Shifting cultures

The saying goes that the most expensive piece of equipment in medicine is the physician’s pen. That may be changing as healthcare cultures evolve.

I recently heard an estimate that more than 90 percent of healthcare costs derive from physician decisions over patient care. The statement that physicians are the linchpin in the cost of care is repeated in background materials in several studies, although when I tracked down references I could not find evidence of a specific study that provided an actual figure.

But there is ample evidence that some practice patterns offer better value than others, as presenters at the MedAxiom Cardiovascular Service Line Symposium in June showed by sharing experiences and insights that helped whittle costs and improve outcomes. Michael Mack, MD, medical director of cardiovascular surgery at Baylor Scott & White Health in Dallas, described how their highly rated heart program continued to challenge itself with peer reviews, quality improvement initiatives and score cards.

Suzette Jaskie, president and CEO of MedAxiom Consulting, offered 12 features that make a service line successful, including alignment informed by evidence-based medicine. “This is the challenge in my mind for physicians to bring value to our system,” she said.

Chris Lloyd, CEO of the Memorial Hermann Physician Network in Houston, seconded that, emphasizing that a thorough vetting of opportunities such as accountable care organizations based on evidence and not guesswork may be initially time-consuming but it pays off in other ways. By concentrating on a compatible fit with primary care physicians, his organization gained access to claims data that proved to be a treasure trove for identifying cost savings and avenues for growth.

Unrelated to the symposium, physicians at Johns Hopkins Bayview Medical Center in Baltimore designed an intervention that saved $1.25 million over one year. The intervention targeted the use of cardiac biomarker testing by initiating an institutional protocol that was reinforced by the hospital’s computerized order entry system.

Increasingly, physicians appear to understand that their everyday habits contribute to the value equation by increasing or decreasing costs and quality of care. They can play a role by initiating proven approaches to add value or by supporting similar efforts.

The symposium illustrated how cardiologists and other specialists have begun to embrace a culture of accountability. Their pens—or more likely their mouse pads—have become the key to better, not more expensive, care.

Candace Stuart

Cardiovascular Business, editor