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As health care costs continue to skyrocket, hospitals and those seeking care are working to find a way to create the best value for the patient’s money.
Value is commonly defined as quality divided by cost, with quality describing the outcome of care, and cost describing the expenses incurred by the patient. There are many different measurement aids used to rank the quality of care at hospitals in the U.S., but there is some thought that these aids might not paint the entire picture of the value of care provided.
“What we wanted to start doing was to share one potential approach to creating a value measure because there's a whole host of ways it can be applied, but it hasn't been done,” says Ben Pollock, Ph.D., Robert D. and Patricia E. Kern Scientific Director for the Science of Quality Measurement.
The Science of Quality Measurement Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery has a unique task of ensuring that Mayo Clinic is providing evidence-based care that also offers the best value possible for its patients. Researchers in this program have developed a more exact value metric to compare the value of care for certain procedures and conditions. The value metric was built from the original definition of value, which is quality divided by cost, and specifically uses risk-adjusted 30-day mortality rates to better identify the quality of care for that specific condition or procedure.
“Our job is to measure quality internally, and then externally be part of the conversation of how quality should be measured, “ says Dr. Pollock.
The value metric was applied within the study to look at one condition and one procedure: cancer and gastrectomy.
When the metric was applied among hospitals with better-than-average 30-day cancer mortality rates, the cost to prevent one excess 30-day mortality for an inpatient cancer encounter ranged from a high of $1.4 billion to a low of $71,000.
When the metric was applied to hospitals with better-than-average 30-day gastrectomy mortality rates, the cost to prevent one excess 30-day mortality for an inpatient gastrectomy encounter ranged from a high of $95 million to a low of $710,000.
The large gaps in value identified by this study represent a great need to pinpoint areas of improvement for the lowest-performing hospitals within the study, notes Dr. Pollock. Also, it asks whether the ranking systems identify the significant cost-saving variation among high-quality hospitals.
Dr. Pollock explains that, for conditions or procedures with low mortality rates, the cost of the procedure may be deemed a higher priority to the patient, so the value metric could be reformulated using different outcomes, such as readmissions or patient experience.
“Depending on the procedure you're getting or the condition you have, it will make a huge difference whether the quality is much more important than the cost of the procedure,” says Dr. Pollock. “There are several ways you could weigh the value metric for that, which may help start the discussion.”
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