Medicare

UConn Health Works to Reduce Complications, Costs In Common Procedures

illustration of a nervous man from the Operation Board Game receiving a partial large intestine transplant. Illustration by Yesenia Carrero / UConn-University Communications


Just seven procedures account for most of the costs and complications of emergency surgeries in the U.S. each year, according to a study in The Journal of the American Medical Association April 27.

UConn Health’s surgeon-in-chief Dr. David McFadden is not surprised. These seven procedures are some of the most common, including gallbladder and appendix removal, and it makes sense that the most common surgeries are also responsible for most of the costs. And since UConn Health is on a constant quest to provide the best care possible, the surgery department was already working on some of the issues discussed in the study.

Just seven procedures account for most of the costs and complications of emergency surgeries in the U.S. each year.

For example, UConn Health participates in the National Surgical Quality Improvement Project (NSQIP), a service that tracks surgical complications such as infections, strokes and heart attacks, and alerts the surgeons to patterns. Catheter-associated urinary tract infections are one such common complication that happens in hospitals across the country. UConn Health surgeons decided that they would no longer accept that.

“We have started a focused, all-out war on catheter-associated urinary tract infections,” says Dr. Stephen Lahey, chief of the Department of Cardiothoracic Surgery and vice chair of quality improvement in the Department of Surgery. The NSQIP data has shown that there are subsets of patients who are much more likely to get urinary tract infections. The surgery department now focuses on those patients and has significantly reduced this type of infection. Reducing post-operative pneumonia in vulnerable populations is the department’s next project, Lahey says.

UConn Health’s work in this area is part of a national focus on improved population health care that stems from the passage of the Affordable Care Act, commonly known as Obamacare. Medicare has begun listing surgical complications that should happen rarely or never, and will lower or deny reimbursement to hospitals where they commonly occur. Private insurers are following suit. This can be a potent incentive for hospitals to support what medical personnel want to do anyway: find and reduce or eliminate the sources of complications.

“While lowering or denying reimbursement for certain patient events such as hospital readmission is a powerful incentive for hospitals to minimize their occurrence, we must never lose sight of the primary reason we do this — providing the best and most appropriate care to our patients,” Lahey says.

The main goal, he says, is “to alleviate suffering and improve the health of the population we serve. If we do that well, the finances will take care of themselves.”

How Should Medical Providers Prepare for Value-Based Care?

Q&A with Dr. Andrew Agwunobi, chief executive officer & executive vice president for health affairs at UConn Health

UConn Health University Tower

Q

What exactly is value-based care?

Value-based care means that future health care payments to medical providers by patients, insurance companies, and governmental agencies will most likely be formulated using a combination of key high-quality care metrics of each hospital’s or doctor’s office’s performance, along with an average of state or national health care service costs.

Medicare has indicated that by 2018 it will move to a value-based payment model. It is anticipated that commercial payers such as insurance companies will follow suit. Failure to provide value-based care in the future will potentially result in decreased payer reimbursements, financial penalties by the Centers for Medicare & Medicaid Services (CMS), and a shrinking number of patients using a medical provider’s services.


Q

How can medical providers best adapt to this new growing trend?

All medical providers, small and large, need to ensure delivery of health care is as cost-effective as possible, and is truly improving patients’ experiences and outcomes. Providers need to implement quality improvement initiatives, track them closely, and make sure key clinical quality metrics are measured and met. But they must also focus on improving the “value” of care, contemporarily defined as health outcomes achieved per dollar spent.

To meet these new expectations and to remain competitive, many health care providers across the nation have been joining or creating accountable care organizations (ACOs). An ACO is a voluntary collaboration of doctors, hospitals, and other health care providers who coordinate care and adhere to quality and efficiency standards in order to provide the best patient care at the most affordable cost possible.


Q

How is UConn Health preparing for value-based care?

UConn Health recently completed a successful large-scale, aggressive cost and savings initiative that is yielding ongoing annual operating and financial efficiencies. Now to remain even more competitive and provide great care at the best cost, we are currently looking at creative affiliation opportunities. We are exploring joining one or more existing ACOs in Connecticut at a leadership level. Our goal is to increase patient access to health care, while improving quality of care and our patient outcomes, and reducing the costs of achieving such good outcomes for our patients.

As part of our efforts toward value-based care, this spring we will begin the implementation process for a new, integrated electronic medical record (EMR) system called Epic. This is a nationally recognized clinical documentation system with the functionality and the capability to integrate all of UConn Health’s patient information across clinical care locations, physician offices, and medical providers into one accessible database.

This EMR will allow the sharing and receiving of the latest medical history of patients being cared for both at UConn Health and at other institutions, while providing our clinicians, researchers, and educators with a state-of-the-art clinical platform to support their ongoing missions. This EMR endeavor will enhance high-quality and cost-effective health care delivery for our patients and people of our region, and will allow for increased population health management.