Financial and clinical pros need to collaborate

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Any separation between the financial and clinical side of the business in healthcare needs to end, contends Harlan Krumholz, MD, and that interplay needs to grow as quality initiatives become more important.

The exchange of data and increased use of analytics will grow in importance as quality initiatives take hold in emerging healthcare reimbursement approaches, such as MACRA, says Krumholz, CIO at Yale University and Yale New Haven Health.

"It’s important that the finance work doesn't get sequestered from the intrinsic work that goes on in the healthcare system,” he said during a presentation at the annual conference of the Healthcare Financial Management Association in Orlando, Fla. “In many organizations, finance became it's own country, distant from the clinical enterprise. When (financial executives) see dollars being spent that don't benefit the patient, you have to get involved.”

The interplay of finance and quality will rise in importance as reimbursement approaches move from volume to value-based care, Krumholz contends. “The continuing rise in healthcare costs can not be sustained over the long run. We can have a debate about what percent of the GDP is right to spend on healthcare, but year after year, we cannot continue to increase it. If you (as financial professionals) see the numbers don't work out, the disruption in people's lives is too great, then there's nothing that's going to work."

The use of data and analytics in healthcare has a comparatively short history. Medicine traditionally has been practiced based on clinicians best hunches, and only in the last 30 years has clinical research started to impact medical practice.

Krumholz, a cardiologist, highlighted the research focused on heart attacks in the 1980s and 1990s. It spotlighted the impact that aspirin, clot-busting drugs and early intervention could have on reducing the severity and mortality associated with heart attacks.

However, even with the evidence in hand, providers show wide variation in how they apply the information to clinical practice. For example, the clinical effectiveness of balloon angioplasty to open coronary arteries hinges on how quickly the procedure is conducted once a heart attack patient arrives at a hospital. But providers show wide variation in “door to balloon time,” with one study showing a range of 50 minutes to almost three hours among a range of hospitals.

Overall results for the industry were improved by studying what the fastest organizations were doing, and those findings have helped to speed door-to-balloon times throughout the country.

“We prevailed on the profession and their professional responsibility,” Krumholz said. “The cardiologists in my field said (the variation in practice) is not acceptable. We started getting information, and the transparency of performance was a powerful impetus. We tried to stimulate performance around competition. Without a team effort, even if the cardiologist did the best job of the world, it didn't matter. To improve, cardiologists needed the ER to be great, the EKG tech to be great, the nurses to be great.”

Finance professionals need to get involved in questioning how current clinical practice affects quality, and thus financial results. Reimbursement policy is beginning to promote this—for example, penalties for avoidable readmissions has placed renewed emphasis on applying analytics to care delivery, and that’s helped highlight the need to improve discharge management, Krumholz told attendees.

For example, myocardial imaging tends to be an expensive, and recent research has not been able to determine “any relationship between this testing and any benefit in outcomes or procedures, such as catheterization or coronary angiogram or revascularization,” Krumholz said. Financial professionals, working with clinicians, can help determine “where we can spend resources where they will do the most good, and how we can cut out what doesn't do any good. Right now, there’s no evidence of any difference in outcomes. If we're spending all this extra money, what's the presumption?"

"Medicine is increasingly an information science, and in the future, it will be a digital information science,” he added. “If there’s not enough science and then we poorly manage the information, we make bad decisions. It’s time to take stock of how we use all this data to improve medical practice.”

Information technology will play a larger role in the push to improve care delivery, he says.

“The complexity of care is increasing, which only means we need more tools to deal with the information we're getting. We’re taking data in ways we've never been able to before, and use decision support at the bedside. At Yale New Haven, we're creating data lakes, need new approaches to handle these unmanageable amounts of data.”

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