As medical costs continue to rise, healthcare organizations are being forced to re-examine practices and procedures to find the most economical ways to balance quality care with sustainable pricing.
Locally, physicians and healthcare providers are implementing new measures to operate more efficiently, say leaders at Baptist Memorial Health Care. And while these leaner processes are cutting hospital costs, they also are benefiting patients.
Baptist participates in the voluntary Medicare Shared Savings Program, which was established by the Affordable Care Act and was intended to decrease unnecessary healthcare costs. Facilities designated as Affordable Care Organizations receive financial rewards and incentives by lowering healthcare costs while meeting federally mandated patient care standards.
Dr. Mark Swanson, chief medical officer for Baptist, said the organization, which operates 14 hospitals in the Mid-South, is managing rising costs through collaboration between caregivers at every level.
“It has to be a concerted effort in order to effectively control costs while providing quality care,” Swanson said. “We don’t want to incur unnecessary costs for the patients or the hospital.”
Adopting new cost-saving procedures sometimes requires a shift in mindset, Swanson acknowledged. And that may vary from vendor relations to patient care.
“We have to look more closely at how hospitals can control costs, and perhaps that may be by reducing the number of vendors we use,” Swanson said. “It also means working with physicians to see how they practiced and find ways to prevent incurring unnecessary costs while at the same time being careful not to alter the outcome for the patient.”
For example, in years past multiple tests may have been routinely ordered for patients who were admitted to hospitals for conditions such as diabetes, heart failure or pneumonia. But more tests did not necessarily indicate better patient care or lead to quicker recovery, Swanson explained.
Similarly, whereas some healthcare facilities may have adopted a standard length of stay for certain ailments, more time spent in a hospital may not be the best treatment option for most patients.
“We looked at the diagnoses for areas with frequent admissions, such as heart failure or pneumonia, and we tried to determine the best tests and medicines and how quickly these patients will get better,” Swanson said. “Some of the tests that were routinely performed may have been necessary in only a small number of cases and not for every
patient. And if some guidelines suggested that a patient should be in the hospital for three days, but we were keeping them four or five days, then we began trying to treat them more efficiently so that they could feel better and go home sooner.”
A 2013 Health Care Cost and Utilization Report (http://www.healthcostinstitute.org/files/2013%20HCCUR%2012-17-14.pdf ) by the nonprofit, non-partisan Health Care Cost Institute (HCCI) found that despite decreased brand prescription drug use, admission rates and outpatient services that year, average prices in all three of those areas increased, and at higher rates than the previous year.
The study mirrored a 2013 Journal of the American Medical Association (JAMA) report (http://jama.jamanetwork.com/article.aspx?articleid=1769899 ), which indicated that of increases in healthcare costs between 2000 and 2011, more than 90 percent stemmed from escalating prices of drugs, hospital care and medical devices.
Eight years before the Affordable Care Act was signed into law, “Medical Professionalism in the New Millennium: A Physician Charter” (co-authored by the American Board of Internal Medicine Foundation (ABIMF), the American College of Physicians (ACP) Foundation, and the European Federation of Internal Medicine and published in the spring of 2002) suggested that the U.S. healthcare system needed to self-regulate in order to remain sustainable.
That article began a national dialogue that led the American Board of Internal Medicine (ABIM) to establish the Choosing Wisely initiative in 2012. The campaign promotes quality care that is more efficient and less costly, and achieved by reducing unnecessary tests, procedures and treatments.
That is the focus of patient care throughout the Baptist system, said the organization’s chief nursing officer, Susan Ferguson.
“The key is to prevent readmission,” she said. “We work toward that in a number of ways, including enhanced admission processes that include family members or caregivers and determining what support systems our patients will have once they are released. In addition, we have developed an extensive patient evaluation system that involves every healthcare professional involved with that patient’s case. We discuss every patient every day to see how they’re progressing and responding to care.”
And in an effort to reduce patient hospital stays, facilities are developing procedures that are less invasive and require shorter recovery periods. At Stern Cardiovascular Foundation, a new device known as the MitraClip is being offered at Baptist to treat mitral regurgitation, caused by a leaky mitral valve that creates a backward flow of blood in the heart.
The condition, which affects about 10 percent of people 75 and above, is regularly treated through open heart mitral valve surgery. However, for patients for whom such surgery is too risky, the minimally invasive MitraClip treatment is a welcome option.
“After a lot of hard work and dedication, we finally started the MitraClip program,” said Dr. Basil Paulus, cardiologist with the Stern Cardiovascular Foundation. “We completed our first two cases in June at Baptist Memphis, and they were both successful.”
So far, the incentives for decreasing costs and improving patient care are working, Swanson said. And that bodes well for the future of the healthcare system and patients alike.
“This is a motivator for physicians to provide the absolute best care for their patients as possible, without having them undergo procedures or treatments that may not have a positive impact on their condition,” Swanson said. “It helps us focus on treating patients in a better, more efficient way that helps them get healthier faster, and that is the best result for everyone.”
RELATED LINKS:
Baptist Memorial Health Care, www.baptistonline.org
Medicare Shared Saving Program, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram
Health Care Cost Institute, www.healthcostinstitute.org
Choosing Wisely, www.choosingwisely.org
Stern Cardiovascular Foundation, www.sterncardio.com
