I’ve been browsing through what is definitely the largest Grand Rounds I’ve ever seen – Nice work, Dr. Jacqueline! Most of us healthcare bloggers are frequently harping on the idea of needing to reduce healthcare costs, but concrete ideas are harder to come by. An article in Grand Rounds by Nicholas Fogelson of Academic OB/GYN is definitely worth reading, and the concept he’s come up with could be implemented in lots of aspects of healthcare.
His idea in a nutshell: Put a digital board in every OR in the country that can keep track of the cost of the current surgery in real time so that the surgeon can see how much he’s spending. Apparently there are a lot of medical/surgical instruments that are disposable, single-use items. There are also non-disposable versions available, which add less cost to the surgery. Dr. Fogelson notes that there is currently little incentive for surgeons to utilize the less-expensive equipment, and some might not even be aware of how much the higher-priced equipment adds to total cost of the surgery. But he points out that we could appeal to the competitive nature of surgeons everywhere by comparing costs for the same surgery performed by various doctors. And if the doctors could see their tally increasing in real time during the surgery, they would be more likely to make cost-saving choices as they go through the procedure.
I love this idea. I think it would also be helpful to include patient outcomes (re-hospitalization data, success of the surgery, patient satisfaction, etc.) along with the cost data when comparing surgeries. It’s possible that the higher-priced surgeries have some level of improved patient outcome, but it’s also very possible that surgeries could be just as successful while also curtailing costs. Without a quantitative analysis, we can only speculate.
As someone who strives to avoid disposable products as much as possible, I also applaud the eco-friendly nature of permanent instruments over their single-use equivalents.
This idea makes me wonder what other aspects of healthcare could benefit from a similar sort of system. Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.