Making a business case for healthcare quality by vqx13199



          Letter from America
                                                                                                                                                   by Howard Larkin

                                               Making a business case for healthcare quality
                                         Study shows evidence-based practice could save thousands of lives and billions of euro

       verybody wants better-quality            MD, who is medical director, clinical and        The cost savings these hospitals are       five years of coordinated government
       healthcare; paying for it is another     quality informatics, for Baystate Health in    seeing far exceed the maximum two per        efforts providing GPs with the practice
       matter. Witness the dismay of the        Springfield, Massachusetts, US, one of the     cent performance bonus they might            tools needed to improve performance
UK National Health Service when                 study participants. “Not only is it possible   receive from Medicare if their               with the results demonstrated in the first
unexpectedly high performance by general        for hospitals to provide high-quality care     performance reaches the top decile           year of the bonus programme, which
practitioners resulted in extra payments        efficiently, but in fact those institutions    among American hospitals. This suggests      began in 2004.
exceeding budget by about ¤560m in the          that achieve outstanding quality               that large financial incentives may not be      In an interview published online by the
first-year of its Quality Outcome               performance appear to benefit from             necessary. As it turns out, excellent        journal Health Affairs, Mr Roland noted
Framework. This programme awards                reduced costs and improved outcomes,”          performance carries its own financial        that without the large investments in
bonuses of up to 30 per cent of base pay        he said.                                       reward in the form of reduced costs, at      computerised health records made by
based on performance on 146 quality                This may prove to be the blade that         least for these hospital services.           many UK GP practices over the last few
measures.                                       severs the Gordian knot of rising                                                           years, the 91 per cent compliance rate
   While the clinical improvement this          healthcare costs.                                                                           recorded in the first year of the bonus
programme has accomplished is                                                                                                               programme would not have been possible.
profoundly important, the cost overrun          Who needs a business case for                  The cost savings these                          These results suggest that investment in
exacerbates political and financial             quality?                                                                                    process improvement and the
problems. Budget deficits are driving a                                                        hospitals are seeing far                     technologies that support it are the real
                                                While improving healthcare quality is,
major reassessment of health services in                                                                                                    keys to better clinical outcomes – and
the UK, as they are in countries across
                                                above all, a moral obligation, making an       exceed the maximum two                       reduced healthcare costs.
                                                economic case for it can only help –
Europe and the globe. The question arises:
how much quality can we afford?
                                                especially in an environment where the         per cent performance                            Encouraging and supporting individual
                                                                                                                                            practitioners and hospitals in adopting
                                                ageing population requiring more services
   But quality improvement theory and a
large body of industrial experience teach
                                                is growing faster than the working             bonus they might receive                     these approaches and technologies will
                                                                                                                                            pay dividends for decades to come. Pay-
                                                population that pays the bills.
us that better quality does not cost more.
                                                   Just as quality improvement requires        from Medicare if their                       for-performance programmes may play a
Investments in doing the job right the first                                                                                                role. But ultimately both clinical and
                                                substantial investment in new tooling and
time are more than offset by reduced
                                                manufacturing processes, and a change in       performance reaches the                      financial value will come from improved
expense for scrap and rework – at least                                                                                                     care processes.
                                                management philosophy in industrial
on the factory floor.
                                                settings, implementing evidence-based
                                                                                               top decile among
   Intuition and many small studies suggest
the same is true in healthcare. Now
                                                care protocols involves significant upfront
                                                costs and the commitment of professional
                                                                                               American hospitals
dramatic evidence from a year-long study
                                                and management resources in healthcare
of 250 US hospitals appears to confirm it.
Adhering to practice guidelines proven to                                                         Indeed, Dr Remus believes the
                                                   Hospitals involved in the Premier study,
improve clinical outcomes also saves                                                           demonstration project experience
                                                which tracked the use of 33 evidence-
money.                                                                                         strongly suggests that basing bonuses on a
                                                based care practices for treating
   According to the study, 5,700 lives                                                         “curve” may actually be
                                                myocardial infarction, heart failure,
could have been saved and 8,100 major                                                          counterproductive. If
                                                coronary artery bypass surgery, total hip
complications prevented if American                                                            only a few can
                                                and knee replacements, and pneumonia,
hospitals had done a better job of using                                                       earn rewards,
                                                spent considerable management time and
widely accepted evidence-based protocols                                                       their incentive
                                                money exchanging tips not only on how
for just five high-risk conditions in 2004.                                                    is to hoard,
                                                to embed effective care processes into
The 10,000 hospital re-admissions and                                                          rather than
                                                daily routines, but also on how to
750,000 inpatient days avoided alone                                                           share, the
                                                consistently measure their use, according
would have saved ¤1.1bn.                                                                       methods they
                                                to Denise Remus, PhD, RN, Premier’s vice-
   These are the conclusions of Premier                                                        use to improve
                                                president for clinical informatics.
Inc, a national alliance of independent                                                        care. “Healthcare
                                                   While the flexibility of managers and
hospitals in the US. They are based on                                                         quality is not a
                                                clinicians in adopting new techniques was
analysis of data Premier obtained while                                                        competition,” she
                                                the most important success factor, this
conducting a pilot study of a pay-for-                                                         says. “The goal is to give
                                                could not be accomplished without
performance programme for the US                                                               all patients the benefit of
                                                significant investment in information
Medicare program, which covers 37                                                              the highest quality care we
                                                systems and other technologies needed to
million elderly and disabled Americans.                                                        know how to provide.”
                                                monitor and assess performance, Remus
   “This analysis is extremely valuable                                                           Similarly, Martin Roland, a
                                                told EuroTimes. She notes that those who
because it provides empirical evidence                                                         leading UK healthcare researcher
                                                have committed to this approach continue
supporting the concept of the business                                                         and consultant on the Quality
                                                to show extraordinary performance
case for quality,” said Peter K Lindenauer                                                     Outcome Framework program, credits
                                                improvements from quarter to quarter.


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