The Institute for Healthcare Improvement (IHI) held its 26th annual forum—a wonderful venue for learning how to achieve better health and better health care at a lower cost. The speakers and exhibits showed in numerous ways how this triple aim can be realized.
All of the sessions I attended were interesting. Most focused on ways to improve health and health outcomes. Some of these improvement are absolutely remarkable, such as, for example, reducing hospital stays from an average of 6 days to 2 for a given treatment. Fewer sessions had reducing costs as a focus—clearly a less fascinating topic in itself!
How to improve the cost side of the equation
There was a very nice and well-organized session: Hospital Finance 101. We all got to play a game that illustrates the challenges of hospital finance. Very insightful, but it also made me wonder. In this game the fact that there are costs was a given, but in reality this type of information is unavailable or hard to get in most healthcare organizations.
The absence of cost data—that is, the actual costs, not what is billed or gets reimbursed—is no surprise for any involved in health care. However, for those of us with a business background, this is utterly shocking, frightening and difficult to believe. How can an organization thrive without having any insight into the actual cost of its operations?
Looking for answers at the vendor booths
A visit to the vendor booths showed that cost was not the favorite topic there either. The trend this year was information analytics. Numerous vendors presented advanced systems, all aimed at making healthcare information easily available, as well as easy to use and interpret.
Unfortunately, few of these systems are able to provide insight into costs. Upon inquiring, I got various answers why not. The most common theme was that such information is typically not available, since only about 25-40% (the estimates varied) of hospitals collect such data. Again, I’m talking about data on actual costs, not on what gets reimbursed. Without the availability of such data, no information system can provide insights into the actual cost of care.
What if hospitals had insight into the actual costs of their operations?
- Data would provide insight into what are valuable approaches and which are not (value = quality/costs).
- Data would also help innovation efforts, as great innovations significantly improve health and health care. (It is good to remember that if the costs are significant too, the adoption of these innovations is typically slow.)
- Data would provide metrics to assess the third leg of the triple aim of improving health, health care and costs. How else will we know otherwise?
The burden of improvements
In his keynote talk, Atul Gawande beautifully illustrated the importance of considering the impact innovations have on the healthcare system. Anesthetics for example, was an innovation that was very quickly adopted, in spite of the inventor trying to keep his invention a secret. The benefits for the patient and the healthcare provider were obvious and immediate. It is no fun to inflict pain. A painless procedure and a quiet patient make operating much more pleasant, safe and effective.
In contrast, it took forever to get antiseptics introduced into the operating room because their benefits were not immediately visible. In addition, especially in the early days, applying antiseptics was an unpleasant and timely endeavor. All of these factors significantly hindered their adoption.
In sum, when we are striving to improve health and health care, we can’t only look at the health outcomes. We have to take the burden these improvements have on the system into consideration, to have any chance of success. If only all the information we needed to track and trace data were available! There is much room for improvement.
Something for all of us to work on—and perhaps a trend for 2015?
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