The World’s Best Cup of Coffee

“Center of Excellence”

It’s a term you may have seen used by health insurers, hospitals and surgery centers in recent years. You might be surprised to learn no universal definition exists for qualifying a surgery center for the distinction.

At its worst, a hospital or surgery center hanging the “excellent” banner out front, or on its website, without any external validation is the modern-day equivalent of the diner with the sign out front announcing, “World’s Best Cup of Coffee”.

That being said, many centers do have a clinical foundation for the designation. Such programs tend to incorporate aspects of quality. They also tend to emphasize providers who are willing to accept lower payment rates, leaving some to wonder, “So did they earn their designation or buy it with discounts?”

A review of the surgery quality resources, including “surgery centers of excellence” programs available from market-leading health insurance companies, shows measures of surgical quality fall into the following categories:

  • Patient satisfaction
  • Readmission rate
  • Surgical site infection rate
  • Number of procedures/experience of the surgeon

What’s missing altogether is any mention of an “operating system” that yields consistent, high-quality results. Knowing the provider has an underlying protocol means that, no matter if:

…the lead nurse is on vacation

…the surgery starts 90 minutes late

…the hospital’s electronic medical record has an obsolete preset order for pain management

…the patient pressures the doctor for opioids (nearly two-thirds of surgeons report feeling frequently pressured on opioids!)

…or any number of other real-world factors comes into play, the pieces are in place to drive quality outcomes. It takes the pressure off the providers and presents a baseline expectation for patients and payers.

We expect this structured approach when the accountant prepares our tax return, when the mechanic changes our car’s oil and when the pilot prepares for our flight. Why should we expect less in surgery?

The operating system for high quality surgery today is Enhanced Recovery After Surgery, or “ERAS”, care pathways. In the field of surgery, over the last decade advanced, innovative providers have separated themselves from their peers by implementing minimally-invasive surgery as part of broader ERAS protocols. Such protocols can take many forms and include interventions before, during and after surgery. ERAS represents the entire surgical experience re-imagined with patients and their recovery front and center.

Given a lack of transparency in healthcare and surgery specifically, what can you do?

For one, you can take the temperature of your surgery quality.

Further, you can start asking questions of the providers in your network. Or partner with organizations like Goldfinch Health that are expertly positioned and designed specifically to drive adoption of Enhanced Recovery-based care.

Whatever the path, at the outset, do this:  Define what excellent care means to you, for your employees, for your health plan members.

That starts with a conversation. Perhaps over a cup of coffee.

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