Efficiency can make health care better and cheaper

Austin American-Statesman, May 11, 2011

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If corporations producing commodities like TVs, microwaves and cars can make better products and save money by eliminating waste and increasing efficiency, so can health care.

There’s a little history leading up to Health and Human Services Secretary Kathleen Sebelius’ visit to Austin last week. It began in 1999, the year that health care across America woke up.

Sebelius’ visit coincided with the 12th anniversary of a report by the Institute of Medicine that upward of 100,000 people die in any given year from medical errors in hospitals. As if the 1999 data weren’t bad enough, a prestigious study published last month indicated that the number might be 10 times that much, with one-third of patients incurring illness or injury while in the hospital.

The Centers for Medicare & Medicaid Services’ stark, dark data show that the agency spent $4.4 billion in 2009 on care for patients harmed in hospitals and another $26 billion on patients who were readmitted within 30 days.

Enter the Patient Protection and Affordable Care Act. Its cumbersome name denotes what it is intended to do — protect patients, hold providers accountable and make health care affordable. The law intentionally left the job of cutting costs to the professional clinicians in the field.

The first year focused on insurance company reform. The second year zeroes in on clinical practice. That’s where the talents of President Barack Obama’s pick to head CMS, Dr. Donald Berwick, come in.

Berwick founded the Institute for Healthcare Improvement and over two decades enlisted thousands of hospitals worldwide to test and identify best practices for patient safety and to ensure their broadest possible adoption.

Sebelius has visited several sites that adopted Berwick’s model. She visited a hospital in Seattle for preventing patient falls and bed sores and a community in Ohio for preventing infection in children.

She visited ICUs in Michigan that used a simple checklist famously chronicled in “The Checklist Manifesto” written by Atul Gawande, a surgeon at Brigham & Women’s. Given the enormous potential for human error in such complex care, adopting a checklist including the simplest things like hand washing and donning sterile gloves, turned out to be enormously effective. In the first year, the Michigan hospitals reduced infections by two-thirds, saving 1,500 lives.

Sebelius came to Austin to learn about the Seton Family of Hospitals’ successes in patient safety. She learned of the nurse-led initiative that virtually eliminated bed sores, ranking Seton first internationally. She learned how major reductions in infections were achieved. She learned how University Medical Center Brackenridge achieves the national standard of restoring circulation in 90 minutes after an acute heart attack — 100 percent of the time.

The biggest draw for Sebelius, however, was to see how Seton dropped its birth injury rate to zero. Partnering with IHI, Seton nurses and doctors developed a bundling of best practices for obstetricians: no elective induced births before 39 weeks gestation and limited use of the drug oxytocin to shorten labor and of vacuum extraction of the baby.

Of interest to Sebelius was the saving in government spending by preventing birth trauma. In 2003, when the safety initiative began, Seton billed Medicaid $500,000. In 2009, Medicaid was not billed at all.

During her visit, Sebelius introduced Partnership for Patients, an initiative begun last month with Berwick’s design. The $1 billion government investment targets hospitals to help them learn about and implement proven methods to improve care. The partnership is expected to avoid millions of unnecessary medical injuries and complications and thousands of deaths. It is also expected to reduce Medicare costs by $50 billion over the next decade.

Her visit also coincided with the release of a federal rule to take effect in 2013. It will reward better-performing hospitals with commensurately higher incentive payments. Government will reverse economic incentives from quantity to quality of care.

Berwick, a recess appointment, might not be long for public office. He has been a target of political criticism and is not expected to win Senate confirmation to remain in his seat past 2011. Hopefully, his legacy of innovation for patient safety will continue. Through public office, his model to change the way health care is delivered represents the government’s first serious attempt to address patient safety.

Given the number of deaths, health care needs to view itself as an industry just as complex and high-risk as the airline and nuclear energy industries — both of which use checklists.

If corporations producing commodities like TVs, microwaves and cars can make better products and save money by eliminating waste and increasing efficiency, so can health care. Most Americans can afford a TV, but no uninsured American can afford health care.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.