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A Flat Fee and Guarantee on Surgical Care

A 90-day "warranty" on open-heart surgery? That's what one hospital group is offering its patients.

Geisinger Health System in Pennsylvania charges members of its health plan a flat fee for elective coronary artery bypass surgery, which includes the cost of both surgery and follow-up care for any complications that occur within 90 days. The warranty covers an "episode of care," in contrast to the standard practice of hospitals adding new charges if patients require more care after surgery. Geisinger declined to disclose its flat fee.

Coronary bypass surgery can lead to a host of postoperative complications. To reduce the risk of such complications, Geisinger is following guidelines developed by the American College of Cardiology and the American Heart Association. The coronary care program, called ProvenCare, outlines 40 specific steps for the care of bypass patients. The steps are also "hard-wired" into the hospital's electronic medical record system to assure adherence.

"We want to make costs predictable and place the burden of risk on those responsible for care," says Ronald A. Paulus, M.D., Geisinger's chief technology and innovation officer.

Still, the program has its critics. Mark D. Aronson, M.D., vice chair for quality at Beth Israel Deaconess Medical Center in Boston, says the approach "seems to me to be a marketing gimmick" rather than a serious quality improvement effort.

"It is hard to believe that surgeons and hospitals aren't [already] working hard to achieve the best outcomes for their patients," Aronson says. He adds that a flat fee might prompt surgeons to "pass on tough cases and leave those to other doctors."

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