117 OR Score: Reducing Operating Room Costs Through a Hospital-Wide Price Transparency Initiative

INTRODUCTION:Surgical costs are very high, but most surgeons have little knowledge of their operating room (OR) costs. A recent study of orthopedic surgeons found that their cost estimates for commonly used orthopedic devices ranged from 1.8% to 24.6 times the actual price. The goal of OR SCORE is to determine whether a price transparency initiative will reduce costs in the surgical departments at University of California San Francisco (UCSF). METHODS:We first surveyed all attending surgeons, resident surgeons, and OR nurses regarding attitudes toward cost/value (n = 219 responses). We then used EPIC data to analyze the time and cost of all surgical procedures at UCSF from 2012 to 2014. We created standardized “surgeon snapshots,” allowing each surgeon to visualize how they compare with their peers on 3 metrics (surgical preparation time, surgical time, surgical supply costs). From January through December 2015, all neurosurgery, orthopedic surgery, urology, and ear. nose, and throat surgeons are receiving these monthly snapshots. Each surgical department is eligible for a $50 000 financial incentive if they meet a 5% target cost reduction goal in 2015. RESULTS:In our initial survey, >95% of residents and nurses agreed that surgeons have the capacity to control costs, but only 56% were aware of alternatives to lower cost. Only 12% of attending surgeons knew how much their procedures cost in comparison with others. While it is early to report on direct supply cost trends, Neurosurgery Spine had a 6.6% decrease in supply costs from December 2014 to January 2015. Other services remained at similar supply costs or increased slightly during this time. By the time of the CNS meeting, we will have direct supply cost trends from the first 9 months of OR SCORE. CONCLUSION:To the best of our knowledge, there are no publications demonstrating cost reduction through a price transparency initiative directed at surgeons, and our work represents one of the first attempts to do this.