(Originally published on Hospital Impact)
“I went to see my physical therapist in an effort to avoid shoulder surgery. When I arrived, I learned my therapist would be treating me along with three other patients. She would instruct me to do an exercise, and when she could, would turn and rush over to another patient to correct that individual’s form prior to doing the same with another, before making her way back to me to correct me as well. Of course, clearly I had been doing my rehabilitation incorrectly (as had my patient peers). I was not engaged but rather scared that I was doing more harm. My therapist was kind, but the system is broken and she was not helpful. I ended up having shoulder surgery, which at first felt beneficial but now that pain is back, my work is in jeopardy and my doctor wants me to begin therapy again.”
–Local small business owner and patient
“Payer X is reducing reimbursements for my patient visits significantly. I currently see each of my patients one on one for a full hour. My patients are engaged and activated. I focus on the whole person. We talk. We discuss what is working for them and what is not. We co-create their treatments. And my focus is 100 percent on their care and on supporting their recovery. This reduction in payment level is a barrier to optimal care provision and would lead to harm for my patients. Patient safety would be compromised due to lack of attention from having to see multiple patients at same time; patients will be placed in harm’s way and could end up being over-treated (having unnecessary surgery due to lack of progress in rehab); and patients will be disengaged. I will not practice this way.”
–Local Physical Therapist
Plan, Do, Study, Act–otherwise known as PDSA in quality-improvement speak–is critical to continuous improvement.
More specifically, PDSA means:
- Plan: the change to be tested or implemented
- Do: carry out the test or change
- Study: data before and after the change and reflect on what was learned
- Act: plan the next change cycle or full implementation
Albert Einstein reportedly said that the definition of insanity is doing the same thing over and over again and expecting different results.
If we tie this to quality improvement, insanity would be skipping the “study” aspect of improvement and thus not reflecting, learning or improving.
Why do I share these stories and these two points?
When faced with the need to reduce healthcare costs, healthcare finance leaders often continue to mandate arbitrary unit cost reductions to decrease medical expense and improve the bottom line.
And yet arbitrary unit cost reductions, although they could positively impact financial results in the short term, do not lead to improved care outcomes, and in fact may actually increase long-term healthcare costs through patient harm and overtreatment.
The examples above are missing a crucial piece: Finance leaders and their healthcare delivery counterparts working collaboratively to develop creative approaches to care provision rather than simply dictating unit cost reductions.
In not doing so, they are (we all are) missing great opportunities to leverage quality improvement and patient-centeredness and to develop models and programs that lead to improved outcomes and overall improved medical costs savings for the entire health system.
The concept of group visits or care when done well (unlike the broken model highlighted above) is one successful example of these opportunities coming together. Using physical rehabilitation as an example, group visits developed with the focus on improved engagement, safety and health outcomes would ensure patients are all rehabbing a specific, similar injury (e.g., ACL tear) for a specific purpose (e.g., to return to skiing) and participating in their care … together. This creates a bond and a healing community where the patients learn from one another, support one another and improve together. (For another example of group care, see Centering Pregnancy). In this example the cost to the system is less, and yet the model and community of health it creates leads to better engagement, activation and experience (of patients and clinicians), improved safety, appropriate levels of treatment, and improved health. The quadruple aim and beyond.
As healthcare finance leaders–be it within a hospital, managed care organization or other–we are part of a system and a community. We have the same mission and vision within each of our healthcare institutions as the CEO, the doctors, the nurses and the entire community in which we serve. And if short-term financial returns that place our patients, families and communities in harm’s way is part of our mission, it is a shameful one and must be changed immediately. If it is not, we need to apply quality improvement to our work and join the efforts to improve optimal care provision with new, innovative and creative financially responsible care models aligned with the quadruple aim. Only then will we truly both honor our mission and create a financially sound organization and system.
It is not too late and yet long overdue.