Treating Patients Better For Less

There is some good news about the overly costly, underperforming American health care system. A growing number of hospitals, doctors, employers and health insurers are finding ways to reduce the cost of delivering medical care while maintaining or improving quality. If enough providers adopt their already proven techniques, this grass-roots movement could transform the entire system in ways that will benefit all Americans.

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It is a measure of how dysfunctional the system has become that these successful experiments — based on medical sense, sound research and efficiencies — seem so revolutionary. Here are some that deserve a close look from the rest of the industry and from Washington:

In Seattle, the Virginia Mason Medical Center, once deemed a high-cost provider, has conducted rigorous internal reviews to eliminate waste and inefficiency. It says that after doctors were required to click through a computerized checklist of the medical circumstances needed to justify a costly imaging test, CT scans for sinus conditions dropped by 27 percent and M.R.I.'s for headaches by 23 percent. It placed nursing teams and supplies closer to patients, freeing nurses to spend 90 percent of their time on direct patient care, far more than the 35 percent at most hospitals. The time needed to process insurance claims was sharply cut by consolidating steps. In a tough environment for hospitals, Virginia Mason has been reporting margins of 4 to 5 percent.

Virginia Mason also collaborated with Starbucks and the company's insurance provider, Aetna, to find better ways to treat patients with uncomplicated back pain, a costly burden to the company. At the start, all patients complaining of back pain typically waited many weeks to see a specialist, who would then prescribe a costly, unnecessary M.R.I. before finally sending them on to a physical therapist. By finding ways to separate out the uncomplicated cases, Virginia Mason was able to send them directly to a therapist on the day the patient requested an appointment, and the vast majority were able to quickly return to work.

The Cincinnati Children's Hospital Medical Center is using computer models to predict the number of intensive-care beds needed for patients having surgery. When necessary, it limits elective surgeries that require access to the intensive-care unit, and the smoother flow of patients has allowed the hospital to avoid $100 million in capital costs to build new bed capacity.

Premier Inc., an alliance of more than 2,600 hospitals across the country, has been testing ways to save money and improve care. It stresses quick treatment to prevent deaths and costly complications from infections, strokes and cardiac crises. It has reduced unnecessary laboratory and screening tests. And it has reduced labor costs by eliminating inefficient processes, like multiple re-entries of the same patient data for admitting, scheduling, discharge and billing, and by using caseworkers or administrative assistants rather than nurses to call patients to remind them of appointments or checkups.

Premier reported in January that over a three-year period, 157 of its hospitals in 31 states saved almost 25,000 lives and reduced health care spending by nearly $4.5 billion, roughly 12 percent of the total three-year cost of care at those hospitals.

Various health insurers are making constructive changes as well. These include assigning case managers to coordinate care for the chronically ill; basing payments to providers on quality and efficiency, not the volume of care; collaborating with providers to set up new models of coordinated care; and working to simplify insurance forms to reduce the stupefying amount of paperwork that must be filled out by doctors and their patients — a move than could save the health care system many billions of dollars a year.

Some of the most creative approaches being tried in the country are described in a recent book published by the Institute for Health Care Improvement, a nonprofit organization in Cambridge, Mass., and in a forthcoming report from the Institute of Medicine, in which the chief executives of 11 health care systems endorse a checklist of 10 steps they say every hospital can take to reduce costs and improve care.

While all of this has been going on, the debate in Washington is still stuck on whether health care reform should have become law and whether it should now be struck down by the Supreme Court or repealed.

There are many reasons to support reform, including the fact that it will give an important boost to improving the system through pilot programs and incentives and penalties, designed to lower costs and improve care. This process is already under way. But it will have a much better chance of succeeding with the right help from Washington.

June 03, 2012, Sunday    Late Edition – Final
Section: SR    Page: 12    Column: 0    Desk: Editorial Desk    Length: 827 words