- Geisinger has unveiled a new surgical program called ProvenRecovery that aims to reduce opioid use and accelerate the post-surgery healing process while improving pain management. Patients are prescribed a "prehabilitative" nutrition-conscious diet before surgery and encouraged to be mobile immediately after their procedure.
- The Danville, Pennsylvania-based integrated health system is rolling the program out across 42 surgical procedures and aims to bring a total of 100 surgical specialties into the fold by the end of 2019.
- Patients are given a combination of non-opioid medications including local anesthesia, acetaminophen, ibuprofen, gabapentin, ketamine and lidocaine, depending on the surgery. Geisinger has seen an 18% reduction in opioid usage across its system since launching the ProvenRecovery pilot in June of 2017.
ProvenRecovery is the latest addition to Geisinger's growing list of population health initiatives, joining the likes of food security program Fresh Food Farmacy, patient refund program ProvenExperience and cost-free genomic sequencing program MyCode Community Health.
ProvenRecovery, which is opioid-avoiding for most procedures but completely opioid-free for others, is Geisinger's latest attempt to stem the unrelenting creep of America's opioid epidemic, which many attribute to the accelerated rate of overprescribing. The integrated health system joins a growing chorus of providers, payers and policymakers taking action.
Cleveland Clinic, for example, uses pharmacogenomic testing to predict when a patient may have little or no response to an opiate-based pain treatment and seek to refill the prescription sooner than anticipated. Last month, President Donald Trump signed a bipartisan law that increases federal funding for research into non-addictive pain management options.
Geisinger CEO David Feinberg, who announced this week that he's leaving the Danville-based system to lead health strategy at Google, told Healthcare Dive in a recent interview the ProvenRecovery pilot has produced a "dramatic decrease in mortality, decrease in length of stay and a decrease in complications."
According to a press release from Geisinger, neurosurgery and colorectal surgery patients in the ProvenRecovery pilot saw their hospital stays cut in half. For colorectal surgery patients, those early discharges accounted for an average savings of $4,556 per case.
The program relies heavily on pre-surgery routine.
"Instead of doing rehabilitation after you've had your surgery, we pre-habilitate you so you're really healthy going into surgery," Feinberg said.
Patients receive 15 nutritional, protein-heavy immunonutrition drinks five days before their inpatient surgery and are asked to drink three a day along with exercise instructions, according to Feinberg. Rather than fast before a procedure, as is standard historical practice, patients are given another fortified drink two hours before surgery.
The drinks, according to Geisinger, "reduce infection, accelerate healing after surgery and account for nutrition gaps in the average American diet."
Neil Martin, Geisinger's chief quality officer and chair of the system's neuroscience institute, had high praise for the program.
"In my 35 years in surgery, this is the innovation with the greatest potential to improve the patient experience, save lives, reduce complications and be less disruptive to patients," Martin said in a statement.