Cost/Value efforts already having an impact on clinical units

 John D. Roberts (left), MD, director, Adult Sickle Cell Program, recently discussed reduced length of stay on 6-7 with Jack Gorero, RN, patient service manager, and Kathleen Kenyon, RN, director, Medicine Nursing Services.
John D. Roberts (left), MD, director, Adult Sickle Cell Program, recently discussed reduced length of stay on 6-7 with Jack Gorero, RN, patient service manager, and Kathleen Kenyon, RN, director, Medicine Nursing Services.

For the past few months, leaders and employees of Yale New Haven Health System have made their opinions known to federal and state legislators about how proposed budget cuts to hospitals and healthcare providers will negatively impact patient care. If the current state budget passes, Yale-New Haven Hospital expects to have to absorb cuts of nearly $150 million over the next two years.

However, even before cuts were proposed as part of the Governor's state budget, Yale-New Haven was working hard to drive down the cost of the care it provides.

Last year, in advance of the hospital's purchase of the Hospital of Saint Raphael and in anticipation of federal budget cuts, YNHH initiated a Cost and Value Initiative that will lead to better quality outcomes while reducing up to $125 million in unnecessary spending each year for the next four years and beyond.

"Improving clinical quality is at the very heart of what we are working to achieve through our Cost/Value Initiative," said Richard D'Aquila, president and COO. "Simply stated, our goal is to enhance our quality of care while we drive down the costs associated with that care."

To achieve the cost savings that will help the hospital weather this challenging environment, it is working in these areas to affect change:

  1. Workforce productivity: take a broader, more YNHHS view of filling open positions to assure full employment; review vacancies more carefully; improve workflow for greater employee productivity
  2. Supply chain management: use evidence and facts to purchase medical devices, general medical supplies and services for the hospital; execute more effective contractual agreements
  3. Benefit plan design: align hospital and system benefits with industry standards, locally and regionally
  4. Clinical redesign: physician-led effort to improve quality of care, eliminate unnecessary costs and over-utilization, reduce length of stay; better determine appropriate care, e.g. where outpatient care might yield better outcome for patient

Thomas Balcezak, MD, senior vice president, Safety and Quality, has been working with the three system hospitals and physicians in the Yale School of Medicine for almost two years on clinical redesign that will improve patient quality and reduce cost.

"We began by developing an interactive database that captures patient data from the three hospitals," explains Dr. Balcezak. "We can collate data on a wide variety of outcomes from avoidable complications like hospital-acquired bloodstream infections and falls with injury, to the effectiveness of expensive drug-eluting stents.

"This kind of data allows us to ask questions about how we practice and get answers about areas of variation," said Dr. Balcezak. "Using data intelligently allows us to strip out waste, find best practices and improve patient care.

"The database allows physicians to examine variation in outcomes, so that they can make decisions about practice changes that will potentially improve their patient care," Dr. Balcezak points out.

Last year, the 23-bed Sickle Cell/General Medicine Unit opened on the 6th floor of the East Pavilion — a unit new to Yale-New Haven that was the result of Cost/Value analysis. Data showed that patients with sickle cell-related illness did not receive care in a constant inpatient unit or from consistent staff.

"When these patients need hospitalization, they now come to this unit with effective protocols for their care," explained Dr. Balcezak. "Because the treatment is consistent and evidence-based, we have reduced average length of stay from eight to five days, dramatically decreased central-line bloodstream infections, and improved overall satisfaction with care."

Physicians and other clinical staff are engaged in examining other areas for process changes including the model of care for hip fractures and colon surgeries.

"We are actively combing through our YNHHS data and researching various protocols at medical centers like our own so we can determine best practices and where we stack up when we compare our outcomes," said Dr. Balcezak. "A big part of Cost/Value is standardizing care — Epic is a wonderful tool for helping with that — and taking out the variation in treatment. It is a fact of life: standardizing care helps strip out unnecessary expense and improves patient outcomes."

"Cost/Value is not about not filling positions or buying cheaper supplies," said D'Aquila. "It is the way to examine high-cost/high-tech medicine to make sure it is delivering superior care for our patients. Cost/Value will become the way we practice safe, high-quality medicine and its success is the reason patients will seek our care."