‘Peaks and val­leys’ in ad­mis­sions prove costly

Modern Healthcare - - COMMENT - By Eu­gene Lit­vak Eu­gene Lit­vak, Ph.D., is pres­i­dent and CEO of the In­sti­tute for Health­care Op­ti­miza­tion and an ad­junct pro­fes­sor at the Har­vard School of Pub­lic Health.

Amer­i­can health­care is ex­traor­di­nar­ily dy­namic—with new tech­nolo­gies, gov­ern­ment ini­tia­tives, struc­tures of health­care providers, im­prove­ment strate­gies and other po­ten­tially trans­for­ma­tional ini­tia­tives. But as valu­able as any of them may be, health­care op­ti­miza­tion will not be­come a re­al­ity un­less we can de­feat what I call “peak day-re­lated dis­ease.” That’s the con­di­tion caused by in­ef­fi­cien­cies from un­nec­es­sary peaks and val­leys of pa­tient flow that oc­cur on a reg­u­lar ba­sis in hos­pi­tals across the na­tion.

Those peaks and val­leys are in­flicted by the health­care sys­tem it­self, not by the pa­tients. The peaks oc­cur for a va­ri­ety of rea­sons—doc­tors’ sched­ul­ing pref­er­ences and in­ef­fi­cient pa­tient flow through the hos­pi­tal, among oth­ers— but they cause over-uti­liza­tion on some days of the week and un­der-uti- liza­tion on oth­ers. Hos­pi­tals, there­fore, have to add beds to ac­com­mo­date the peaks, even though many of those beds are empty on the other days.

The re­sult­ing costs—and po­ten­tial sav­ings—are sub­stan­tial. The cap­i­tal cost of a med­i­cal or sur­gi­cal bed is be­tween $1 mil­lion and $3 mil­lion, de­pend­ing on the part of the coun­try; an­nual op­er­at­ing cost of each bed is at least $250,000. Elim­i­nat­ing the need for beds can gen­er­ate sub­stan­tial sav­ings and greater ef­fi­ciency within in­di­vid­ual hos­pi­tals. With almost 6,000 hos­pi­tals in the na­tion, the po­ten­tial sav­ings for the health­care sys­tem are ex­tra­or­di­nary.

While this might sound pre­pos­ter­ous, it’s of­ten eas­ier for hos­pi­tals to pre­dict emer­gen­cies than pre­dict the elec­tive ad­mis­sions they sched­ule. How many pa­tients will come to the ER on a given day for a bro­ken bone, for in­stance, can be pre­dicted with some pre­ci­sion, based on a fa­cil­ity’s his­tory. How many pa­tients will be ad­mit­ted to the hos­pi­tal for an elec­tive pro­ce­dure, how­ever, is much harder to de­ter­mine, be­cause there are more vari­ables within the hos­pi­tal. Yet those vari­ables are read­ily con­trol­lable.

By smooth­ing the pa­tient flow to re­duce those peaks, hos­pi­tals can avoid un­nec­es­sary cap­i­tal and op­er­at­ing costs; re­duce mor­tal­ity, read­mis­sions, med­i­cal er­rors and over­crowd­ing, and gen­er­ate sav­ings. That’s a win for providers and pa­tients alike, and a key to con­trol­ling the na­tion’s health­care costs.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­care.com.

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