Mea­sures of pro­duc­tiv­ity need to re­flect in­dus­try’s changes

Modern Healthcare - - COMMENT -

The new U.S. Bureau of La­bor Sta­tis­tics mea­sure of hos­pi­tal pro­duc­tiv­ity, fea­tured in the July 13 ed­i­to­rial (“New ap­proaches needed to solve hos­pi­tals’ pro­duc­tiv­ity woes,” p. 30) ad­mit­tedly rests on a crude mea­sure of out­put. Un­der the BLS mea­sure, out­put is ba­si­cally a count of ser­vices pro­vided that does not ac­count for how ser­vices have evolved, and qual­ity and out­comes have changed.

As the ed­i­to­rial rightly points out, the mea­sure fails to take into ac­count qual­ity ad­vance­ments. Over the past 10 years, hos­pi­tals have made sig­nif­i­cant im­prove­ments in pa­tient safety, ad­her­ence to ev­i­dence-based care and pa­tient sat­is­fac­tion. Be­tween March 2008 and June 2012, na­tion­wide scores re­ported by Medi­care’s Hos­pi­tal Com­pare web­site show steady im­prove­ment across all mea­sures of pa­tient ex­pe­ri­ence. Since 1999, mor­tal­ity due to heart dis­ease has fallen by 25%, cere­brovas­cu­lar dis­ease by 32%, pneu­mo­nia by 21% and can­cer by 6%.

These im­prove­ments in med­i­cal prac­tice, qual­ity and out­comes make a real dif­fer­ence in peo­ple’s lives and im­ply a sig­nif­i­cant change in out­put that needs to be ac­counted for in any mea­sure of pro­duc­tiv­ity. A sim­ple count of ser­vices alone misses the mark. In fact, econ­o­mists have noted that in some sec­tors, such as ed­u­ca­tion and nurs­ing, pro­duc­tiv­ity can­not im­prove rapidly be­cause of hu­man fac­tors. For ex­am­ple, it takes a nurse es­sen­tially the same amount of time to change a ban­dage to­day as it did 20 years ago. What’s more, Medi­care is ad­just­ing its pay­ment up­dates and value-based pay­ments for pro­duc­tiv­ity im­prove­ments and ef­fi­ciency mea­sures.

Fi­nally, as one ex­am­ines this topic, a broader look that con­sid­ers the shift from in­pa­tient to out­pa­tient care is needed. A count of ad­justed ad­mis­sions—a com­pos­ite mea­sure of in­pa­tient and out­pa­tient vol­ume—finds that hos­pi­tal vol­ume ac­tu­ally rose by 22% be­tween 2001 and 2013. This in­crease is slightly more than the in­crease in hos­pi­tal em­ploy­ment, de­mon­strat­ing that hos­pi­tals are evolv­ing not only to im­prove pa­tient care and the treat­ment of ill­ness within their walls, but to ac­cept re­spon­si­bil­ity for main­tain­ing and en­cour­ag­ing health in their com­mu­ni­ties.

Linda E. Fish­man Se­nior vice pres­i­dent of public pol­icy anal­y­sis and de­vel­op­ment Amer­i­can Hos­pi­tal As­so­ci­a­tion

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