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December 2009

If Higher Quality Care Costs Less, Why Does Health Care Still Produce Potentially Avoidable Complications? -- by Francois de Brantes, MS, MBA


For years, healthcare services researchers have maintained that there is little, if any, link between the cost of care and its quality. They drew this erroneous conclusion by using both flawed data and flawed methods of analysis.  The researchers used claims data to measure quality (flawed data because quality can only be reliably measured using medical records), and looked at total costs of care (flawed method).


During the past several years we have focused on improving our understanding of variation in the total cost of care, using defined windows of time to bound medical episodes of care.  For example, we can reasonably bound a medical episode for acute myocardial infarction within a 30 day time window, including the hospitalization of the patient and any care post-discharge during the balance of the window.  As we’ve performed these analyses, we noticed that we could split the total costs consumed during these windows of time into two components — typical or evidence-informed care (costs that are to be expected in such cases) and costs associated with potentially avoidable complications (costs that should not occur if care were delivered optimally. What we found is that these potentially avoidable costs consume anywhere between 15% and 20% of all dollars spent in the US health care system.  More importantly, we also found that higher quality providers had far fewer costs associated with potentially avoidable complications and that, as a result, their episode costs were also lower.

So if better quality costs less, why aren’t we seeing providers rush to improve the quality of care they deliver and lower overall costs? Because the way they’re paid encourages them to do the opposite. If a patient develops an infection during a hospital stay, the hospital gets more money due to a longer stay and the attending physicians bill for more services. No wonder then that health care costs are rising faster than the general rate of inflation.  And until we get the payment incentives right, it’s hard to see how we will ever achieve a high-performing health care system. The bottom line today is that what we call potentially avoidable costs, someone else in the industry is calling revenue.  That has to change.


Francois de Brantes, MS, MBA is CEO of Bridges to Excellence and Prometheus Payment, Inc.



Leapfrog Group Issues List of Top 2009 Hospitals

Leapfrog_Logo_Tagline  On December 3, 2009, The Leapfrog Group issued its annual list of "Top Hospitals."  For the first time, The Leapfrog Group added efficiency measures into the equation.  Across three categories including urban, rural and children's, Leapfrog recognized 34 hospitals, among the 1206 who participated in the voluntary Leapfrog Hospital Survey, as hitting high marks on quality, patient safety and efficiency.

Arrowsight Featured in American Medical News

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In this week's American Medical News, Kevin O'Reilly explores the various ways hospitals are attempting to conduct patient safety surveillance.  The article was inspired by new state-based plans mandating the monitoring of hand hygiene practices (Maryland) and surgeries (Rhode Island).  Arrowsight is highlighted as offering services and technology proven to be effective in measuring and improving hand hygiene practices. The Joint Commission's Mark Chassin suggests that such tools are important in trying to increase accountability for patient safety among health care providers.


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