Improve care by treating fewer patients: Column

Corrections and clarifications: An earlier version of this column incorrectly stated the name and location of the hospital CHI Health St. Francis in Grand Island, Neb.

Hospitals are experimenting with a novel way to improve American health care — they're treating fewer patients.

Consider Boston Children's Hospital, which recently invested $5.6 million in community health efforts after deciding it could do more to advance kids' health by keeping them out of the hospital. For every dollar spent on its Community Asthma Initiative, Boston Children's has trimmed $1.50 from its overall health costs.

Admitting fewer patients may seem counterintuitive to a hospital's mission. But with an emphasis on keeping costs down, hospitals are finding ways to keep people well rather than treating them after they're sick.

Hospitals are undergoing a major shift, building collaborative teams that are improving the coordination of health care. They're partnering with other health care providers and experimenting with new ways to provide care where people live and work — not just at the local hospital.

These changes can help slow down the growth in the cost of hospital and health care. In 2013 U.S. health care spending growth hit 3.7%, its lowest level since the government began tracking it in 1960, according to the Center for Medicare and Medicaid Services. A key driver of this trend is the low growth in hospital prices which increased by only 2.2% in 2013. Hospital spending growth has also slowed from 5.7% last year to 4.3% this year.

What's more, annual growth in hospital spending has declined in the past three years, from around 8% to under 5% even as patient acuity levels have risen.

That hasn't been an accident. Hospitals are slowing spending by turning to best practices and evidence-based medicine, using data to determine the best course of treatment for patients.

This approach has already borne fruit. Readmission rates for Medicare patients have dropped in recent years. About 130,000 fewer seniors came back to the hospital for the same illnesses between January 2012 and August 2013, according to the Centers for Medicare and Medicaid Services.

In other words, hospitals are ensuring that they are addressing patients' needs the first time — and thereby avoiding a second round of costs to treat the same problem.

Reducing readmissions generates huge cost savings for patients and hospitals alike. Inpatient admissions rates at Western Maryland Health System dropped by more than 30% over the past four years. And the one-hospital system is in better financial shape thanks to these declines. With these savings the hospital is in a better position to serve the needs of its community.

Hospitals are also looking beyond their walls to better coordinate care among primary care doctors, home health caregivers, rehabilitation centers, nursing homes – and many other types of providers. And they're expanding wellness and prevention services for those with chronic diseases like Alzheimer's, diabetes, heart disease and hypertension, which account for upwards of 75% of health costs. Keeping people healthy and at home is better for patients and communities — and a better for controlling health care costs.

There's certainly room for improvement. Nearly one-third of patients with four or more doctors treating their chronic conditions reported coordination problems with tests or medical records, according to the Commonwealth Fund. Those problems lead to costly repeat visits and tests.

Fortunately, successful models for coordinating care abound. CHI Health St. Francis in Grand Island, Neb., helps elderly residents live independently, avoid frequent re-hospitalizations and maintain a high quality of life through its Staying Well At Home tele-health program. A nurse coordinator trains individuals in how to monitor their vital signs and what those signs mean. The information is shared with the patient's physician, who can follow-up with the patient before their symptoms become critical. Nearly 200 individuals participate in the program, helping reduce 30-day readmissions.

The Dartmouth-Hitchcock Medical Center's Spine Center works with community health centers and public health groups to expand access while improving quality and efficiency throughout the system. The center conducts academic research on treatment outcomes and cost-effectiveness. That research has led to an emphasis on less expensive — but no less effective — non-surgical treatments for many spinal conditions.

America's upward health cost trajectory is not sustainable. No one understands that better than hospitals. To restore our nation's fiscal health — without sacrificing its personal health — hospitals are working collaboratively with their communities to ensure that fewer patients walk through their doors.

Rich Umbdenstock is president and CEO of the American Hospital Association.

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