Value tak­ing a ma­jor role

Modern Healthcare - - SPECIAL REPORT - —Mau­reen Mckinney

The days are num­bered for lofty qual­ity- im­prove­ment projects that don’t have clearly de­fined price tags and pro­jected cost sav­ings, ac­cord­ing to in­dus­try ex­perts.

In a year in which cost con­tain­ment and ef­fi­ciency are ex­pected to be front and cen­ter, pro­posed qual­ity and pa­tient-safety ini­tia­tives will need to spell out their ex­pected im­pact on both pa­tient care and a hospi­tal’s bot­tom line.

Put sim­ply: “The de­part­ment that used to be qual­ity is now value,” says Dr. Robert Wachter, pro­fes­sor and chief of the di­vi­sion of hospi­tal medicine at the Univer­sity of Cal­i­for­nia at San Fran­cisco.

The kinds of projects that were com­mon­place sev­eral years ago—those that were “ag­nos­tic” about cost—are fad­ing away, Wachter says, re­placed as or­ga­ni­za­tions look at cost as a pri­mary, or at least a sec­ondary out­come.

Not sur­pris­ingly, bud­get-strapped hos­pi­tals are look­ing closely at is­sues like read­mis­sions, but they’re also di­rect­ing their at­ten- tion to­ward curb­ing high-cost, low-value tests and ser­vices.

Those ef­forts have been buoyed by ini­tia­tives such as Choos­ing Wisely, a col­lab­o­ra­tive ef­fort spon­sored by nine med­i­cal so­ci­eties to iden­tify com­monly or­dered but of­ten un­nec­es­sary tests and pro­ce­dures, Wachter says.

“Th­ese days, a project that im­proves qual­ity by a smidgen but doesn’t im­prove cost will lose to a project that keeps qual­ity where it is but re­duces cost by 10%,” Wachter pre­dicts. “That might not be fair, but as de­part­ments be­come in­creas­ingly in­te­grated, I think that’s what we’ll see.”

That in­te­gra­tion brings its own set of chal­lenges, too, as hos­pi­tals pon­der how best to share fi­nan­cial data across de­part­ments and how to di­vide staff among projects.

“Or­ga­ni­za­tions, in­clud­ing my own, strug­gle with that cross­walk,” he says.

Mau­reen Bisognano, pres­i­dent and CEO of the Cam­bridge, Mass.-based In­sti­tute for Health­care Im­prove­ment, echoes Wachter’s pre­dic­tions. In De­cem­ber, at the IHI’s Na­tional Fo­rum in Or­lando, Fla., Bisognano said that pa­tientsafety and qual­ity-im­prove­ment projects will need to cal­cu­late their re­turn on in­vest­ment from the out­set.

“I’ve heard more about con­trol­ling cost lately than I’ve heard in the last 20 years,” she said. “More and more, I am see­ing qual­ity-im­prove­ment projects with price tags at the bot­tom.”

Mau­reen Bisognano, pres­i­dent and CEO of the In­sti­tute for Health­care Im­prove­ment, talks about the im­por­tance of value at the group’s Na­tional Fo­rum, which took place in Or­lando, Fla., in De­cem­ber.

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