michael Englesbe, MD, a Michigan Medicine transplant surgeon who has studied and championed the idea for nearly a decade, spoke with HealthLeaders about his advocacy for "Pre-hab." The following is a lightly edited transcript.
HLM: This program has been in effect for five years, but participation is quite low. Why?
Englesbe: We haven't necessarily proven scientifically that it works. It makes sense. Patients like it, but the primary outcomes we've followed so far have been financial outcomes, which matter to hospitals.
Doctors care more about things such as complications and survival. Most relevantly, it's just hard to change practice.
Strategically we've focused on hospitals but we've learned that the work is done by the surgeons, and surgeons really don't engage with the hospitals where they practice, and vice-versa. There are a lot of complex finances and politics between the various parties involved here that are going to take time to sort themselves out.
HLM: Could anyone in the care continuum take ownership of pre-hab?
Englesbe: Someone has to do the work. Even though it is minimal work, everyone at every hospital and office is already working fulltime so any incremental additional work is a big deal.
It's hard to change physician practices, and that is particularly true among surgeons. I'm a surgeon. I speak their language. So if anyone can convince them it would be someone like me.
It will catch on when the small amount of money it costs to enroll patients and engage them in this program is either mandated, because globally it makes financial sense, or it gets paid for by payers, and we are making progress in that space.
At a macro level, patients training and being optimized for surgery reduces costs profoundly, but that money isn't real to the people who have to do the work. The analogy is you pay your federal taxes but you don't necessarily feel intimately in contact with where that money goes.
That is the way practitioners feel about the cost savings and downstream implications for a lot of these things. That being said, in two years we've gone from one to now 40 practices participating in the program. We are gaining momentum, but it's taking a long time.