INNOVATION FUND Technology and AI in Healthcare Implementation and Integration SHOWCASE 2019

Development and Implementation of a Surgeon Cost Report Card: Behavioural Economics Applied to Surgical Cost Containment

Implementation & Integration

Timothy Jackson


MSH-UHN Academic Medical Organization, Toronto Western Hospital


MSU-15-025 We developed a novel tool called the Surgeon Cost Report Card, which provides timely cost and quality performance feedback to surgeons. Using the initial version of the tool, we demonstrated that it was effective in reducing the average cost of a surgical procedure commonly performed at the Toronto Western Hospital. Based on the initial findings, additional funding was obtained from the Ministry of Government & Consumer Services under the OntarioBuys program to develop a scalable reporting platform, or “Cost, Quality and Outcomes (CQO) Report Card,” for implementation across all surgical divisions at the University Health Network (UHN). This ‘next-generation’ platform links supply costs and case information with clinical outcomes to enable value-based decision-making in supply chain. We anticipate that the platform will increase surgeon engagement in discussions with administrators about value in surgical care delivery.


MSU-15-025 Withn the framework of value-based health care, hospitals are expected to deliver safe, high-quality, and cost-effective care. Costs associated with surgery represent a significant portion of a hospital’s budget, and there is wide variation in cost for the same given surgical procedure performed by different surgeons. In this project we aimed to apply benchmarking and performance feedback strategies to reduce the cost in the operating room (OR), specifically the cost of disposable supplies. To achieve this goal, we developed a “Surgeon Cost Report Card,” which provides timely feedback to surgeons about the cost of their surgeries in comparison to their peers. The first generation of the tool provided detailed information about the use of resources in the OR. Upon implementation in the Division of General Surgery at Toronto Western Hospital, we demonstrated a 7% decrease in the average cost of Roux-en-Y gastric bypass. Given its success, we obtained additional funding through the OntarioBuys program (Ministry of Government & Consumer Services) to further the development of the tool. The second generation of the tool, a reporting platform or “Cost, Quality & Outcomes (CQO) Report Card” that links supply costs with outcomes information, is aimed to address the following: 1) need for a data analytics platform to meet the demand for high-volume, user-friendly comparative surgeon cost reporting; 2) cohort development to ensure robust data for like-procedure comparison; and 3) integration of patient outcome data to support evidence-based decision-making that is focused on value (not lowest cost). We anticipate that this new platform will encourage a move towards practice standardization that achieves cost-savings without compromising safety or quality of care, which is essential during a time when hospital budgets are increasingly being squeezed by tight fiscal policy.

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