It's a simple but troublesome truth that, as The New York Times puts it, “How much you spend on medical care depends on what you get, but also where you get it.”
And in an age when the whole medical community is pushed to increase efficiency, this reality is challenging to providers and to hospital systems. How are we to cut costs and provide high-value and high-efficiency care when costs vary not only by the care provided, but by where it’s provided, and who pays for it?
Costs of the same operation or care can vary dramatically in different places. This is due to different prices (and costs), of course, but it also has to do with the "intensity" of care.
If you deliver a baby in a teaching hospital, it costs $2,000 more (on average) than delivering at a community hospital. Part of that is because of the difference in prices, but part of it is because the "intensity" of care (number of providers, specialization of providers, services provided) is greater at the teaching hospital.
As the healthcare system struggles to provide care that is high-value for patients and efficient for providers and hospital systems, it's hard to know whether and when high-intensity care is worthwhile and when it's just, well, expensive.
So a recent study of Medicare hospitalizations -- led by Laura Burke and Ashish Jha at Harvard -- is interesting. It analyzed about 11 million Medicare hospitalizations and found that almost all patients had lower mortality rates at teaching hospitals.
But, as the New York Time synthesizes, "Among patients admitted for operations like hip replacements, the patients with the most health problems over all were the ones likeliest to benefit from a teaching hospital. On the other hand, among people admitted with conditions like pneumonia or heart failure, though all groups did better at the teaching hospitals, the difference was greatest for the relatively healthy patients." So, interestingly, the high intensity care lead to better outcomes overall, but there are situations in which the difference is not significant.
This led us to wonder whether there are ways that community hospitals or individual providers could provide the advantages of teaching hospitals, but at a lower cost, and in their care setting. As the study shows, "The more advanced technologies available at teaching hospitals explained some, but not all, of the difference. Other factors like subspecialty expertise, more clinicians involved in care, and greater availability of ancillary services may also be playing a role.”
The importance of subspecialty expertise and the inclusion of more providers in care points to the potential of healthcare collaboration, especially where supported by a tool or technology like iClickCare. If a community hospital can loop in sub-specialists that are not based at that hospital (but on their schedule, asynchronously)... and if the tool supports team collaboration in a meaningful way... it raises the question whether telemedicine-based healthcare collaboration could provide the benefits of the intense care at teaching hospitals, but at a much lower cost.
Of course, this will need to be studied on a large scale for conclusive results -- but anecdotal results from our colleagues indicate this does work. You can get the benefits of high-intensity care, but from a community hospital, at a lower cost.
Looking for a low-cost way to implement a telemedicine program? Download our Quick Guide to explore hybrid store-and-forward telemedicine: