(Steve Griffin | The Salt Lake Tribune) Chris Pelt, an orthopedist at the University of Utah, center, looks on as his patient, Julie Harris, works with physical therapist Chuck Graybill Thursday, November 7, 2013.
It has been less than 24 hours since Julie Harris had her right knee replaced, and the University of Utah Hospital patient is walking the recovery ward halls.
"This is good. You’re doing great," coaxes her physical therapist with an approving nod from U. orthopedic surgeon Christopher Pelt. He predicts she’ll be discharged the next day.
Early mobility has long been documented to speed recovery, ease pain and decrease chances of complications, such as blood clots and infections, explains Pelt.
But until recently, this standard of care wasn’t uniformly applied at the U. — not because providers willfully ignored it, but because they didn’t know they were wavering from it.
A new data tool developed by the U. is helping doctors and surgical teams visualize when they stray from protocols by shining a light on the costs racked up by their patients. It’s sparking conversations about how to deliver better care more efficiently.
And though it’s less than a year old, it’s making a measurable difference, said Vivian Lee, senior vice president at University of Utah Health Sciences. Over just six months in 2013, provider teams brainstormed more than 500 strategies to streamline care, projected to save $7.1 million annually.
"There’s been a lot of press lately about charges, the price tag we stick on our services," said Lee, referring to articles such as "Bitter Pill," Time magazine’s exposé on hospital markups, such as charging $25 for a Tylenol pill.
"But the bill is just a made-up number. The true problem in health care is we don’t understand our costs," said Lee. "If you don’t know your costs, you can’t drive down health spending in this country."
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What will this cost me? » It seems remarkable, even unbelievable. Imagine a car manufacturer not knowing how much a windshield costs or a unit of labor.
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But there hasn’t been an imperative for hospitals to know, explains industry consultant James Orlikoff, known in health care circles as Dr. Doom.
"Until recently hospitals were rewarded for being inefficient, because the more inefficient they were, the more they were reimbursed," he explained, referring to the fee-for-service model that pays providers for ordering more tests and treatments.
Because charges are divorced from actual costs, some services are priced as high as the market will bear, he said, while others are reimbursed below cost, or not at all.
But consumers, employers and the government have started pushing back.
"Consumerism is being injected into health care," Orlikoff said. "People are demanding to know, ‘How much will this procedure cost me? And don’t say my insurer will cover it, because I’m now having to pay more of the bill.’ "
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‘The value equation’ » Our health system is bloated and broken, Orlikoff said. Americans spend an estimated $2.8 trillion on medical care, including $750 billion on wasteful treatments, the Institute of Medicine reported in 2012.
And medical errors are the third leading cause of death, surpassing auto accidents and diabetes and killing an estimated 440,000 in the U.S. annually, according to a 2013 study in the Journal of Patient Safety.
"My dream," said Lee, "was to create a tool that would give us outcomes against cost, because that’s really the value equation."
Working with the university’s business school and computer science experts, the U. built what Lee calls the Value Driven Outcomes (VDO) tool. The system can run each patient against 135 million rows of billing and payroll data to show the cost of every procedure, or episode of care — from gauze tape to minutes of nursing labor — and reveal differences from one U. provider to the next.
It is also able to integrate quality data, such as rates of mortality, readmissions, bleeding and infection.
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