It is well-known throughout the business world that variation and a lack of standardization lead to poor quality and higher costs. The same is true in health care, whether the issue is an episode of care around a surgical procedure or long-term management of chronic disease.
Standardized care that reduces clinical variation—defined here as the over-, under-, or unnecessary utilization of healthcare services and resources—has been shown to improve quality and outcomes in the ambulatory, acute, and post-acute settings. Thus, care standardization is a vital aspect of organizational efforts to improve care under value-based contracts.
What’s at Stake
Exemplifying the importance of reducing variation, the use of protocol-driven care in the ICU has been observed to lead to a significant reduction in healthcare-acquired conditions. Although poor performance in this area partially can be attributed to issues with clinical documentation, wide variation in care exists across the continuum—especially for certain serious conditions such as the recognition and aggressive treatment of sepsis.
Clinical variation affects the value of care in other ways, including:
Costs. Unnecessary clinical variation leads to increased costs, as seen in many surgical procedures and the encompassing episodes of care. Factors that influence and elevate costs include the use of unnecessary preoperative testing, physician preference decisions that increase implant costs or extend operating-room time, and a lack of standardized postoperative care that leads to prolonged lengths of stay and inappropriate use of post-acute resources.
This failure to standardize the coordination of care has also led to unnecessary emergency department visits and hospital readmissions. The wasteful and imprudent use of diagnostic and therapeutic resources is also monitored in the ambulatory setting, and at least one vendor is offering insurers comparisons of providers using a value-of-care index.
Patient experience. Standardized care, coupled with strong provider engagement and communication, is a patient satisfier. Patients and their caregivers rely on the healthcare system to provide the “standard of care” with reliable outcomes at reasonable costs. Discussions around evidence-supported treatments allow patients to feel better informed, and such talks create a high level of trust in the proposed therapeutic solutions.
Standardized care may not always lead to desired outcomes or completely avoid complications. But the communication and reinforcement of the appropriateness of therapeutic choices will support confidence in the care team and reduce the chance of frivolous litigation.
Read the article in its entirety here. This piece originally appeared in the March 2019 issue of HFMA’s Leadership e-newsletter.
Douglas Ardoin, MD, MBA, is managing principal and John Malone is principal for Lumina Health Partners. Fill out the form below to receive a slide deck about the benefits of reducing clinical variation.