Dr. Dan Anderson, MD | Physician Informaticist, NDSC
Dr. Dan Anderson, M.D., is a physician informaticist at National Decision Support Company. He has practiced both hospital and emergency medicine and has worked extensively in clinical decision support and educational technology. Dr. Anderson has held leadership positions in multiple software companies specializing in health informatics and continues to innovate at the intersection of medicine and computer science.
The Advisory Board’s 2018 annual survey of healthcare CEOs revealed a new top priority for healthcare leaders: cost containment. Previously favored growth strategies are less able to mitigate shrinking margins as reimbursements wane and the cost of doing business continues to mount. The problem is compounded by steady transition to value-based payment and risk-sharing models, as well as the aging US population and its concomitant shift to federal payment systems.
Moody’s reported that 2016 annual expense growth for not-for profit providers exceeded revenue gains by 1.2% (7.2% versus 6%). Rising cost was driven primarily by higher labor costs, technology investments, and increasing costs for medications. Experts expect this to continue and compound, fueling the surge in hospital mergers and acquisitions. Since 2000, over 2,500 hospitals have been involved in mergers or acquisitions, with the rate tripling since 2004.
Despite the widely held belief that mergers mean significant cost reduction, evidence of this has been hard to find. Hospital costs continue to mushroom, now at over 10 times that of 1980. A recent study, published in the Journal of Health Economics, reported that although the biggest system mergers lowered costs about 7.5 percent, systems under 10 facilities saw only 3.4 percent cost reductions and independent hospitals saw virtually no improvement.
This all paints a bleak picture for hospitals, especially if they incur looming CMS payment reductions under PAMA and the Affordable Care Act. In some cases, the magnitude of those reductions could actually exceed the narrow margins they are operating on. Luckily, there is untapped opportunity for further cost reduction on a fairly large scale by reducing variations in care and eliminating unnecessary testing. The challenge is to build and deliver a solution that can be easily integrated in complex hospital systems and workflows, in a minimally invasive way that brings real value and lasting, measurable results to the organization. The best successes have involved a combination of Clinical Decision Support (CDS) with institutional commitment to a continuous process-improvement framework comprising feedback, education, and accountability at all levels. The best designs are proactive and self-correcting, rather than reactive or punitive.
Developing CDS is expensive and requires considerable high-level resources, making it impractical for most organizations to develop themselves. National Decision Support Company (NDSC) serves as a central source of best advice and brings years of experience integrating this advice into EHR and hospital workflows. Hospitals save millions of dollars by not having to create, curate, and integrate their own CDS, while their providers are confident that the advice comes from top specialty societies and academic medical centers. The CareSelect™ Platform draws from the American College of Radiology’s long-respected Appropriate Use Criteria for advanced imaging, along with other Qualified Provider Led Entities like the American College of Cardiology and the National Cancer Care Network. In addition, NDSC works closely with top academic centers namely the Mayo Clinic, Johns Hopkins, Cleveland Clinic, and others to continuously refine the CDS content and delivery.
NDSC’s CareSelect platform is an enterprise solution that controls costs by reducing variation in provider resource utilization, guiding providers to the most efficient strategies for diagnosis and management while curbing over utilization and unnecessary or duplicative testing. Health systems leverage NDSC technology and services to benchmark providers and processes and identify opportunities to reduce their overhead. They choose from thousands of rules proven to impact the metrics that they prioritize. Precision advisories within the workflow inform providers on appropriateness and superior diagnostic and treatment strategies. Coupled with a prior authorization strategy that automates the medical review process, this can substantially reduce both provider and administrative burdens.
NDSC is a preferred vendor for the top EHRs and its solutions are in use across the entire healthcare provider market, logging millions of CDS transactions in all 50 states. Organizations range from large, multi-state, integrated delivery networks to standalone ambulatory care settings, and they trust NDSC’s CareSelect Platform to manage and track the actionable delivery of thousands of evidence-based guidelines within the EHR. These guidelines help organizations comply with regulatory requirements, benchmark and reduce variations in care with the goal of improving care, reduce costs and streamline communications between providers and payers.
NDSC has unmatched experience with workflow integration of clinical guidelines. That intellectual capital combined with its close working relationships with the best content sources and EHR vendors gives NDSC a perfect recipe for continued success. Our team of clinicians, informaticists, engineers, and data scientists sustain and continuously improve a central source of best advice, scalable as a cloud-based service for any and every hospital, with minimal deployment impact. We are proud to lead the way to better, more affordable healthcare in America.
√ Read about Einstein Healthcare Network’s success in leveraging their implementation of CareSelect Imaging to develop a custom PECARN subroutine to determine the appropriateness of CT for pediatric patients with minor head trauma.
√ Read the study: Impact of a Commercially Available Clinical Decision Support Program on Provider Ordering Habits
√ Learn how Mayo Clinic saw a 33.6% average reduction in volume across the ordering of Red Blood Cells, Platelets and Plasma with the deployment of the transfusion guidelines now in CareSelect Blood.
REFERENCES:
1. Cost containment is a top priority among health system executives, by Alex Kacik, July 11, 2018.
http://www.modernhealthcare.com/article/20180711/TRANSFORMATION02/180719989/cost-containment-is-a-top-priority-among-health-system-executives
2. “Not-for-profit Providers’ Rising Expenses, Dwindling Revenue Could Spur Mergers” by Alex Kacik, Modern Healthcare, August 22, 2017. http://www.modernhealthcare.com/article/20170822/NEWS/170829975
3. “Do Hospital Mergers Really Cut Health Care Costs?”, by Dee Gill , January 31, 2018
https://www.anderson.ucla.edu/faculty-and-research/anderson-review/hospital-mergers-cost
4. “Do hospital mergers reduce costs?” by Matt Schmitt, Journal of Health Economics
Volume 52, March 2017, Pages 74-94. https://doi.org/10.1016/j.jhealeco.2017.01.007
