Health systems find the nexus between improved patient care and lower costs
At five Bon Secours Health System hospitals on the East Coast, giving fewer blood transfusions during heart surgeries has had some counterintuitive results: Not only did costs fall, but care improved, officials say.
"People think transfusions are good, but … the higher rate of transfusions that people get, that's associated with a longer hospital stay and a higher death rate," chief medical officer Marlon Priest says.
Bon Secours' campaign to reduce blood transfusions during heart bypass and valve replacement surgeries is part of a growing national trend to standardize care and rein in differences in how doctors and hospitals practice medicine.
Health systems, insurers and government agencies say the goal is to limit unnecessary care and save money.
"Everybody's realizing we can no longer have business as usual," says Ken Welch, chief medical officer of Banner Estrella Medical Center in Phoenix. "We have to look at things we're paying for that have questionable value and try and get rid of those things."
Many doctors are wary.
"Things I see in the (academic) literature don't play out at the bedside," says Robert McNutt, an oncologist at Rush University Medical Center in Chicago who recently cautioned against using data to drive treatment decisions in the Journal of the American Medical Association. "I don't want to treat an 80-year-old patient who is frail with chest pain the same as a 42-year-old person who has chest pain while heavy lifting on a construction site," McNutt says.
In the Bon Secours system, heart surgeons helped create new blood transfusion guidelines about three years ago at hospitals in Virginia, New York and South Carolina, Priest says. Since then, the share of heart surgery patients receiving transfusions fell to 42% from 66%, and the average amount of blood transfused dropped by nearly two-thirds, he says. The system saved $1.1 million as a result.
"The complication rate went down and the length of time people spent in the hospital went down," he says.
The movement to standardize some medical treatments is being fueled by more detailed and plentiful data that can pinpoint hospitals and doctors that are outliers. Premier, an alliance of more than 2,500 hospitals and health care facilities, maintains a database that allows members to compare themselves on clinical and financial measures.
Mounting pressures, including reduced reimbursements from publicly funded health programs such as Medicare and Medicaid, have spurred more hospitals to act, spokeswoman Amanda Forster says. "Before, doctors have not standardized because they would say, 'My patients are different. They're sicker,' " Forster says. "There was a dearth of data to prove anything to the contrary."
When Bon Secours used Premier's database to look for areas of improvement, it found several, including blood transfusions during heart surgery, Priest says.
He acknowledges that not all patients are best served by the new transfusion criteria and that doctors are still expected to use their judgment. "There will be patients that fall outside of those parameters. We accept that," Priest says. "But we shouldn't accept that there should be no standards of practice."
In the Banner Health system, which stretches from Alaska to Arizona, officials found striking differences in the use of pieces of film or fabric — called adhesion barriers — during cesarean sections.
The barriers are used to prevent abnormal scarring after abdominal and pelvic surgery, and marketers had urged them for C-sections, Banner's Welch says.
Some hospitals used the barriers during 79% of C-sections, while others used them less than 1% of the time, Welch says. When Banner analyzed the data, it concluded the barriers made no difference. "The physicians believed it made their subsequent C-sections easier. … No data, no facts. It was just their impression," Welch says.
After trying for six months to persuade doctors to stop using the barriers, the system told them it no longer would provide the product for C-sections starting this year. Banner has since saved more than $1 million and the barriers have been used in fewer than 1% of C-sections so far in 2011, Welch says.
"We have seen … no ill effect on our patients or their babies," Welch says. "One physician said, 'If it's not doing any harm, why can't I use it?' I said that's taking resources away from something else. Unfortunately, we're at a point in medicine where we can't do that any longer."