March 07, 2011
Last week, policymakers, healthcare specialists and medical practitioners descended upon the Columbus Club at Union Station in Washington, D.C. for the National Journal s Policy Summit, Bill of Health: The Impact of Healthcare-Associated Infections on Healthcare Costs and Patient Care Quality. The summit, underwritten by BD, boasted participants from across the healthcare spectrum, including representatives from NIH, National Quality Forum, the Department of Health and Human Services, SHEA and yours truly. Their goal was to address the 1.7 million Hospital Acquired Infections (HAIs) that occur annually in the United States and account for up to 4.5 billion in excess healthcare costs.
Given such daunting statistics, I was surprised by the esteemed panel s general sense of optimism, perhaps spurred by the CDC s recent report of a 58% reduction in ICU central line infections between 2001 and 2009. Dr. Donald Berwick, Administrator with the Centers for Medicare & Medicaid Services (CMS), opened the discussion by stressing that our current healthcare structure is unsustainable in terms of costs, but hope is not lost. Berwick suggested that with growing public awareness and an increase in accurate data collection, society is moving away from a culture of blame to one of science.
When asked why the United States is not doing a better job at providing healthcare, Berwick pointed to the healthcare industry s fragmented state, where efficiency, timeliness, and genuine innovation take a back seat. Organizations must learn to act in a more cohesive manner by harnessing the latest technology, sharing information, building partnerships, and reducing waste. Although there was little talk about how to overcome this fragmentation, it was said that CMS and its Innovation Center will continue to play an important role as a hub where policymakers and practitioners may share lessons learned and best practices. According to Berwick, only through a concerted effort to integrate and innovate can the U.S. improve quality, reduce costs, and sustain our healthcare system.
Public reporting will also play a key role in increasing communication and accountability, where outcome measures, physician comparisons, Medicare surveys, and patient complaints are easily accessible in one place. However, for these services to be truly effective, the public must be able to easily navigate such sites, access its data, and provide continual feedback. Hospital Compare is a starting point for providing this kind of accessible interface.
The one-on-one with Dr. Berwick was followed by a panel discussion that included Nancy Foster, VP for Quality and Safety at the American Hospital Association, Dr. Richard Calderone, Professor of Microbiology and Immunology at Georgetown University, Dr. Jerome Granato, CMO at Excela Health, Lisa McGiffert, Campaign Director for Consumers Union s Safe Patient Project, and Dr. Don Wright, Deputy Assistant Secretary for Health and Healthcare Quality at the U.S. Department of Health and Human Services. Most of the panel s discussion wavered between CMS s hospital value based purchasing program (Section 3001 of the Affordable Care Act), standardization, and various cost-saving measures such as utilizing the Toyota Production System.
When the moderator asked the panel what they believed was the most important provision in the Affordable Care Act, their answers were startlingly similar: the transformation from paying for volume reporting to paying for quality outcomes and innovation. CMS s hospital value based purchasing program (VBP), a major driver behind these quality outcomes, represents a shift from a passive system of reporting measures to one in which quality of care outcomes matter most. VBP identifies and provides a financial bonus to those healthcare facilities with superior or improved qualities of performance. In turn, this may encourage practitioners and hospital leadership to answer some very fundamental questions on best practices and cost effectiveness why is hospital A doing better than hospital B and how might we achieve the same or better? Conversely, CMS must take the important step to ensure hospitals in disadvantaged areas, or centers that service the most vulnerable communities, are not left by the wayside.
According to Dr. Granto, one method to reduce waste and streamline services in healthcare facilities is to implement the Toyota Production System, but rather than installing windshield wipers on a production line, trained healthcare practitioners would follow a standard set of procedures to carry out a particular task to reduce error, speed procedures, and provide better care to patients in need. Allegheny Hospital in Pennsylvania achieved many milestones through use of this model. Despite initial resistance from many staff members due to, in part, a don t tell me how to do my job mentality, the numbers clearly show that TPS paid off big time. For example, between 2003-2004 AGH achieved a 90% reduction in CLABs, dropping from 49 to 3 patients infected. On top of the improved patient outcomes, the hospital saved $14,572 per CLAB prevented. You do the math.
The eye toward zero HAIs talk is good, and we have taken great strides recently, but much more is needed. Substantial organizational and procedural changes must occur if we are to see similar success stories like Allegheny Hospital. As Dr. Granto demonstrates, where there is a process, there is a way to make it more efficient. Changing long-held beliefs and business-as-usual practices can create friction, and it is for this reasons that we need innovative, strong leadership that can build partnerships and limit the scope of fragmentation, utilizing available technology to share information on best practices.
Image credit: Flickr: insk0r
