Healthcare Efficiency

Yes! Cost is the numerator in the efficiency equation.  It it the factor that will pay for all the other needed improvements in healthcare.  If 30 to 50% of healthcare costs are "waste," think of the money we could have to invest in improvement!  Several initiatives aim to reward providers for efficiency.  Remember to include time in your cost equation--both provider time AND patient time.  Advice for those with Healthcare Savings Accounts (HSA) or Flexible Spending Accounts:  Third parties (HMOs, insurance companies, Medicare, etc.) reimburse at roughly 50% of charges and do so only after at least 90 days.  Thus, if you go to a practitioner and put green money on the table, expect at least a 20% discount from charges. You are NOT powerless!  If you don't get that, go elsewhere.  My daughter told her pediatrician (who was 60 min late seeing her kids), "You're going to be less busy in the future, because I'm taking my business elsewhere!"  Vote with your feet.  There are too many doctors to put up with inefficient care or steep prices.  Expect good serivce at a reasonable price, and you will get it.  Tolerate poor service, and you will get that too.  Efficient healthcare provides the best of both worlds--the patient gets good value, and the provider is more efficient.  I once wrote that healthcare could be improved if Medicare cut their reimbursements in half.  Most hospitals would go bankrupt, but those that remained would be VERY efficient.  Note:  we're talking about micro-efficiency here--the cost for an individual patient visit.  (The Medicare drug benefit is pure politics and has nothing to do with efficiency.)

Posted by Dr. Robert Burney at 05:41 PM | Permalink | Comments (1)

Let's define quality here as conformance to standards of care AND satisfaction of customer needs.  I say "and" to include both technical and service aspects of healthcare.  Quality initiatives have been criticized because they neglect cost.  For example, the NQF has been developing standards for care of specific conditions and settings without regard for the cost of these changes or assessment of the value to the patient.  If there is any improvement in efficiency, it is an accident. In fairness, these standards should create better results for the patient and this should reduce costs to the system.  However, cost considerations are not part of the standards and thus many of these may have a negative effect on efficiency.  It is possible to increase the quality of care while decreasing cost, but that won't happen by accident.  Plan for success!  For example, it is possible to reduce or eliminate nausea and vomiting after anesthesia by judicious choice of anesthetic drugs and techniques.  The result is a shorter stay in recovery room (decreased cost) and a happier patient (improved quality).  Accessible scheduling can even out patient flow in urgent care centers.  Reduced waiting time pleases patients, and improved provider productivity reduces cost.  The combination in either case means improved efficiency and improved quality.  Sometimes, you need to start with a clean slate to plan a new patient care process with due consideration to both cost and quality.  QFD anyone?

Posted by Dr. Robert Burney at 08:02 PM | Permalink | Comments (3)

Remember, COST is the numerator of the EFFICIENCY equation.  The HMO movement reduced costs, but it also changed the denominator--the healthcare services were not the same.  Eventually, Americans decided they didn't like gatekeepers, limited options, and third world providers.  To care about efficiency, consumers must have a choice.    On a micro level, as Mickey states, it's all about what hapens to me.  When I walk into an ER, I want to see a doctor . . . NOW; and when able, I will choose an ER that sees me promptly.  Some emergency rooms now see patients within 30 minutes (http://www.oakwood.org/Emergency/index.asp).  From the institution's viewpoint, there must be motivation to be efficient.  Private, for profit institutions are intrinsically more efficient than universities--they have to be.  In thinking about this, you must keep the denominator constant--same healthcare service.  And you must include the patient's time in the numerator.  That's a cost also.  Misuse of healthcare (over/under use) is largely a value judgement.  If you don't want to pay for the healthcare I want, you will call it overuse.  On a macro level, some healthcare use is driven by personal choices--obesity, smoking, inactivity.  Population healthcare would be more efficient if we changed individual habits.  Demand management.  Think broadly about cost--spending money on anti-nausea drugs will reduce the total cost of the patient's recovery room stay.  Every $1 spent on sex education classes saves $3 in costs for teen pregnancies.  Next time--quality vs efficiency.

Posted by Dr. Robert Burney at 12:25 PM | Permalink | Comments (2)

Each of the six aims of the Institute of Medicine has inspired research or standards, except efficiency. The AAAHC has measured the cost of performing certain procedures and determined factors that make some institutions more efficient than others, and the NQF sponsored a panel on efficiency at its annual meeting. Other organizations (AHRQ, NCQA, RAND) have begun to think, but concrete action is missing. DEFINITIONS: Efficiency will be defined as "Cost per unit service provided." Within cost, we will include both time and money, because they are not always equivalant. (Who's time and who's money?) We must also look at macro-efficiency and micro-efficiency. On a macro level, consider the care of populations or groups of patients with a common disease or condition. Micro-efficiency looks at individual patient care or procedures. It is possible to be efficient on the micro level but inefficient on a macro level. One might perform an angioplasty very efficiently on a patient who shouldn't have neede the procedure if the larger shystem has been more successful at convincing him to change his lifestyle. One must also be careful to distinguish between efficient and cheap. Not always easy. Between 30 and 50% of healthcare expenditrues have been ascribed to waste. However, efficiency will not solve problems of overuse. (Is this a problem or a value judgement?) Finally, we must take a long term view in looking at costs. It may seem "efficient" to ignore otitis media in the moment, but what about the kid's hearing six years later?

Posted by Dr. Robert Burney at 04:38 PM | Permalink | Comments (4)