In the current value-based reimbursement climate, what hospital isn’t looking for ways to boost quality care while trimming costs? But according to a recent AHC Media article, many hospitals are missing out on a particularly effective way to do so: standardizing patient care.
“Some hospitals have addressed this, but I would say the majority have not,” Nancy Lakier, RN, BSN, MBA, CEO and managing principal of consulting company Novia Strategies, Poway, CA, told the publication. “If they have not addressed clinical variation, their patients are getting variable care based on the expertise of the individuals caring for their patients. Some people are more highly skilled than others, but more than that, we all have good days and bad days. Why not have protocols in place to support that care meeting optimal standards?”
Years ago as a nurse executive at Scripps Health, Lakier tackled the managed care wave by cleaning up clinical variation in the San Diego-based health care system. Clinician prerogative was swapped out for best practices, which led to clinical pathways, protocols and practice guidelines.
The move saved the organization tens of millions of dollars, according to the article.
“Now, with the Affordable Care Act, we’re looking again at how to standardize care to best practice,” the consultant told AHC Media. “We have seen numerous times how it improves care for the patient and reduces costs. So many times, we are providing care ‘just because.’ The doctor has always ordered labs that way, or it’s just routine to do a task this way, whether it’s right or not.”
A lack of care standardization has its roots in earlier days, when clinical decision-makers were trained at different institutions with different schools of thought. They brought these variations into practice with them, and treated patients they way they were taught, Lakier told the publication.
While health care has made strides in integrating care in recent years, the reality is, the same patient could still likely receive different treatment based on which hospitals and which clinicians are the providing care.
The result? The article provides quite a few, and — spoiler alert — they’re not what hospitals are driving for in this day and age: “poor clinical outcomes, substandard care, wasted resources, excessive costs, and disappointing experiences for patients and families.”
That’s according to David A. Di Loreto, MD, FACS, MBA, senior vice president of GE Healthcare Camden Group in Chicago, who also reminded the publication’s readers how providers in the modern-age are receiving reimbursement: through value-based contracts that factor clinical outcomes, patient experience and health care costs into payment rates.
It doesn’t take an MBA to see the results of clinical variation are not the best ingredients for a healthy bottom line.
Still, standardized care does have its critics, most of whom are clinicians who resent having outsiders question their decisions and habits. Younger health care providers, most of whom have been trained with a greater emphasis on best practices, are less likely to resist standardization, according to the piece.
Lakier offered a couple pieces of advice for successful standardization efforts. First, use data on measures such as readmission rates, morbidity, mortality and costs to introduce discussions with providers on the effects of clinical variations.
“Pretty soon they’re talking to one another and saying, ‘Wait a minute, how come your costs are different from mine? What are you doing to get your patients a shorter length of stay than mine?’” Lakier told AHC Media. “If this isn’t done in a collaborative and informative way, you’re going to have resistance.”
Second, make the project interdisciplinary, with all team players aware of standardized care processes so there are checks and balances in the effort.
With any luck, the “overuse, underuse, different use, and waste of healthcare practices and services with varying outcomes” — how the AHC Media article describes clinical variations —will fade away as more hospitals adopt standardized, evidence-based care practices for truly value-driven care.
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