Academic journal article Journal of Healthcare Management

Improving Readiness and Reducing Costs: An Analysis of Factors That Influence Site Selection for Army Outpatient Surgical Services

Academic journal article Journal of Healthcare Management

Improving Readiness and Reducing Costs: An Analysis of Factors That Influence Site Selection for Army Outpatient Surgical Services

Article excerpt

INTRODUCTION

In the United States, the costs of surgical services are rising annually. According to the Health Cost Institute (2015), the amount spent on outpatient surgical services is the highest per capita among all healthcare service categories; in 2014 alone, the cost per capita increased from $12 to $526. Reducing per capita costs of healthcare is an important part of the Triple Aim, which also includes population health and experience of care (Institute for Healthcare Improvement, 2013). Because surgery is the top revenue source for most hospitals, there has been a sharpened focus in policy and research on improving cost containment strategies (NBC News, 2014).

The military health system (MHS) has not been immune to the escalation in costs associated with providing surgical services. Military beneficiaries receive care at military treatment facilities (MTFs), referred to as direct care, or at civilian healthcare facilities, referred to as purchased care. Regional contracts in the purchased care network are operated through TRICARE, the military's healthcare benefits program (Military Health System Review, 2014). When a beneficiary receives care in the purchased care network, the variable costs typically exceed the variable costs of that same care when provided at an MTF (Kokulis, 2013). In addition, when patients are sent to the purchased care setting instead of an MTF, providers at the MTF experience a decline in exposure to diverse cases, which could make a negative impact on provider readiness (Mattar et al., 2013). Although the MHS utilizes surgical resources from both direct and purchased care, the goal is to serve most, if not all, 9.6 million beneficiaries in the direct care system to control costs and maintain the readiness of military providers (Military Health System Review, 2014).

As the costs of providing surgical care in the purchased care network rise, healthcare costs in the MHS will become unsustainable unless more effective cost containment strategies are developed and implemented (Kokulis, 2013). Although 25 of the 33 MTFs across the Army's medical system have at least one dedicated operating room, outpatient surgeries are still performed in the purchased care network (Military Health System Review, 2014). Recapturing surgical service encounters that occur in the purchased care network, which the MTF has the capacity and expertise to perform, is vital to cost containment efforts and maintaining provider readiness (Kokulis, 2013). As a result, recapture consistently remains a command priority at MTFs across the Army (Military Health System Review, 2014).

Although factors that influence site selection have not been broadly studied, studies of nonmilitary beneficiaries have identified patient-specific factors that influence site selection. one predictor is a patient's distance from a healthcare facility (Mooney, Zwanziger, Phibbs, & Schmitt, 2000). Quality measures and case mix further influence a patient's surgical service site selection (Varkevisser, van der Geest, & Schut, 2012; Ejaz et al., 2014). However, the vast majority of MHS beneficiaries do not decide whether care is rendered in the direct or purchased care setting; the decision is typically made by the MTF. Consequently, those factors that have been shown to be significant predictors of surgical service site selection are less relevant in the military population. We did not identify any studies that examined direct or purchased care outpatient surgical service site selection for the military population.

Our study examines the factors that influence site selection (direct care or purchased care) for outpatient surgical services among U.S. Army beneficiaries. It is important to identify these factors because reduced surgical care at the MTFs may result in increased costs and reduced provider readiness and clinical readiness to support the military mission. The factors that influence outpatient surgical service site selection may provide policy and clinical recommendations for healthcare administrators to use in improving the retention of surgical service care provided at all Army hospitals in the United States. …

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