The Healthcare Management Council, Inc. Delivering Cost and Quality Benchmarks for your Hospital organization.

Want to improve healthcare ROI? Compare clinical utilization.

This recent article revealed that physician self-referrals of imaging services other than standard x-rays resulted in higher costs with no demonstrable improvement in quality of care or patient convenience.  Yikes.  The implied promise when physicians lobbied to purchase complex medical equipment like ultrasounds, mammogram machines, MRIs, CT Scanners, and the like was four-fold – improved quality, faster diagnoses, patient convenience and lower costs. 

The article’s result is counter-intuitive, isn’t it?  Of course, if you go to the doctor with a headache and she says, “Let’s zip into the MRI and take a look”, we Americans are pleased.  How convenient!  And something is happening, an aggressive action to uncover the malady.  The American patient isn’t.  We are allergic to the tincture of time, so an MRI is much better than “Let me know if the headaches are still bothering you in two weeks”.  Even if after the MRI we are told, “Come back in two weeks”, we are pleased that at least some diagnostic work-up was done. 

But that’s not what the data says happens.  The data says that doctors over prescribe when the MRI is just sitting there, lonely and woeful, waiting to be paid off.  Their usage patterns change and it’s not to our benefit. 

Do the physicians do this on purpose – intentionally set out to over-utilize a highly specialized imaging procedure?  Undoubtedly some did.  But my bet is that many truly believed that patient convenience, faster diagnoses and tighter quality controls would yield a better, less costly result than either watchful waiting or referring a patient to a hospital or imaging clinic.

Unfortunately, though, physicians neglected to measure their assumptions and we did not require it of them either.  They did not perform a rigorous study of their results and utilization patterns post ownership.

The best study would have been a cost/benefit comparing utilization and results before and after owning the MRI.  Lacking that, a comparison of clinical utilization with all the patients reporting a specific type of symptom would work.  Compare results broadly too – not just against other self-referral docs, but also in hospitals, in urgent care centers, and in practices who don’t own the MRI.  That’s the only way that we’ll be able to know what really works and is a good use of our precious healthcare dollars. 

 And once they have the results of their comparative clinical utilization studies?  They must actually make practice changes based on the data.   

Luckily lots of clinical utilization comparisons are available in your HMC Benchmarks.  Have you and your physicians had a look at it lately?