The Number of American Deaths Due to Hospital Acquired Conditions

Since 2010, many improvements have been made to protect the safety of patients during their stay in hospitals. This has not only saved the healthcare industry billions of dollars but, more importantly, has saved the lives of over 50,000 people.

Hospital Cost Cutting — Critically Important but Short Sighted at Times?

For inpatient care, hospitals reimbursement is capped based on a patient’s disease.  CMS reimburses a set rate for each disease related group, or DRG.  Many commercial health plans follow this approach or negotiate a fixed rate for each day of inpatient care.  As a result, hospitals are cost conscious.

Hospitals look for ways to reduce costs.  For example, as Julie Weed published in the NY Times on July 9, 2010 (“Factory Efficiency Comes to the Hospital”), hospitals seek ways to improve hospital efficiency.   For example, in 2009, Seattle Children’s Hospial reduced costs per patient by 3.7 percent, for a total savings of $23 million. And as patient demand has grown in the last six years, the hospital avoided spending $180 million on capital projects by using its facilities more efficiently. It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.

The question rises whether cost reductions affect the quality of care.  Often, improvements in procedures can maintain or increase the quality of care.  Seattle Children’s Hospital spent about $20,000 overhauling the process to sterilize instruments, avoiding a $3.5 million expenditure to expand that department. More efficient scheduling in the M.R.I. department reduced the average waiting time for non-emergency M.R.I.’s from 25 days to 1 to 2. 

There is an opportunity in Illinois to address the inefficient use of CT scans.  The Chicago Tribune reported today (“New government report raises questions about CT scans at Illinois hospitals;  Scans at hospital outpatient departments under a spotlight” by Judith Graham, Tribune reporter, July 11, 2010) that federal data published on on a web site called Hospital Compare illustrates that It showed that Illinois hospitals provided double chest CT scans twice as often as did hospitals nationally in 2008. In most cases, a single scan is all that’s necessary.  Illinois’ rate of double CT scans of the abdomen also exceeded the national average.  What an opportunity to reduce unnecessary costs without sacrificing quality of care!

Not all cost savings opportunities involve sophisticated diagnostic imaging equipment or complex procedures.  Simple, relatively inexpensive devices that are used frequently can present opportunities to save costs and affect quality of care.  MedSpan recently conducted a study of tube attachment devices.  Whether for endotracheal tubes, wound drainage tubes, oral gastric or nasogastric tubes, most hospitals attach these tubes with tape.  Tape is inexpensive but requires frequent changing, which uses nursing time, and does not effectively stabilize the tube.  Unstable tubes are subject to inadvertent movement, which can lead to adverse incidents.  Tape can irritate or tear the patient’s skin. 

Special devices are available to better stabilize these tubes.  However, they are more costly than tape.  Hospitals must weigh the improvement in care and the savings in nursing time versus the greater materials cost.  In today’s challenging economic times, it can be challenging to invest in such devices to improve care in ways that are not externally measured and reported or to avoid treating adverse events, such as skin tears, that are not costly.  However, improved tube stabilization devices for central lines that can reduce costly blood stream infections are an easy financial decision for hospitals.

Hospitals are always looking for ways to reduce the cost of care and they should be.  Many exist, from enhanced use of costly capital outlays to improved inventory management to better use of relatively inexpensive but commonly use medical devices.  Always, hospitals will examine the impact on the quality of care.  Whether measured and publicly reported or not, hospitals should seek to at least maintain, if not improve the quality of care.

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