Few would disagree that patient health should be optimized prior to elective surgery to decrease complication rates. In the United States there is a well intentioned movement to increase public reporting of complication and readmission rates around elective surgeries (by hospital, not by surgeon as of yet). In addition, hospitals may be financially penalized for readmissions and complications in the future.
Some risk factors for complications and readmissions such as diabetes control, weight loss, coronary artery disease optimization and smoking cessation can be very difficult to optimize.
Making hospitals responsible for complication rates from a financial and public reporting standpoint is conceptually an excellent idea. However the danger is that this may limit access to care for sicker patients, as hospitals become more concerned about complication risk. Risk adjusted outcome scoring can be used for challenging patients, but it is difficult to assign a cumulative risk for patients with multiple medical co-morbidities.
Some health systems have taken an alternative approach and have gone so far as to place hard stops for elective surgery. For instance as I understand it the National Health System in the United Kingdom currently limits elective hip and knee replacement to patients with a body mass index under 35 kg/m2.
What is the best way to incentivize the improvement in health of patients prior to elective surgery; 1. front end rules or guidelines limiting surgery to patients who meet certain criteria, or 2. back end financial and public relations incentives to drive a reduction in negative outcomes. Or we are certainly open to option 3…….