[This week's blog post borrows heavily from a recent blog post written by Dr. Gregory Sorensen, CEO of Siemens Healthcare - http://blogs.hbr.org/2014/01/to-cut-health-costs-focus-on-the-first-minutes-of-care/.]
We've all heard the expression - "time is of the essence". But a recent blog post I came across (see above) compelled me to share with my readers the incredible application of this expression to the health care industry. Not only does effective triage and initial diagnosis portend better outcomes, it also has a significant impact on efficiency and costs. And let's face it…at a time when health care consumes nearly a fifth of our nation's gross domestic product (GDP), finding ways to cut health care costs is critical.
So it got my attention when Dr. Sorensen reported in his blog that - "It is in the first 15 minutes of a medical encounter that up to half of all medical costs are set in motion. Placing this in a dollars and cents perspective, nearly $1.4 trillion is impacted by what happens in less time than it takes to listen to Led Zeppelin's "Stairway to Heaven". Coincidentally, 15 minutes is also the average amount of time a primary care physician spends with a patient.
The Institute of Medicine found that between 20 - 50 percent of health care spending is either wasted or unnecessary. Perhaps more compelling is the fact that studies show that much of this inefficiency is directly attributable to care that never should have been provided, primarily due to incorrect diagnosis. In short, what happens in that first 15 minutes is extremely important. Driving this point home, Dr. Sorensen provides the following observations:
- Diagnoses that are missed, wrong or delayed affect an estimated 10 to 20 percent of cases, numbers much greater than drug errors or surgery on the wrong patient or body part;
- As far back as 1991, the Harvard Medical Practice Group study found that diagnostic error accounts for 17 percent of preventable errors in hospitalized patients, while autopsy studies covering four decades reveal that nine percent of patients experienced a major diagnostic error that went undetected while they were alive;
- A 2012 study found that 40,500 people die each year due to fatal diagnostic errors in U.S. intensive care units, nearly equal to the lives taken annually by breast cancer;
- In a review of 25 years of U.S. malpractice claim payouts, from 1986 through 2010, researchers at Johns Hopkins found that diagnostic errors—not surgical mistakes or improper medication—accounted for 35 percent of total claims, generated payments of nearly $39 billion and resulted in death or disability almost twice as often as other error categories;
- A 2009 report published in the Journal of the American Medicine Association found that diagnostic errors account for 40,000 to 80,000 hospital deaths in the U.S. each year, with errors of diagnosis being the most common, the most costly, and the most deadly form of medical error;
- A recent commentary on a Texas VA study as reported by Kaiser Health News estimates that “with more than half a billion primary care visits annually in the United States . . . at least 500,000 missed diagnostic opportunities occur at U.S. primary care visits, most resulting in considerable harm.”
To better address this challenge, Dr. Sorensen offered the following four ideas:
- BETTER COORDINATION OF CARE - The Affordable Care Act endeavors to change the way health care providers are paid, moving away from quantity of care to quality of care.
- TECHNOLOGY - Studies have linked the use of software to better diagnosis and treatment protocols, resulting in significant reductions in hospital stays.
- RESEARCH - Innovations that improve pathology result in more correct diagnosis and treatment which again, reduce costs.
- BETTER BASELINES - Shockingly, not a single hospital in the U.S. tracks or counts diagnostic errors. Doing so would allow for the establishment of relativity's that would no doubt result in the prevention of errors.
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