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Publications & Articles

The following were written by Twin Peaks Group Principals, Advisors or colleagues in the perioperative community:

  • “Calculating the true cost of robotic hysterectomy” by Vikram Tiwari. Dan Krupka and Warren Sandberg appeared in the August 2014 issue of Healthcare Financial Management.  Our article builds on an excellent editorial by Joel Weissman and Michael Zinner, which appeared in the February 2013 issue of the Journal of the American Medical Society.  To read more about our work, please read the blog about our article.  To obtain a copy of the article, please contact us.
  • Several of our publications, listed below, draw attention to the distinction between the average cost of a complication or infection and the cost saved by a hospital that eliminates the complication or infection. It turns out that this is a very large and important difference. The average cost includes medications and supplies, the salaries and benefits of staff delivering the care, and overhead – support staff, administration, depreciation on facilities and equipment, and utilities. A successful quality program eliminates the cost of medication and supplies but little else unless the program is so large that it leads to staff reductions. Unfortunately, many articles that report financial benefits of quality improvement programs use the average cost rather than the incremental cost savings. Our latest attempt to correct this fundamental error appears in the May 2014 issue of JAMA Internal Medicine. There, Warren Sandberg, William Weeks and I draw attention to the error made by the authors of “Will a policy of refusing reimbursement for health care-associated infections be a sufficient incentives to drive improvement?” The authors assert it will because they base their response on average cost. We say “no” for the reasons cited above.
  • Despite much good work and some changes in incentives, hospital quality is improving very slowly.  And, as we showed in our 2012 article in Health Affairs, hospitals still suffer financially when they improve quality because their incremental cost saving is more than offset by loss of reimbursement revenue.  To address this problem Dan Krupka and Warren Sandberg propose that payers be mandated to steer patients to services (at hospitals) that deliver at least an average performance.  This would ensure that hospitals improving quality would be rewarded with more patients.  For details please read our blog, “Facilitated Quality Competition as a Driver of Health Care Value,” posted on September 30, 2013 in Health Affairs.
  • “Performance Improvement in the Perioperative System.” Kathleen Brooks and Dan Krupka, Healthcare Financial Management, December 2012.  Kathy, Vice President of Jackson Surgical Assistants, and Dan Krupka describe how to build a portfolio of projects for the perioperative system that supports the organization’s strategy and does not overload the organization’s capacity.  It illustrates the portfolio-building process with examples of projects.  Each project description includes its objective, the timeline, the composition of the project team, and the financial impact on the hospital.  For a pdf of the article, please contact us.
  • “The Impact on Hospitals of Reducing Surgical Complications Suggests Many Will Need Shared Savings Programs.” Dan C. Krupka, Warren S. Sandberg, and William B. Weeks. Health Affairs (Millwood) Web First October 17, 2012.  A summary appeared in the December 2012 issue of OR Manager.  You can download a PDF of the summary here.
  • “The Correct Business Case for the Michigan Keystone Patient Safety Program in ICUs.”  Krupka D.C. & Sandberg WS.  American Journal of Medical Quality 2012, 27(2), 175.
  • “Rx: How Hospitals and Vendors Can Increase the Impact of Perioperative Technology Investments.” White paper by Brooks, K., Krupka, D.C. & Logue, P.J.  Download PDF (120K PDF)
  • “Cost Savings Lessons from Operating Rooms of the Future.” Krupka, D.C.  Healthcare Financial Management Association December, 2008 issue of “Healthcare Cost Containment.” Download PDF (800K PDF)
  • “Reducing non-operative time: methods and impact on operating room economics.” Krupka, D.C., Sathaye, S. & Sandberg W.S.  International Journal Healthcare Technology Management, Vol. 9, No. 4 (2008).
  • “How to Increase OR Throughput and Profitability.”  Krupka, D.C., Logue, P.J., Sathaye S. & Warren Sandberg.  White paper by Twin Peaks Group, LLC. October, 2008.  Download PDF (225K PDF)
  • “Making Stretcher Tables Work in Your Facility.” Krupka, D.C. & Logue, P.J.  Outpatient Surgery Magazine. February, 2008.  Download PDF (3MB PDF)
  • “Operating room design and its impact on operating room economics.” Krupka D.C. & Sandberg W.S.  Current Opinion in Anesthesiology 2006, 19: 185-191.

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