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Value-based health care efficiency may lead to better patient outcomes
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A joint statement from the American Heart Association and American College of Cardiology identified four important attributes for measuring and publicly reporting efficiency in health care.
The “Standards for Measures Used for Public Reporting of Efficiency in Healthcare” statement presents efficacy measures that are suitable for the public as well as the care provided for the prevention or treatment of CVDs and stroke. The statement emphasizes the importance of considering a combination of costs and clinical care to understand the value delivered by particular strategies.
The four attributes mentioned in the statement: integration of the quality and cost, valid cost measurement and analysis, minimal incentive to provide poor quality of care, and proper attribution of the measure.
These attributes are relevant to a wide variety of settings, including hospitals, managed-care organizations and group practices, according to the writing group. For example, measures that capture only length of stay for a HF admission could lead to practices of premature discharge from the hospital, which is subsequently associated with a higher rate of readmission that could worsen care and increase cost, according to a press release.
“The best place to focus is where reducing costs may actually enhance patient outcomes,” Harlan M. Krumholz, MD, professor of cardiology, epidemiology and public health at Yale University School of Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, said in the release. “Measures should help us identify where we are wasting resources and assist us in tracking our performance in the interest of achieving better value in health care. Cost alone is not a good barometer for determining quality of care and efficiency.”
The standards can provide targets for intervention and focus attention on opportunities to improve, including structure and process performance measures, according to Krumholz, chair of the writing group.
For more information:
- Circulation. 2008;doi:10.1161/CIRCULATIONAHA.108.190500.
- J Am Coll Cardiol. 2008;doi:10.1016/j.jacc.2008.09.004.
This is an extremely important statement because there is wide variability in the definition of efficiency. Some definitions are pure cost control measures while other definitions are more patient-centered and include cost benefit analysis in the definition. These are not just outcome definitions but also the value of the treatment strategy for the cost expended.
This policy was written in hopes of better defining the components of efficiency that need to be considered when determining societal needs. I’m sure that this was not an easy document to write, nor is it an easy one to read. The policy identifies the importance of integrating quality and cost, a valid assessment of true cost, the removal of perverse incentives, and the appropriate attribution of the care episode. These components all interact in determining the value of an episode of care or diagnostic strategy. Risk adjustment is also a critical part of this evaluation process since the cost of similar episodes of care may vary dramatically, based on the co-morbidities. Our health care payment system currently has many perverse incentives that promote the use of increased care with little reinforcement of best care. The goal of efficiency measures is to move beyond just outcome but also determine whether the outcome obtained was worth the resources expended, i.e. value.
Finally, proper attribution of cost and benefits of care can be very difficult and might be better served by collective attribution. This, however, removes the individual from direct responsibility for efficiency and as such may make it more difficult to enforce individual responsibility from the patient to the provider and to the system improving the efficiency of care.
The complexity of these multiple interconnecting issues requires a very cautious approach in the application of efficiency which should not be interpreted as an unwillingness to be efficient but as a desire to get it right in the interest of patient care and societal benefit.
– James Dove, MD
Cardiology Today Editorial Board member