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American medicine seems to be based on the notion that more tests mean better health care. But a 4-year-old federal project is finding success – including better outcomes and cost savings – with a different strategy.
Three Charlotte-area hospitals participating in the program recently received cash awards for consistently meeting nationally recognized standards of care when treating patients in three categories: heart disease, pneumonia, and knee and hip replacement surgery.
Gaston Memorial Hospital in Gastonia, Stanly Regional Medical Center in Albemarle and Cleveland Regional Medical Center in Shelby are among 250 hospitals in the “pay-for-performance” project, sponsored by the Centers for Medicare and Medicaid Services.
The idea behind the project is to give financial incentives to hospitals for consistently providing routine treatments and follow-up care for patients with common chronic illnesses that account for high health costs. There are measures, such as prescribing a daily aspirin to prevent heart attacks, which should be routinely performed to achieve the best results. Hospitals are evaluated on whether they cover every measure with every patient at every encounter.
For meeting its goals, Gaston Memorial will receive $204,000 this year. The other two hospitals have not published their award amounts.
In this fourth year of the project, one patient who benefitted is Florence Carson, a 64-year-old Gaston resident with congestive heart failure.
Carson was in and out of Gaston Memorial seven times between October and February, almost once a month, because of breathing problems caused by the accumulation of fluid in her body.
But since February, she hasn't been back.
Carson and hospital officials say the change is the result of education and assistance she received from doctors, nurses and clinical specialists focusing on routine quality measures as part of the pay-for-performance project.
Among other things, they instructed Carson on the importance of weighing herself daily to monitor fluid accumulation, a signal that she needs a change in her medicine dosage. Rather than simply telling her what to do, the staff made sure it was easy for Carson to comply by providing a digital scale that accommodates her wheelchair.
“We're staying home, and she's doing much better mentally and physically,” said Carson's husband, Buck. “It's just been a much better experience since we got those scales.”
Repeat visits to the hospital, a common problem for heart-failure patients, not only diminish quality of life but add to the cost of health care.
By following evidence-based standards for treating heart failure, Gaston Memorial has reduced re-admission of heart failure patients significantly. For example, in 2005, 7.7 percent of heart-failure patients were re-admitted to the hospital within 30 days of discharge. This year, that rate is down to 3.7 percent. Deaths from heart failure have also decreased, from 4.9 percent in 2005 to 1.6 percent this year.
“You would hope this is happening across the nation, but you will find that is not always the case,” said Jan Mathews, director of clinical performance improvement at Gaston Memorial. “Different physicians and different hospitals don't practice the same. You don't get that same standardized care.”
Although the project focuses on quality, not cost savings, the consistent application of evidence-based care saves money, too, said Susan DeVore, president of Premier, the Charlotte alliance that administers the project. “You're not trading off cost for improved quality and safety. The two move together.”
Data from the project's hospitals show that in the first three years, 70,000 lives and $4.5 billion were saved because of fewer complications, shorter hospital stays and fewer re-admissions.
As lawmakers debate health care reform, they could take a cue from this project and change incentives for hospitals and doctors. Instead of getting paid for ordering more tests and procedures, they should be rewarded for routine care that is proven to work. It could save lives and money.
Karen Garloch: 704-358-5078
