Value taking a major role

The days are numbered for lofty quality-improvement projects that don't have clearly defined price tags and projected cost savings, according to industry experts.

In a year in which cost containment and efficiency are expected to be front and center, proposed quality and patient-safety initiatives will need to spell out their expected impact on both patient care and a hospital's bottom line.

Put simply: “The department that used to be quality is now value,” says Dr. Robert Wachter, professor and chief of the division of hospital medicine at the University of California at San Francisco.

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.

In December, at the IHI's National Forum in Orlando, Fla., Bisognano said that patient-safety and quality-improvement projects will need to calculate their return on investment from the outset.

“I've heard more about controlling cost lately than I've heard in the last 20 years,” she said. “More and more, I am seeing quality-improvement projects with price tags at the bottom.”