Clinical Pathway Discloses One Surgeon's $425 Habit

PHILADELPHIA--When practice guidelines or pathways take financialconsiderations into account, they may be termed clinical financialpathways (CFPs). This technique was developed by Kent Giles, MPPM,vice president of development at PhyMatrix, a physician managementcompany headquartered in West Palm Beach, Fla, and is currentlybeing utilized by PhyMatrix to reduce unnecessary medical costs.

Developing CFPs involves seven steps, Mr. Giles said at the Associationof Cancer Executives meeting (see also page 20): Select a diseaseprocess, form a knowledgeable team, clarify the current stateof medical knowledge, develop the pathway, assign costs to eachprocess, implement the pathway, and monitor the results.

During development of the prostate CFP, he said, the team foundthat one urologist was using three surgical trays per radicalprostatectomy to access the three instruments he needed, sincethe hospital routinely placed only one of these instruments onthe surgical tray.

This practice, which added $425 in unnecessary costs for extrasterilization and wasted anesthesiologist and surgeon time, waseliminated with implementation of the CFP, and the patient's timeunder anesthesia was reduced by 30 minutes, ie, a quality enhancement.