As the federal government and insurance companies put pressure on Connecticut hospitals to improve the quality of care while driving down costs, the industry is responding with a host of efforts to reduce medical errors, slash readmission rates and improve hospital processes.
The primary objective, industry officials say, is to find ways to become leaner and more efficient, while ultimately improving the quality of care for patients to make them healthier in the long run.
And a lot of the improvements are being driven by new technology and data tracking, which is helping to pinpoint problem areas.
Attacking inefficiencies and cost drivers is becoming more important, especially as the healthcare reform law begins to link hospital reimbursements to performance outcomes.
At the same time, Medicare and commercial payers are reducing or eliminating payments to medical care providers that make serious but preventable mistakes in patient care, putting pressure on hospitals to improve quality, or risk losing key revenue.
The stakes are high. With most of the state’s acute care hospitals operating on thin margins, and Connecticut already among the most costly in terms of health care expenses, the need to become more efficient is crucial.
“Delivering higher quality care in a more cost effective way is the only way we are going to survive into the future,” said Steven D. Hanks, the executive vice president and chief medical officer at The Hospital of Central Connecticut in New Britain.
Hanks said many hospitals are using evidence-based medicine to improve care quality and reduce costs. And a lot of it is data driven with the use of electronic health records or national registries of data held by government healthcare payers or other industry organizations.
Over the past few years, Hanks said, there has been a great emphasis on gathering data so hospitals can compare their performance to peer institutions. But just recently are hospitals beginning to act on the information to improve quality conditions.
“Data allows you to spot things you wouldn’t recognize looking at cases individually,” Hanks said.
St. Francis Hospital, for example, is taking part in the National Surgical Quality Improvement Program (NSQIP), a data driven initiative that allows the hospital to compare its quality surgical performance to other hospitals around the country.
NSQIP collects data on 135 variables, including preoperative risk factors and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures.
Scott Ellner, St. Francis’ director of surgical quality, said the system helped the hospital identify a need to reduce post operative urinary tract infections. In response, the hospital changed some of its procedures based on best practices used by other hospitals, and has reduced infections by 56 percent. That’s a led to a considerable savings, Ellner said, since it costs about $12,000 to treat each infection.
St. Francis has also introduced a medical checklist into its surgical operating room to standardize procedures among practitioners and avoid costly mistakes.
The checklist includes dozens of steps to be taken during pre- and post-operative care, and in the ICU, operating and recovery rooms. It includes things like making sure the right patient and the right body part is being operated on, and making sure clear instructions are set on how to take care of the patient after surgery.
While such mistakes may seem unlikely, they do happen. Surgeons at Yale-New Haven Hospital, for example, were recently cited by the state for performing surgery on the wrong leg of a motorcycle accident victim. Besides putting the patient in jeopardy, the mistake was also costly, requiring an additional surgery to remove a pin from the patient’s right leg and the placement of a new pin in his left leg.
“Whenever you have complications like a urinary tract infection or a wrong-side surgery, it reduces the value of care,” Ellner said. “All of that is costly. But it’s not just for costs savings; it’s for the benefit of the patient as well.”
The Hospital of Central Connecticut is giving tools to its clinicians to improve front-line decision making. For example, nurses have a bar code scanner that matches up the correct drug and dose with the right patient. The nurse scans bar-codes on the patient’s wristband and on the medication to ensure it’s a match. That has reduced medication errors in the hospital by 70 percent, Hanks said.
The hospital is also taking a page out of the private sector by adopting “lean” principals, a discipline commonly used in manufacturing for streamlining and efficiency. The effort includes a total redesign of HCC’s emergency department processes, which has helped lower patient wait and turnaround times.
Alison Hong, interim vice president of quality and patient safety at the Connecticut Hospital Association, said there are various areas hospitals are working to improve quality, and reducing medical mistakes is one of the strategies.
But more important is the effort to improve the delivery and coordination of care, which can ultimately help fight the bigger cost drivers like hospital readmissions or postoperative complications. The key, Hong said, is improving care coordination and making sure patients receive information they need after they leave the hospital.
Studies show about one in five patients return to hospitals for avoidable readmissions within 30-days of their treatment, which costs Medicare $17.4 billion annually.
“Hospitals are asking themselves ‘are there things that could be done as part of follow-up care so patients don’t have to return in short order,’” Hong said.
One thing hospitals are doing more often is scheduling early follow-ups, including appointments within three to five days of treatment. In some cases, hospitals are scheduling appointments for patients with other providers.
The key, Hong said, is to get all providers — including hospitals, primary doctors, specialists, nursing homes, and home health agencies — communicating.
The rising cost of health care has put an onus on hospitals and other providers to change their ways. And if they haven’t been on board yet, health care reform and insurers are aiming to push them in that direction.
Under the new health care law, for example, hospitals could lose up to 2 percent in Medicare reimbursements for above average readmission or medical error rates or inefficient operating systems, said Stephen Frayne, senior vice president of health policy for the Connecticut Hospital Association.
At the same time Medicare and commercial insurers like Aetna are adopting tough reimbursement policies that withhold payments to medical care providers who make serious but preventable mistakes in patient care. That includes errors like leaving a foreign object in a patient after surgery or providing contaminated drugs that may lead to a patient’s death.
Jean Rexford of the Connecticut Center for Patient Safety said there is still a long way to go in terms of improving patient quality.
“I think there is a growing awareness and it’s an urgent problem,” Rexford said. “Some hospitals are making a good faith effort and understand patient safety. Other hospitals continue to miss the point.”
