The Medicare program, which also serves as the model for private health insurance, will begin to hold providers at increased financial risk for errors they make in the course of providing care, including when patients acquire preventable infections or have to be readmitted to the hospital due to poor care during the initial stay.

There will also be a host of quality measures for which hospitals will be held accountable in "pay for performance" programs. 

Hospitals have already begun newly seeking methods to improve the safety, quality and efficiency of their care in preparation for the health care payment reform that is coming from both the public and private sectors.  One private-sector example is Prometheus Payment, Inc. which has a series of pilots underway. 

Arrowsight is uniquely positioned to help hospitals improve care, reducing the likelihood they will suffer financially as a consequence of providing unreliable care.  Careful measurement and feedback to clinical staff on their compliance with key patient safety protocols can dramatically improve and help to sustain a high-level of performance long term.  Arrowsight looks forward to being an important partner to hospitals as they work to position themselves to succeed as the new law is implemented over the next several years.

The updated report, replete with tools to improve safety, draws on new evidence published since the last report was issued in 2009.

Two-thirds of sentinel events in hospitals are thought to happen because of poor communication (Joint Commission), and inadequate nursing handoffs are widely believed to increase the chances of negative consequences for patients.  However, this systematic review of nursing handoff literature from the 1987-2008 discovered that little research has been done to determine best practices.  The Joint Commission now wants hospitals to standardize this process, but there is little evidence to support one approach over another.

• 64% say that the health care environment is detrimental to their delivery of quality care
• 59% believe the quality of medicine will decline in America over the next five years

Despite the medical advances that enter into the health care delivery system on an ongoing basis, only 18% believe that the quality of medicine will improve over the next five years.  However, seven in ten physicians believe that electronic health records can help reduce medical errors and improve physician compliance with clinical guidelines and feel that the benefits justify the costs of installing such systems.

• Medical schools do not teach safety science and do not equip doctors in training with needed interpersonal skills
• Medical schools and teaching hospitals need to create learning cultures that emphasize patient safety, transparency, and collaborative behavior
• Medical Schools and teaching hospitals need to begin intensive patient safety training for faculty so that they can serve as adequate models for their students

The report also suggests that the accrediting bodies for medical schools (the Liaison Committee on Medical Education) and residency programs (the Accreditation Council for Graduate Medical Education) revise their accreditation standards to promote a more significant focus on patient safety.

To achieve a successful partnership modeled after the Commercial Aviation Safety Team, which has contributed to the ongoing decline in deaths due to aviation, Dr. Pronovost and his colleagues cite the need for leadership, financing and active participation by relevant government agencies, provider groups and health care delivery systems.

But what is it that keeps health care professionals from sanitizing their hands?  Is it the length of time that it takes to do it?  Is it interrupting long-established work flow habits for any length of time?  We need more research to understand all of the impediments. However, we do know that getting people to establish good habits (even stopping for a 4-second hand cleaning) takes lots of work and constant feedback.  Unfortunately, even new inventions like these plasma cleaners can't change human nature.

 

For years, healthcare services researchers have maintained that there is little, if any, link between the cost of care and its quality. They drew this erroneous conclusion by using both flawed data and flawed methods of analysis.  The researchers used claims data to measure quality (flawed data because quality can only be reliably measured using medical records), and looked at total costs of care (flawed method).

During the past several years we have focused on improving our understanding of variation in the total cost of care, using defined windows of time to bound medical episodes of care.  For example, we can reasonably bound a medical episode for acute myocardial infarction within a 30 day time window, including the hospitalization of the patient and any care post-discharge during the balance of the window.  As we’ve performed these analyses, we noticed that we could split the total costs consumed during these windows of time into two components — typical or evidence-informed care (costs that are to be expected in such cases) and costs associated with potentially avoidable complications (costs that should not occur if care were delivered optimally. What we found is that these potentially avoidable costs consume anywhere between 15% and 20% of all dollars spent in the US health care system.  More importantly, we also found that higher quality providers had far fewer costs associated with potentially avoidable complications and that, as a result, their episode costs were also lower.

So if better quality costs less, why aren’t we seeing providers rush to improve the quality of care they deliver and lower overall costs? Because the way they’re paid encourages them to do the opposite. If a patient develops an infection during a hospital stay, the hospital gets more money due to a longer stay and the attending physicians bill for more services. No wonder then that health care costs are rising faster than the general rate of inflation.  And until we get the payment incentives right, it’s hard to see how we will ever achieve a high-performing health care system. The bottom line today is that what we call potentially avoidable costs, someone else in the industry is calling revenue.  That has to change.

Francois de Brantes, MS, MBA is CEO of Bridges to Excellence and Prometheus Payment, Inc.