Reformulating the 80/20 Rule
by Ariana Berberich
Hospitals have instituted widespread quality efforts to prevent the non-reimbursed AHRQ off-quality incidents. While these quality improvement initiatives are well-intentioned, ironically, they are misguided. Based on research using our national database of hospitals (ranging in size from 5,000 to 80,000 adjusted admissions), and their admitting physicians (ranging in number from 35 to 1350), additional expenses related to off-quality incidents are not actually widespread among the hospitals’ admitting physicians but are focused among a handful. The implications of this are that broad brush patient safety initiatives will be less effective than those focused on the few physicians with quality problems.
At each hospital, HMC ranked the physicians by their off-quality expenses and determined the percentage of physicians responsible for 80 percent of the extra expense associated with patients who experienced off-quality incidents. Regardless of size, service, and number of physicians, the pattern remained the same with a mean/median of 6 percent of the admitting physicians responsible for 80 percent of the off-quality expense.
Ignore this at your peril.
The physicians at Hospital A show a typical pattern of off-quality expense with a small number responsible for a majority of the off-quality excess. Those physicians in red contribute 80 percent of the total facility off-quality expense.
Ariana Berberich is an HMC analyst.
