Geisinger Medical Center: Where a Warranty on Coronary Artery Bypass Surgery Signals a Commitment to Excellence

This story originally appeared in IHI's 2008 Annual Progress Report.
John Podgursky, 62, did not know there was a warranty on the bypass surgery he had in the summer of 2007 at Geisinger Medical Center in Danville, Pennsylvania. But even if he had, he would not have needed it. His surgery and recovery went just fine.
It all started when he was mowing his lawn in Elysburg, Pennsylvania, a quiet community about an hour southwest of Scranton, in the heart of the anthracite coal region. Semi-retired from a lifelong career in the Bureau of Mines, Podgursky says he felt some tightness in his chest. He felt it off and on for the next few days.
A series of examinations and tests revealed that Podgursky needed triple bypass surgery. “One artery was 100 percent blocked, and two others were pretty blocked up as well,” he recalls. The surgery was booked for the very next day.
Podgursky was twice lucky. First, to get on the surgical schedule so quickly, and second to be at Geisinger, where the warranty itself is far less important than what it symbolizes. 
“The warranty is our sign to the outside world about our values,” says Karen McKinley, RN, MBA, Vice President, Division of Clinical Effectiveness, and Patient Safety Officer. “We have identified 40 best-practice steps in the process of bypass surgery, and it is our commitment to hit those 40 metrics each and every time.” Under the terms of the warranty, which Geisinger calls ProvenCareSM, Geisinger charges insurers a flat fee for a bypass that includes 90 days of routine follow-up care. If a patient suffers complications, Geisinger pays for the treatment at its facilities.
Albert Bothe, MD, Geisinger’s Chief Quality Officer, says that the bypass warranty is just the beginning. “We have other groups of physicians queuing up to get their version of a warranty done,” he says. Bothe says plans are underway to add other procedures, including cataract surgery and total hip replacement.
While the warranty has attracted media attention as well as significant interest from other health care organizations, its main goal — to promote perfect care — is working. In 2005, Geisinger’s three hospitals performed all 40 bypass components 59 percent of the time as a composite measure. Since the warranty was implemented in February 2006, that composite score hovers around 100 percent.
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