In a recent speech, Alex Azar, the U.S. secretary of health and human services, said, “There is no more powerful force than an informed consumer.” What about an informed provider? If health systems are truly going to improve the value of the care they deliver, they need to enlist doctors in the effort. According to a national survey conducted by University of Utah Health, 89% of physicians believe the overall cost of health care in this country is too high. Now we need to give doctors a chance at engaging in the conversation by developing tools to make cost transparent to them.
For the past five years, University of Utah Health has been working on a tool that does just that. Its Value Driven Outcomes (VDO) initiative provides physicians with cost data to assess health outcomes per dollar spent. VDO is a modular, extensible framework that draws from the health care system’s enterprise data warehouse and provides access to data on both individual patient encounters and populations of patients.
VDO includes data that helps to define quality (for example, national quality metrics and clinician-defined quality metrics) and cost (including supplies, pharmacy, imaging, and laboratory utilization; human resource utilization; and the general ledger, the organization’s complete record of financial transactions, including the acquisition costs for specific medical supplies). The tool uses this data to calculate and integrate cost information with relevant quality and outcome measures. In other words, it provides physicians with the data necessary to make value-based decisions on behalf of their patients.
The operating room is one of the most resource-intensive environments in our health care system. So, as surgeons, we wanted to use the VDO framework to create a tool that specifically addresses the role surgeons play in driving value: providing the benefits of surgery at a reasonable cost. We developed Operating Room Cost Accountability (ORCA), a tool that compiles an itemized list of supplies used for each procedure a surgeon performs.
ORCA itemizes the acquisition cost for every surgical supply item, itemizes supply usage by individual surgeons for every operation they perform, calculates a surgeon’s average cost for the procedure, and identifies the actual cost per minute in the operating room. In other words, it provides surgeons with cost data for the resources under their control. From their offices, they can sit with a computer or tablet and, before going to the operating room, see exactly how much each item costs. They can weigh benefit and cost and ask the fundamental value question: Is it worth it?
The tool also shows how long a surgeon takes to perform each procedure and their average time for performing that procedure. The surgeon can use all of the data to compare their time and costs to all other surgeons who perform the same procedure, and begin to ask questions.
Take groin hernia surgery. One of our general surgeons can search ORCA for all groin hernia cases performed in our health care system. The surgeon can see the cost associated with the supplies used in the operating room and compare her use to her peers’. For the repair of groin hernias, for example, the surgeon would see a sixfold variation in cost related to the different types of mesh that surgeons at our institution select to fix hernias. Yet the current literature doesn’t show any discernible difference in patient outcomes related to the type of mesh used. The use of a more expensive mesh is simply, well, more expensive.
ORCA was made available to all surgeons in our health care system for the last year. What we’ve found is that the real opportunity to drive value arises when groups of surgeons who perform the same procedure get together and decide on standard operations that optimize both clinical outcomes and costs.
For example, some surgeons performing laparoscopic repairs of groin hernias use a specially devised balloon dissector to create a working space in the abdominal wall. Others simply create a working space manually. The surgeons who used the balloon spent an additional $400 but argued that it saved operating room time and therefore cost. The data showed otherwise: The surgeons who did not use the balloon completed their operations faster on average — and with similar outcomes. The balloon users quickly learned from their colleagues how to perform the surgery without it and subsequently shortened their operating times and lowered the overall cost of the operation.
Whether the decision concerns standardizing supplies used for a specific procedure, like repairing groin hernias, or general supplies to stock in the operating room, ORCA allows us to identify the physician stakeholders who should be at the table. Recently, surgeons who use advanced electrical dissecting devices employed ORCA to identify and eliminate some of the more costly devices that provided no additional benefit. This saved 27% (over $250,000) of the overall cost of these devices at our main hospital within the first six months.
High-value clinical care demands that we optimize both patient outcomes and costs. But in order to do that, we’ll need to engage physicians in making value analyses when they recommend treatments for their patients. While we are still far from the goal of achieving a large-scale, sustained, and meaningful movement toward high-value care in this country, our early experience with ORCA shows that knowing just a little about the cost implications of treatment choices gets the conversation going and inspires action. Cost transparency may not be the whole solution, but we believe — and our experience shows — that it’s a very good start.
from HBR.org https://ift.tt/2HOE6dN
