Surgical Episodes of Care

Surgical Episodes of Care

With the evolution of Bundled Payment programs and increased value-based performance payor agreements, utilizing apples to apples comparisons of cases across the full episode of surgical care can drive up to 10X greater value in reducing unwarranted clinical variation

Where it matters:

  1.  Provider-owned Health Plans
  2.  CMS Bundled Payment Programs
  3.  Commercial At-Risk Performance Contracts
  4.  Shoppable Procedures

Example of  Opportunities Identified:

  • Reducing cost by performing a surgery at an ambulatory surgery center versus the hospital operating room
  • Reducing operating room time, improving outcomes and reducing cost by not performing a common secondary procedure
  • Reducing cost and improving outcomes by sending a patient to in-home rehab versus inpatient rehab
  • Utilizing an alternate medication that impacts inpatient length of stay and medication cost with the same, if not better, outcomes

As an example of Empiric’s evaluation of Surgical Episodes of Care, Empiric uses Data Science and Machine Learning to identify unwarranted clinical variation in Claims Data through a process of cohorting, variation targeting, K-Means clustering and articulation of opportunity

Laparoscopic Cholecystectomy
Cohort Family

Laparoscopic Cholecystectomy Outpatient Adult Payor Medical Claims

K-Means Clustering

Identify Opportunities

Secondary Procedure or No Secondary Procedure =  Cholangiogram

Medication Utilization = Inj. Cefazolin Sodium