Care Transformation Center Blog

How to determine which elective surgeries are optional

When deciding whether to perform preference-sensitive procedures, such as joint replacement or spinal surgery, providers face a host of competing incentives. Aging patients and new health insurance marketplaces have created significant opportunity for increased surgery volumes.

However, beginning fiscal year 2015, provider organizations will be subject to Medicare penalties if patients who receive total hip and total knee replacement surgery are readmitted within 30 days post-discharge for any reason. Now more than ever, it is important to ensure that the “right” patients are receiving the “right” care at the “right” time.

In many cases, elective surgeries are an appropriate course of treatment, but clear care pathways can first provide patients with effective and less invasive care that can reduce potentially avoidable surgeries. The primary components of an elective surgery right-sizing strategy include: clear clinical appropriateness criteria, standardized assessment protocols, and pre-surgical case review.

Stay tuned: Next week, we'll share new resources for reducing avoidable chronic pain-related admissions. For more information on Population Health Advisor's research on reducing avoidable utilization, contact Christina Wild at

Key considerations for succeeding under CJR

Learn what it takes to succeed under mandatory bundled payments and the strategies active bundled payment participants have implemented.