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Value-Based Healthcare Efficiency Measures Lead To Better Patient Outcomes

Ruzanna Harutyunyan's picture

With growing healthcare costs and attention to controlling the use of expensive tests and procedures, there is a need for proper measures of efficiency and value of the services provided, according to a new American Heart Association and American College of Cardiology joint healthy policy statement published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.

"Standards for Measures Used for Public Reporting of Efficiency in Healthcare" presents the critical attributes of valid efficiency measures that are suitable for the public and the care provided for the prevention or treatment of cardiovascular diseases and stroke. Measures that emphasize only costs can promote clinical care that neglects the best interests of the patient. The statement emphasizes the importance of considering costs and clinical care together in an effort to understand value that is delivered by particular strategies.

"The best place to focus is where reducing costs may actually enhance patient outcomes," said Harlan M. Krumholz, M.D., chair of the writing group that authored the statement. "Measures should help us identify where we are wasting resources and assist us in tracking our performance in the interest of achieving better value in healthcare. Cost alone is not a good barometer for determining quality of care and efficiency."

The authors said these four attributes are important in any effort to measure and publicly report efficiency:

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• Integration of the quality and cost;
• Valid cost measurement and analysis;
• Minimal incentive to provide poor quality care; and
• Proper attribution of the measure.

"These standards provide important guidance for such measures. When done well, they can provide targets for intervention and focus attention on opportunities to improve.

When done poorly they can provide incentives for care that is not in the best interest of patients or society," Krumholz said.

The statement cited several examples of how inefficient measures can lead to unintended adverse outcomes for patients. Efficiency measures that emphasize restraining costs without considering the consequences could markedly undermine health outcomes and even lead to higher costs in areas that are beyond the measurement. For example, measures that capture only length of stay for a heart failure admission, could lead to practices of premature discharge from the hospital, which is subsequently associated with a higher rate of readmission that could worsen care and increase cost.

"Properly designed public reporting programs will promote the provision of services that improve clinical outcomes while controlling or reducing costs," Krumholz said. "It is important for patients and policymakers to know whether practitioners and healthcare systems are delivering high-quality, evidence-based healthcare at a reasonable cost.

"Several government, public and private organizations are making progress in developing provider performance measures that focus on efficiency," Krumholz said. "But their definitions of efficiency vary and there is a great need to develop consensus regarding the properties of measures that will serve the interest of patients and enhance the value of our investment in healthcare."