Patients are receiving better care and costs are dropping, thanks to the new University of Utah Health Care program known as Value Driven Outcomes. That's according to results published in the Journal of the American Medical Association.
The program breaks down health procedure costs to highly specific levels, revealing variabilities that are otherwise hidden from view. After addressing inefficiencies exposed in three common procedures -- joint replacement, in-hospital laboratory testing, and sepsis management -- patients fared better and costs fell by up to 11 percent, according to the findings.
"In order to provide higher value care, we need to better understand our costs," said lead author Vivian Lee, M.D., Ph.D., M.B.A., senior vice president at University of Utah Health Sciences and CEO of UUHC, in a statement. "We're making the case that an organization can quantify and manage value, and that's going to be a huge part in improving the healthcare system."
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For example, knee and hip replacements, along with extensive burns, Cesarean deliveries, and drug abuse, were placed on a list of 19 procedures with the highest total direct costs. Though removing a damaged knee and replacing it with an implant is a common procedure, analyses with VDO revealed that costs varied considerably between what should have been nearly identical surgeries.
Combing through millions of fields of data, VDO analyses determined that a stand-out culprit behind variations in cost for joint replacement surgeries was the length of hospital stays. It took longer for some patients to be discharged than others.
For the multidisciplinary team of doctors, nurses and operations engineers who were charged with problem solving, the newly exposed issue was a worry for two reasons. It became clear that patients weren't consistently getting out of bed and moving within a day after surgery, a measure that is important for optimal recovery. Additionally, when patients stayed in the hospital longer facility utilization costs rose.
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To ensure that every patient had early mobility, the team reconfigured physical therapists' schedules so that one would be available no matter what time of day a patient's surgery took place. Within two years after implementing the changes, the mean length of hospital stays dropped from 3.5 days down to 2.9. During that time, total costs for joint replacements fell by about 10 percent, with 30 percent of that savings coming from shorter times in the hospital.
Another large proportion of the total cost reduction, 40 percent, came from standardizing supplies, a major source of variability in the procedure's costs. Administrators renegotiated supply contracts, and made sure that surgeons used implants and other supplies that were under discount.
In addition to slashing costs, patient outcomes improved. Within one and a half years, a composite score reflecting the quality of care rose from 54 to 80 percent. According to a number of nationally and locally defined quality measures, patients were having fewer complications such as hospital acquired infections, unplanned readmissions, and emergency department visits.
Implementing the VDO program on two additional common procedures had similar impacts. In the case of in-hospital lab testing for acutely ill patients, the program revealed that some healthcare providers were ordering unnecessary tests. An education campaign drove down unnecessary testing, decreasing mean costs from $138 to $123, or 10 percent, per day. In a pilot project for the management of sepsis, one of the top three killers in hospitals, streamlining procedures and raising awareness of warning signs shortened the mean time to administering potentially life-saving antibiotics from 7.8 to 3.6 hours.
"I feel like by the time I retire I'm going to think, 'Oh my gosh, how could we have not even been thinking about value and quality back then?'" said Lee. "It's hard to imagine."
Twitter: @JELagasse