Money Encourages Lean Healthcare Improvements

Money talks, and when it is being used to encourage better quality healthcare, doctors are listening.

The federal Centers for Medicare and Medicaid Services (CMS) is midway through a four-year project to offer doctors incentives for quality improvements in healthcare. The latest data on the program – for its second year, April 1, 2006, through March 31, 2007 – show positive results.

The project involves 10 physician groups representing 5,000 physicians. Those 10 groups received $16.7 million in incentive payments for improvements in quality of care and health outcomes for patients with congestive heart failure, coronary artery disease and diabetes.

And while the CMS news release and supporting documents describing the second-year results don’t mention the word lean, several lean concepts clearly contributed to the improvements.

One focus of the project is technology, such as implementation of electronic health records. Technology is not typically viewed as lean tool, but in many cases the technology was used to provide better information and better tracking of patients. And measurement is clearly a part of a lean strategy.

Several of the physician groups focused on improving chronic disease management and coordination of complex cases. Think of that as looking beyond one department or silo to view (map?) all efforts. Sounds lean to me.

Further, consider these descriptions, provided by CMS, of some of the efforts:

Dartmouth-Hitchcock Clinic focuses on improving quality while reducing costs through implementation of evidence-based care initiatives. The clinic uses recognized experts to educate physicians and support staff in understanding evidence-based care guidelines. Electronic tools and reports including disease registries, dashboard reports to track progress on quality measures, and electronic medical record enhancements are used by the physicians and staff at the point of patient contact to identify patients with chronic disease and care gaps. Evidence-based care implementation also requires changing workflow processes and roles for support staff…

St. John’s Health System developed a comprehensive patient registry to respond to the demonstration’s quality improvement incentives. The registry is designed to track patient information, identify gaps in care, and ensure that appropriate and timely care is provided. A key element of the patient registry is the visit planner which is designed to complement physicians’ established clinical work-flow process. It provides a “to do” list for physicians prior to each patient visit, with reminders for needed tests or interventions. The visit planner consists of a one-page summary for each patient showing key demographic and clinical data, including test dates and results. An exception list highlights tests or interventions for which the patient is due and provides physicians with reports on areas where patient care can be improved…

There are elements of training and standard work in these descriptions, and there seems to be a recognition of the importance of processes. Sounds like some steps in the right directions.