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  • Writer's pictureL. Pearce McCarty, III MD, MBA

The Importance of Engaging Surgeons in Cost Containment


“Surgeons don’t care about cost!” is a depressingly inaccurate statement that I – as a practicing orthopedic surgeon – hear repeatedly from certain hospital administrators. Well, we care, and with good reason. The decisions surgeons make about what – and what not – to use in the operating room are significant cost drivers. In fact, one multivariate model demonstrated that the single most significant predictor of variation in surgical supply cost is…you guessed it…the surgeon!

Surgical cases can constitute 50% of a hospital system’s top line revenue and essentially 100% of an ambulatory surgery center’s revenue.

Moreover, 40% of the cost of surgical care episodes derives from supply utilization within the operating room. So, the way we manage these costs either boosts or busts operating margins in a meaningful way.

Looping back to surgeons, multiple published studies¹⁻²⁻³ support the idea that we not only care about costs, but that when presented with cost information in an effective format, we will make decisions that lower cost. So, what is an “effective format”? An effective format is:

  • Convenient – lets us digest the data when it is convenient for us, not after a long, stressful day in the operating room

  • Curated – shows us cost data that matters

  • Actionable – doesn’t show us data that we can’t do anything about

Add to this format a dash of behavioral economics – think leaderboards, peer comparisons, benchmarking, scorecards, etc. – and we have effective decision architecture – the needle really starts to move!

What kind of difference can engaged surgeons make in cost reduction? Try a 32 – 64% reduction in direct supply cost per case when we are engaged, have line-of-sight to relevant costs and are presented with the opportunity to take action.

An excellent study by Skarda et al. looked at direct cost reduction per case for laparoscopic appendectomy in a large pediatric hospital. Engaging surgeons and achieving a marked reduction in clinical variation (i.e. surgeons doing the same procedure, but in different ways using different supplies), the authors reported a 64% decrease in supply cost per case. Interestingly, as illustrated by the graph at right, the costliest surgeon pre-engagement became the least costly surgeon post-engagement! Engagement works!

In conclusion, surgeons can inadvertently sabotage or intentionally support cost containment efforts. Surgeons care about what they cost, but need cost information delivered in an effective format. What steps will you take to engage your surgeons?

Surgeon engagement tools like DOCSI provide both transparency and optimization recommendations to surgeons allowing them to review and approve optimizations with the tap of a button. Learn how Allina Health created 7-figure savings by using DOCSI in our new case study.


Dr. McCarty is a practicing orthopedic surgeon in Minneapolis, MN, former team physician for the MN Twins Major League Baseball Team, healthcare leader and entrepreneur.



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