The kinds of projects that were commonplace several years ago—those that were “agnostic” about cost—are fading away, Wachter says, replaced as organizations look at cost as a primary, or at least a secondary outcome.
Not surprisingly, budget-strapped hospitals are looking closely at issues like readmissions, but they're also directing their attention toward curbing high-cost, low-value tests and services.
Those efforts have been buoyed by initiatives such as Choosing Wisely, a collaborative effort sponsored by nine medical societies to identify commonly ordered but often unnecessary tests and procedures, Wachter says.
“These days, a project that improves quality by a smidgen but doesn't improve cost will lose to a project that keeps quality where it is but reduces cost by 10%,” Wachter predicts. “That might not be fair, but as departments become increasingly integrated, I think that's what we'll see.”
That integration brings its own set of challenges, too, as hospitals ponder how best to share financial data across departments and how to divide staff among projects.
“Organizations, including my own, struggle with that crosswalk,” he says.
Maureen Bisognano, president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement, echoes Wachter's predictions.