Title: Improving%20the%20Quality%20of%20Care%20to%20Reduce%20Health%20Care%20Costs%20and%20Improve%20Productivity
1Improving the Quality of Care to Reduce Health
Care Costs and Improve Productivity
- Iowa Health Buyers Alliance Annual Conference
- October 15, 2008
- Jim Mortimer
- j.mortimer_at_earthlink.net
- 773-343-8663
2Improving the Quality of Care to Reduce Health
Care Costs and Improve Productivity
- Estimating the Cost of Poor Quality Health Care
- Midwest Business Group on Health 2003
- Intermountain Health Care/RTI AHRQ study 2007
- Better care costs less
- Information for Iowa from the Dartmouth Atlas of
Health Care - Actions you can take
3What is it? It is an estimate of the total costs
of ineffective and inefficient processes and
procedures. Juran Institute
4Second Printing April 2003
5Estimated Cost of Poor Quality Health Care
- The Annual Cost of Poor Quality Care Per Covered
Employee - 2002 - 1,500 Direct Health Care Expense
- 400 Indirect Cost
- 1,900 Total Cost of Poor Quality
- MBGH/Juran Report - 2003
6Health Care COPQ Categories
- Overuse
- Underuse
- Misuse
- Other
- Administrative Waste
- Delays
- Service deficiencies
7Example of Overuse Antibiotics
- Problem Of 110 million prescriptions written for
antibiotics, 40 are unnecessary (17 million for
common cold). - There is a growing number of organisms resistant
to antibiotics (estimated cost is 5 billion
annual national cost to treat)
8Example of UnderuseDiabetes Screening
- 46.7 of adults age 40 and over with diabetes
received all three recommended screenings during
2004 to prevent disease complications - Rate has held constant for three years
- HbA1c test, eye exam, foot exam
- AHRQ National Healthcare Quality Report 2007 page
40 - http//www.ahrq.gov/qual/qrdr07.htm
9Example of Misuse Medical Errors
- Problem IOM report estimates that 44,000 to
98,000 deaths per year due to inpatient medical
errors - In the USA
- Half are preventable
- Medication errors alone cause 7,000 deaths per
year - Errors cost 17 to 29 billion per year (half for
direct care costs)
10- Cost of Poor Quality or Waste in
- Integrated Delivery System Settings
- Final Report
- Submitted to
- Cynthia Palmer, MSc
- Agency for Healthcare Research and Quality
- 540 Gaither Road
- Rockville, Maryland 20850
- Submitted by
- RTI International
- 3040 Cornwallis Road
- P.O. Box 12194
- Research Triangle Park, North Carolina 27709
- Authored by
- Brent James, MD, M.Stat.
- Intermountain Health Care
- 36 South State Street, 21st Floor
- Salt Lake City, Utah 84111-1486
- K. Bruce Bayley, PhD
- Intermountain Health Care/RTI AHRQ study 2007
- 122 pages with appendices
- Very technical
- Not yet published in peer reviewed journal
11Cost of Poor Quality or Waste inIntegrated
Delivery System Settings
- Overall findings
- 32 of care should not have been undertaken at
all Overuse - 35 of effort in all care undertaken is non
value-added - 56 is conservative cost of poor quality care
- 32 Overuse 24 NVA (0.35 x 68) 56
- (Does not address misuse, errors and underuse)
- Email correspondence with Dr. B. James
12Better Care
- Better care costs more
- Better care costs less
- It depends
13Eliminate Underuse
B
The Goal
A
The Industry Today
14Association between Medicare spending and quality
ranking -- U.S. States
Iowa
Wisconsin
Illinois
Baicker and Chandra, Health Affairs, web
exclusives W4-184, 7 April, 2004
15- Dartmouth Atlas of Health Care2008www.dartmou
thatlas.org
16Atlas Categories of Services
- Effective care Evidence-based services that all
patients should receive. No tradeoffs
involved. Acute revascularization for AMI - Preference-sensitive care Treatment choices that
entail tradeoffs among risks and benefits.
Patients values and preferences should
determine treatment choice. CABG for stable
angina - Supply-sensitive services Services where
utilization is strongly associated with local
supply of health care resources frequency of
MD visits, specialist consultations use of
hospital or ICU as a site of care
Wennberg, Skinner and Fisher, Geography and the
Debate over Medicare ReformHealth Affairs, web
exclusives, February13, 2002
17Dartmouth Atlas Websitewww.dartmouthatlas.org
18Total Medicare Reimbursements per Enrollee (Part
A and B) (2005)Midwestern Hospital Referral
Region Rates (HRRs)
City Name State Rates
Chicago IL 9262.14
Mason City IA 6902.78
Dubuque IA 6889.93
Waterloo IA 6619.47
Minneapolis MN 6442.21
Madison WI 6440.14
Sioux City IA 6379.04
Rochester MN 6375.67
Davenport IA 6258.47
Portland OR 6257.68
Salt Lake City UT 6180.15
Cedar Rapids IA 6043.52
Iowa City IA 5930.74
La Crosse WI 5581.97
19Chicago HRR Inpatient CareMedical and Surgical -
2005
20Des Moines HRR Inpatient CareMedical and
Surgical - 2005
21Des Moines and ChicagoSide by Side
22Studies comparing regional differences in
spending and the content, quality, and outcomes
of care
23Relationships between inpatient reimbursements,
volume, and price of care among chronically ill
patients during the last two years of life
(2001-05)
24Persistent Intensity Patterns
- the amount of care given to patients early in
the two-year period preceding death was highly
correlated with the care intensity during the
last six months of life for each individual
hospital. 2008 Atlas Executive Summary page 11
25Dartmouth Atlas Hospital Specific Data
- Medicare enrollees who died with two or more
admissions to the same hospital in a two year
period (2001-2005) - Enrollees with one or more of the following nine
chronic conditions - Congestive Heart Failure, Chronic Lung Disease,
Cancer, Coronary Artery Disease, Renal Failure,
Peripheral Vascular Disease, Diabetes, Liver
Disease, Dementia
26Hospital Care Intensity IndexIowa Hospital
Referral Regions (HRRs)
- Hospital Care Intensity Index
- The HCI is based on two variables
- the number of days patients spent in the
hospital and - the number of physician encounters (visits) they
experienced as inpatients. - It is computed as the age-sex-race-illness
standardized ratio - of patient days and visits. For each variable,
the ratio of a - given hospitals utilization rate to the national
average was - calculated, and these two ratios were averaged to
create - the index. States, regions, and hospitals with
high scores - on this index used inpatient care much more than
those - with low scores. The HCI for regions and
hospitals was converted - into a percentile score calculated according to
where - that region or hospital fell in the ranking of
all regions and - hospitals for which we had an index estimate. We
have calculated - the percentile ranking so that approximately 1
of - the hospitals in the database fall into each
percentile. - Page 110 of 2008 Atlas Report
27- Hospital Care Intensity Index
- Des Moines HRR
28Dartmouth Atlas of Health Care Iowa Area Hospital
Care Intensity Report For Iowa Health Buyers
Alliance October 15, 2008
29Iowa Area Hospital Care Intensity Report
- Performance Measure Categories
- Spending
- Intensity and Utilization
- Capacity
- Quality
- 53 hospitals measured in the report
30Iowa Area Hospital Care Intensity Report
- Five Regions
- Des Moines and Central
- Sioux City and Northwest
- Iowa City and Northeast
- Quad Cities and Southeast
- Omaha/Council Bluffs and Southwest
31Iowa Area Hospital Care Intensity Report
- Data in Four Sections
- State Area Rankings
- Regional Rankings
- Sample Hospital Profiles
- Consumer Reports Website Atlas information
32(No Transcript)
33 Section 1 State Area Ranks
34(No Transcript)
35(No Transcript)
36(No Transcript)
37(No Transcript)
38- Section 3
- Hospital Profile
- Performance compared to national percentiles of
all hospitals
39- Section 3
- Hospital Profile
- Performance compared to national percentiles of
all hospitals
40- Section 3
- Hospital Profile
- Performance compared to national percentiles of
all hospitals
41- Section 3
- Hospital Profile
- Performance compared to national percentiles of
all hospitals
42- Section 3
- Hospital Profile
- Performance compared to national percentiles of
all hospitals
43Making Hospital Intensity Data Useful for
Patients and Consumers
- 2008 Dartmouth Atlas Chapter 4Los Angeles, CA
case studywww.dartmouthatlas.org - Consumer Reports July 2008Too Much
Treatment? article and Website
www.consumerreports.org/health/doctors-and-hospita
ls/hospital-home.htm
44Long Beach, CA2008 Dartmouth Atlas Chapter 4
45Medicare spending, resource inputs, and care
intensity among hospitals in Long Beach, CA
46Consumer Reports Compare Hospitals for Chronic
Care page www.consumerreports.org/health/doctors-
and-hospitals/hospital-home.htm
47Consumer Reports Compare Hospitals for Chronic
Care page www.consumerreports.org/health/doctors-
and-hospitals/hospital-home.htm
48Actions you should take
- Compile your data
- Claims data from your carriers on cost and
quality problem drivers. Estimate cost of poor
quality - Dartmouth Atlas www.dartmouthatlas.org
- AHRQ NHQR and State Snapshots http//statesnapshot
s.ahrq.gov - Commonwealth Fund State Scorecard data
www.cmwf.org - Health Plans HEDIS measures
- Local Coalition information IHBA and HPCI
- NBCH eValue8 health plan performance survey
www.nbch.org
49Actions you should take
- Work with coalitions, carriers and consultants to
identify interventions that should have positive
ROI for identified problems - Publish data for use and education of employees
and the public - Work with carrier/health plan to pioneer payment
incentives for providers and benefit incentives
for covered populations - Educate employees and the public to avoid errors
and to self-manage chronic conditions - Join with other public and private employers to
share problems identified in your/their
data/experience and the work of implementing
interventions at the community level.
50The New York Times 6/14/07Reed Abelson
- In Health Care, Cost Isnt Proof of High
Quality - Pennsylvania Health Care Cost Containment Council
Report Cardiac Surgery in Pennsylvania 2005
www.pch4.org - Heart bypass surgery payments to hospitals vary
between 20,000 and 100,000 - Comparable length of stay and mortality rates for
high and low-paid hospitals - Two of highest paid hospitals had higher than
expected death rates. - One of the best performing hospitals was paid an
average of 33,549 less than half of the 80,000
average for the 60 hospitals studied - Certain payers are paying an awful lot for poor
quality Marc Volavka, Executive Director,
Pennsylvania Health Care Cost Containment Council