In a fee-for-performance world, we are all under huge amounts of pressure to improve our metrics.
We are expected to cut costs, drop readmissions, decrease length of stay, and even improve healthcare provider burnout.
As you probably know, we believe that telemedicine-based healthcare collaboration can dramatically improve almost every one of these metrics. But a recent study had us asking -- is there a down side?
A recent JAMA study looked at 115,245 fee-for-service Medicare beneficiaries hospitalized with heart failure at 416 sites across the United States. Then, they looked into the consequences of a Hospital Readmissions Reduction program implemented at the sites.
Happily, and as expected, implementation of the Hospital Readmissions Reduction Program was associated with a subsequent decrease in 30-day and 1-year risk-adjusted readmissions. The shocking part, however, is that implementation of the program was also associated with an increase in 30-day and 1-year risk-adjusted mortality.
In other words, people were coming back to the hospital less, but they were dying more.
This type of story -- in which we see unexpected consequences of well-guided programs in healthcare -- comes up frequently. And it's easy to adopt a kind of nihilism in the face of a study like this: nothing will actually improve the situation so why bother.
But we believe that that is the wrong conclusion. Rather, it's crucial to pioneer new initiatives to both improve care and improve our performance against metrics. But initiatives must be holistic. It's not enough to create a program that aims to improve readmissions but worsens care overall. That's why we are such advocates for telemedicine and healthcare collaboration. Initiatives like these are holistic enough that results across multiple dimensions of care are improved. On the flip side, it means that the "sell" to hospitals that have to improve in one dimension in 6 months is more difficult.
But ultimately, the only sustainable improvements are those that take care, metrics, and the whole picture into account.
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