Friday, May 18, 2007

Let's warranty that surgery

In Bid for Better Care, Surgery With a Warranty - From The New York Times: By REED ABELSON

What if medical care came with a 90-day warranty?

That is what a hospital group in central Pennsylvania is trying to learn in an experiment that some experts say is a radically new way to encourage hospitals and doctors to provide high-quality care that can avoid costly mistakes...

Geisinger is by no means the only hospital system currently rethinking ways to better deliver care that might also reduce costs. But Geisinger’s effort is noteworthy as a distinct departure from the typical medical reimbursement system in this country, under which doctors and hospitals are paid mainly for delivering more care — not necessarily better care.

Since Geisinger began its experiment in February 2006, focusing on elective heart bypass surgery, it says patients have been less likely to return to intensive care, have spent fewer days in the hospital and are more likely to return directly to their own homes instead of a nursing home....

In almost no other field would consumers tolerate the frequency of error that is common in medicine, Dr. Berwick said, and Geisinger has managed to reduce the rate significantly. “Getting everything right is really, really hard,” he said....

Around the world, other modern industries — whether car manufacturing or computer chip making — have long understood the importance of improving each piece of the production process to tamp down costs and improve overall quality.

But hospitals have been slow to focus their attention on standardizing the way they deliver care, said Dr. Arnold Milstein, the medical director for the Pacific Business Group on Health, a California organization of large companies that provide medical benefits to their workers. Geisinger “is one of the few systems in the country that is just beginning to understand the lessons of global manufacturing,” Dr. Milstein said....

Even Geisinger’s chief executive, Dr. Steele, acknowledges that the effort could prove overly ambitious. “I’m not betting the whole business on it,” he said. He has also pushed Geisinger further into other areas like clinical research and disease-management programs.

But he also says there is an enormous value in simply showing that a hospital system as large as his can successfully standardize care, demonstrating “the benefit to patients and the benefit to buyers” — all backed by a 90-day warranty.

This is a very interesting article, worth reading in its entirety.

The article develops an extended comparison to leading-edge manufacturing techniques and associated quality assurance programs. Another interesting comparison, not made in the article, is to tort theories of strict liability of the sort pioneered by Guido Calabresi (Yale Law professor, former dean, and now federal judge, and my Torts teacher a generation ago). That will be worth a longer posting when time permits.

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