Let’s Do Something About Health Care Costs
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For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care. In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and infections, along with significant improvements across many care standards for a wide range of surgeries that were done using the tool. And yet the take-up rate on this tool — which is so simple it fits on one single sheet of paper — is very slow to occur.
On some level, I just don’t get it. There are task forces, committees, commissions, and councils all over America that are working on the cost/quality problem — and here we are — with a proven, simple tool that reduces cost and variation and improves quality and safety — and we can’t get it adopted. The “advocates” don’t call for the adoption of checklist tools. The policy making community isn’t demanding them. Health plans, including this one, have been slow to move, and so has the provider community. Why?
The truth is, I don’t know why, but I suspect the tool is simply too simple. People in health care — and I include myself and my colleagues in this category — think everything in health care is complex, so when someone comes along with a simple tool that does all the things a checklist can do, we simply don’t buy it — literally or figuratively. This bums me out. Maybe some smart policymaker will come along and grab the bull by the horn and make it happen through regulation or legislation. Then we can stop talking about what we’d like to do about cost and quality, and maybe talk about what we did.
Charlie,
This group of advocates have been calling for checklists for awhile now.
We blogged about it over and over again - for example here (”Hospitals incorporating the ‘checklist’ pioneered by Dr. Peter Pronovost of Johns Hopkins have reduced their infection rates by as much as 78 percent… How many hospitals in Massachusetts are using the checklist? How many are thinking about it? Is anyone keeping track? Is anyone asking?”); or here (”I had learned that a consortium of Michigan hospitals had succeeded in reducing the rate of certain kinds of hospital infections to zero. I had no idea the key innovation tool they employed was a ’stupid little checklist’ … In the future, when we hear how difficult and challenging it is to improve patient safety, infection rates, mortality, and the like, there’s a new retort — have you tried using a checklist?”).
Can’t HPHC refuse to pay any hospital that doesn’t plan to implement a checklist? Give them a deadline. That would get their attention more than blogs, committees and task forces.
Brian Rosman
Health Care For All
Charlie - Why doesn’t HPHC publish which of its network hospitals have ICUs actively using a checklist? No reason you can’t make this information public and cause the hospitals that don’t currently use a checklist to justify to their patients why they don’t.
Brian - if you and I both think this is such a good idea, how did the two of us let a whole year of discussion about health care cost control and quality improvement go by without advocating for checklists as part of the recently enacted legislative package? I didn’t. Shame on me. I won’t make that mistake next year. How about you?
Sean and Brian - I think you both raise an interesting disclosure issue - which I’ll process with folks at HPHC a bit and get back to you on. Interesting idea. And by the way, there’s no reason the DPH or the Health Care Quality and Cost Council couldn’t do the same thing for all providers in MA.
Charlie — I think regulators could do more to require hospitals to report data regarding infection rates, risk adjusted mortality rates and 30 day readmission rates publicly on a user friendly website so both patients and doctors could access the information quickly and easily. Hospital leadership, for their part, should create a culture which values both high quality care and sound processes and that empowers nurses and techs to speak up when they see something wrong without fear of being intimidated or punished by doctors (especially surgeons). Finally, if insurers know that some hospitals clearly perform worse than others on metrics like infection rates, risk adjusted mortality and 30 day readmissions, those hospitals could be placed in a second or third tier which would require patients to pay more out of pocket if they receive care there.
I have a different take on why good ideas like checklists and other best practices aren’t adopted. I call it “Smart People’s Disease.” Smart people tend to think they’re, well, smart. If there’s a good idea, they would already have had it. Besides, you’re not them and you don’t do what they do, so you couldn’t possibly have anything worth hearing. It’s a lack of humility and flexibility.