Payment Policy
COST: We Made the Hospital Bed, So Lie In It
I want to expand on Joanne's excellent and thorough post yesterday on the new Dartmouth Atlas Project report. One sentence in the AP/WaPo story especially caught my eye: the supply of beds in a locality is a key driver of how many days patients spend in the hospital. In other words, the more beds you have, the more patients you will admit. According to the Dartmouth report, this doesn't affect the fairly clearcut necessary hospital stays, an elderly patient with a hip fracture for instance. But, when the decision to hospitalize a patient is "more discretionary—as is the case for patients with heart failure and most other medical conditions—admission rates are strongly correlated with the local supply of hospital beds." Hmm.
QUALITY: Oops, We're Not Paying Again
"Oops I did it again," may have made millions as a pop song, but for 11 preventable medical errors, it will no longer get you paid by the Indianapolis-based insurer, WellPoint, according to an article in today's Indianapolis Star.
WellPoint joins a growing number of public and private payers in efforts aimed at promoting quality, reducing errors, and controlling costs in our medical system. WellPoint's new policy adopts the steps taken by the Centers for Medicare and Medicaid Services last fall to no longer pay for preventable medical errors, injuries and infections that occur in hospitals.
Like CMS, WellPoint will make sure that neither it nor its patients pay for three so-called "never events"—surgical mistakes that should never happen under any circumstances. They are:
- Surgery on the wrong body part
- Surgery on the wrong patient
- The wrong surgery performed on a patient.
Additionally the insurer will limit payments for the following events, all of which are highly preventable when evidenced-based guidelines are adhered to:
QUALITY: Can What Works for Toyota Heal Hospitals?
There's a great story out of the Seattle Post-Intelligencer this morning by Cherie Black on the innovation at Virginia Mason Medical Center in Seattle. Central to their work is the Toyota Production System, which seeks to eliminate wasted time and mistakes. It works with cars - what about health care?
Virginia Mason said benefits include an 85 percent reduction in how long patients wait to get lab results back, and $1 million savings on inventory costs.They've redesigned facilities to make patient and staff work flow more productive. The hospital reduced overtime and temporary labor expenses by $500,000 in one year and increased productivity by 93 percent. While direct cost savings aren't passed on to patients with the new system, less waiting, increased safety and more efficient care are.
(CEO Gary) Kaplan's vision is to have patients start their appointment in the parking garage with a smart card that triggers their entire appointment process. No more waiting rooms, just move directly from the garage to an examination room.
Total flow -- no waiting, no waste and it's all about the patient.
"We have more than enough resources in health care," Kaplan said. "We just need to stop wasting it and only do what's appropriate and value-added and we'd save billions."
