Hospitals Forge Cost Cutting Rules : Procedure Management

This sure seems like a good thing, eliminating waste by having doctors run the show and setting limits for procedures. The only thing not mentioned here is what effect will this waste management have on lawyers and how they operate when things go wrong?

Hospitals Cut Costs by Getting Doctors to Stick to Guidelines
Source: Jeanne Whalen, "Hospitals Cut Costs by Getting Doctors to Stick to Guidelines," Wall Street Journal, September 22, 2014.

September 25, 2014

Health care costs are already high -- and unnecessary procedures only add to the strain placed on hospitals and consumers alike. Many procedures get overused due to doctors' personal preferences, institutional customs, pressure from patients and doctors' desire to avoid getting sued. Yet sticking to the guidelines produced by professional societies such as the American Heart Association enabled a Delaware-based hospital group Christiana Care to cut its daily costs by 70 percent without harming patient care.

The improvements seen in Delaware follow the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign, which looks to cut clinical waste by decreasing the overuse of overkill procedures for everyday ailments. Examples of these procedures include the overuse of cardiac telemetry, MRIs for lower back pains, and imaging scans for uncomplicated headaches.
By sticking to the American Heart Association's guidelines for cardiac telemetry usage, Christiana Care:

• Cut the mean daily number of non-ICU patients monitored with telemetry by 70 percent,
• Cut the mean daily cost of delivering non-ICU telemetry by 70 percent, and
• Maintained the same level of patient care as before the movement, keeping mortality rates and "code blue" emergency calls stable.

The big difference for many doctors in the "Choosing Wisely" campaign is that the decisions are made by doctors, not administrators. "I think it's becoming increasingly accepted," said Dr. Marc Larochelle, a physician who helped implement a similar overhaul on blood tests at Johns Hopkins Bayview Medical Center in Baltimore.  Encouraging doctors to consider costs is better than "having nonmedical folks try to figure that out and push down from above changes that make less sense."