The Cost of High-Quality Healthcare
The mantra of the managed care movement of the early 1970’s, that has been resurrected and promoted as gospel, is that high-quality care will save dollars. For certain, medical mistakes or poor quality care, which result in complications, can certainly prolong or necessitate treatment, and clearly drive up cost—to say nothing of increasing patient morbidity and perhaps mortality. On the other hand, high-quality care often requires vigilance and persistence by highly trained providers, or the introduction of expensive treatments. Automatic internal defibrillators are expensive—but appropriately applied, they save lives. Heart transplantation and ventricular assist devices are expensive, but they save lives. Similarly, data demonstrates that there is an inverse relationship between readmission rates and mortality for patients with congestive heart failure. No one would object to reducing unnecessary hospital readmissions, but early or frequent readmissions do not necessarily represent unnecessary readmissions—they may actually represent high-quality healthcare. In fact, data has demonstrated that hospitals with higher costs for certain diagnoses actually have lower mortality rates. Where the balance between quality and cost will ultimately be found is not yet clear.
There is, however, one somewhat hidden and increasingly prevalent cost, which warrants attention - the cost of reporting quality. On a physician level, studies reveal that reporting quality can cost a physician or practice up to $40,000 per year per physician. On a hospital level, the mandate to participate in multiple professional society quality driven databases, as well as to comply with a seemingly endless array of quality metrics to include:
- Accountable Care Organization-driven, and
metrics are examples that present a seemingly bottomless pit of expense. Data acquisition requirements are numerous and include:
- Expert Data Abstractors
- Informatics Expertise, and
- Data Analytics
In short, a highly trained team is required to facilitate the integration of clinical and administrative information. One can readily understand the current rush for hospital and health system mergers, the mass exodus of physicians from private practice, and the growth of an entire industry of quality vendors and professionals - all in no small measure - due to an effort to accommodate the increasing burden of quality reporting. Whether or not this process will ultimately result in an improvement in the quality of care remains to be seen. What does however emerge clearly is that the reporting of quality metrics will not be cheap.