In what former Centers for Medicare & Medicaid services administrator Don Berwick, MD, called "a breakthrough," hundreds of hospitals in a data- practice-sharing project have shown significant reductions in cost, mortality, and infections.
Some 333 hospitals are participating in the Premier Healthcare Alliance's data- and practice-sharing project called Quest. Premier's President and CEO Susan DeVore says the project has saved 92,000 lives and $9.1 billion, compared with what would be expected for its hospitals.
"What is intuitive in other industries, where if you buy something that doesn't work well it's going to cost you more in the long run, the same is true in healthcare, but people don't seem to get that," Berwick said at a news tele-conference Tuesday.
He added the Quest team has shown "as carefully as it's been done anywhere I've looked, that as quality gets better, and as the patient experience improves on the whole, costs can fall quite a bit."
"Quest is undoubtedly a breakthrough…given how interesting and how unexpectedly good the results are," and if the project goes forward outside acute care settings, "it can be a breakthrough for all American healthcare," he said.
The Quest project began in 2007, with hospitals collecting baseline data for evidence based processes of care, costs and mortality every year. It has published annual and sometimes quarterly reports with transparent data for participating hospitals that allow them to compare themselves, share solutions, initiate strategies for improvement and then measure again the following year to see what worked and what didn't.
Tuesday's report comes at the 4.5 year mark and shows that Quest has:
- Reduced the median cost per discharge by $1,110, largely from reduced supply costs by 29% and reduced labor costs by 26%. This translates to a total saving of $9.13 billion over four years "90% of the cost of the entire Medicare sequestration cut to hospitals."
- Reduced central line bloodstream infections by 59% since 2007.
- Reduced falls and pressure ulcers by 64% since 2007.
- Reduced mediastinitis after coronary artery bypass graft surgery by 58% since 2007.
- Reduced mortality by 36% compared to what was expected, given the case mix of the participating hospitals. This occurred largely because of strategies to reduce sepsis blood stream infections by 24% since 2007, and outpaces national averages. "Quest members experience mortality rates that are 10% lower than the national averages.
- Delivered evidence based care measures to heart attack, heart failure, pneumonia and surgical care patients "at least 95% of the time."
The report also mentions several case studies showing lives saved.
For example, Quest participant East Alabama Medical Center initiated a sepsis reduction project that improved care protocols and prompt interventions at the first signs of infection.
"When it works, it really has an impact," the report says. "EAMC estimates its rates have dropped 71%, saying 163 lives and more than $34 million over three years from avoided sepsis-related complications misdiagnoses and readmissions.
"If all hospitals in the U.S. could achieve the two-year results of the Quest participants, it would result in approximately 87,250 additional lives saved annually…more than the number of patients who die of Alzheimer's disease, influenza, diabetes, liver disease, hypertension or Parkinson's disease each year."
But in its 29-page progress report, Premier said that problems and challenges remain:
"Despite overall improvements, there are measures where more can be done in the area of harm. For instance, QUEST hospitals still experience variation and opportunities to eliminate harm in discrete areas such as hospital-acquired c. difficile, surgical site infections, third- or fourth-degree perineal laceration and post-op respiratory failure."
Additionally, it said, that that Quest participating hospitals only "slightly" outperform other hospitals in patient experience scores.
Even though they've overall improved by 3% since the baseline, "and maintain a 1% edge over non-participants," largely through improved nursing and medication communication strategies, "significant opportunities for improvement remain in the areas of pain management and responsiveness of hospital staff."
Another area that could see better improvement is in 30-day readmissions, where Premier says "significant opportunities remain" in the area of heart failure, chronic obstructive pulmonary disease, septicemia, renal failure, digestive disorders, antepartum diagnoses and pneumonia."
Thomas Macaluso, MD, chief quality officer for Memorial Healthcare System of South Broward, Fla., said the six-hospital public healthcare system in South Broward has been participating in Quest since 2010, with very positive results.
For example, he said, by creating dedicated heart failure units within the hospital, they've been able to standardize handoffs and assure multi-disciplinary rounding.
In a statement, Premier's DeVore says hospitals across the country should pay attention, because all of them need to reduce costs.
"Since fiscal year 2010, sequestration, loss of disproportionate share and bad debt payments, ongoing reductions to the market basket and productivity adjustments are projected to have a cumulative effect of reducing hospital payments by $250 billion over the next 10 years."
She added: "We hope this effort provides valuable information around the biggest opportunity areas, as well as effective tactics that will help hospitals better weather ongoing financial challenges."