- Posted by Kate McGinley
- On January 27, 2020
- 0 Comments
This week, we take a look at the problem with trying to eliminate, or reduce, variation, and some thoughts about what physicians can do to educate others about why this approach is problematic. If you missed the early posts in the series, discussing why variation elimination is limiting, why initiatives to reduce cardiovascular care variation fall short, and the importance of the uniqueness of each patient, catch up using the link.
Reducing Variation Consumes Valuable Healthcare Resources, and has Low Impact
Despite the incredible volume and velocity of healthcare data, most physicians are still struggling to get data-driven answers to their questions. It is not uncommon for a simple question of patient counts to take weeks, or even months, to answer. Oftentimes, tying patient outcomes to physicians requires a massive, months-long effort, in collecting and refining data, and the final product still doesn’t reflect the realities of those patients: some are sicker than others. Variation initiatives are often managed with this kind of data, resulting in, at best, short term changes that produce incremental results. While tens of millions of dollars may seem like significant savings, in organizations with budgets in the billions, those returns, once reduced by the cost of the variation program, amount to less than single digit percentages.
Even worse, some variation-reduction programs could harm patients. Sure, device X is 10% of the cost of device Y, but if device Y performs better in female patients above 60 with a history of hypertension and have a pacemaker, shouldn’t those patients have access to device Y? If organizations implement variation reduction programs without looking at this kind of nuance, they are doing their patients a disservice. Faced with this reality, many physicians bristle at participating in variation elimination work, and friction is created in the organization: the physicians can’t access the data to prove their point, and administrators question the need for keeping expensive devices in supply stock. The questions are left unanswered, agreement is not reached, and frustration continues, with patients none the wiser.
So what can physicians do to change the conversation, and push their organizations to support them in asking, and answering, the real question, which is “How do I bring all of the best possible practices to every one of my patients?”
Solving that problem requires a collaborative, performance-oriented approach. Instead of fighting variation, we can embrace it in an effort to learn from the best practices. Best practices for physicians don’t have to be limited to just procedures or other condition treatment modalities. Physicians can and should be able to quickly and continuously access the answers to best practices in the following areas:
- Performance — Asking physicians to change what they do, without being able to answer how they are doing, is fundamentally unfair. If a physician is already at the lowest limit of blood product utilization, given their specific cases, should they be instructed to lower the amount of blood products used, or reprimanded for their usage? We hope the answer is no, but we recognize that with variation reduction programs, the answer is almost invariably, “yes”.
- Practice — Every physician wants to practice to the best of their abilities. Often, getting data to understand what practice patterns produce noticeably better outcomes, or how each physician can optimize their own practice falls well behind standard reporting on the priority list. Much of that reporting, too, is about variation. How can doctors possibly improve their practice if they can’t get the data to do so?
- Outcomes — Every physician we know cares deeply about patient outcomes, and when they talk about those outcomes, they consider quality, cost, and patient experience. While a range of digital health vendors have emerged to help with some of these outcomes, no one else gives physicians the comprehensive, 360-degree view of outcomes in one place.
At Biome, we’re driven to enable physician performance, and we’ve designed a cardiovascular performance cloud that enables physicians to answer their questions about their performance, practice, and outcomes quickly, accurately and repeatedly by powering the cloud with a knowledge network:
- Give Every Physician the Ability to Ask the questions they need answered and the correct data and analytics needed to accurately answer their questions
- Find the best practices that stem from the natural differences in patient populations, costs, and performance
- Highlight these best practices with unprecedented speed and accuracy [months waiting for publication vs. immediate socialization of best practices, including many the physicians themselves didn’t even know they exhibited]
- Understand what powers the results—why do those best practices achieve results, and what population populations do those best practices apply to?
- Collaborate to bring those best practices into the operating rooms, cath labs, and clinics of every other physician that can benefit from them.
If, on the other hand, a physician notices performance that they would like to improve, our engagement experts help physicians understand the root causes of performance gaps, ask the right questions to understand how they can improve, and help coach, based on what has worked with other physicians in the same situation. We continue to help monitor and manage performance, so that it never drops off, and positive changes become new, permanent ways of working.
Reducing costs and improving quality doesn’t have to be the difficult sojourn so many variation programs make it seem to be. Rather, a new approach, rooted in performance, collaboration, and learning, has proven results at leading heart institutes across the country.