Healthcare Efficiency and Effectiveness, a Balancing Act

This morning I had the occasion to read a new piece of legislation, titled “The ACO Improvement Act of 2014,” that was introduced barely two weeks ago. I like new stuff, especially new legislation designed to improve old legislation. Seems like there’s been more of that the last few years, especially dealing with healthcare issues, than ever before—and probably for good reason. The reason? Because of the complexity, not just of healthcare but the human animal that depends on it when old age, accidents, disease, or all three, raise their ugly heads.

The new legislation is entitled “Improvement…” for one reason. It seeks to close the perceived gap between cost and improved patient outcomes. In short, and in a limited way, the authors of the legislation want an even closer—if not perfect—fit between efficiency (lower cost) and effectiveness (better patient outcomes).
Improved Healthcare Efficiency
The question is, “Is that possible?” Maybe, but not without doing two things – (1) limiting patient options to predetermined and approved sources and treatments, and (2) only rewarding those organizations that achieve or exceed stringent standards (quality) of care. This is especially true in the case of the movement toward the two-sided risk model.

So, why is a healthcare simulation software provider concerned with such legislation? Good question. I’ll try to give you a good answer.

Although there are many sides to the definition of “quality” within healthcare, not all are necessarily quantifiable or reflective of every patient outcome. Those that are, however, almost always have a measurable, cost-based effect. For example, one of the aspects of patient care this legislation addresses is the current requirement that a patient have at least three in-patient days before becoming eligible for transfer to a Skilled Nursing Facility (SNF). The proposed legislation seeks to overturn that requirement. If successful, most hospitals now saddled with the resulting inpatient burden would change their protocols such that a SNF-eligible patient could be identified in the Emergency room rather than taking up an inpatient bed for three days. Depending on their setting, the result of the change could mean as much as an 8 – 10% reduction in mandated patient days for any given hospital! Doesn’t sound like much, does it? Well, it’s a huge reduction in unnecessary cost.

Again, why is a healthcare simulation provider at all interested?

Because changes like the one I mentioned are occurring throughout the healthcare industry, changes that automatically both free and tie-up facilities, manpower and a wealth of resources in ways that are only beginning to be realized. More importantly, we’re only beginning to imagine the long term benefits and costs. So, in the world where change (and large scale change at that) is the routine rather than the exception, how can any healthcare organization hope to remain progressive and cost effective at the same time? The answer is, “Through comprehensive, proactive, tractable planning.” And the key word is “Tractable.” It doesn’t mean capable of being kept track of, as most people wrongly assume. It means capable of being easily controlled or influenced. In short, planning has to be accomplished using tools whose outcomes are easy to interpret and easy to defend, tools that support rapid evaluation and implementation of recommendations, and tools that can be employed across a wide spectrum of settings and in response to any kind of change where cost is critical and the marriage of reduced cost and improved patient outcomes is no longer optional.

Simulation can, and Flexsim HC can do it better than any simulation software on the market today.

Give us a try! You won’t be sorry. Instead, you’ll be in compliance… and cost effective.

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