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Divide between healthcare, finance creates challenges in patient outcomes, costs

Patient outcomes are the marker of a system's quality, and that quality is often reflected in the costs.

Jeff Lagasse, Associate Editor

Despite some progress over the past 10 years, opportunities to improve patient outcomes and reduce the total cost of care still exist. According to Harlan Krumholz, MD, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, one of the reasons there's still work to be done is because of the divide between healthcare and finance.

Speaking at the Healthcare Financial Management Association's annual ANI conference in Orlando, Krumholz said the nation's economy is intrinsically dependent on the success of the healthcare system.

Yet, many on the finance side of healthcare are concerned primarily with whether their hospital or health system is operating in the black, paying little attention to outcomes. Krumholz said patient outcomes are the marker of a system's quality, and that quality is often reflected in the costs -- what an organization decides to spend money on, and why.

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"The continuing rise in healthcare costs cannot be sustained over the long run," said Krumholz. "Year over year, you cannot continue to increase it the way we've increased it, and you can't increase it without getting the value back. ... We've got to address the costs, and we've got to address the value."

To illustrate his point, he used an example from his field of cardiology. In the 1980s, clinicians discovered that simply taking aspirin within half an hour of a cardiac arrest resulted in a 25 percent reduction in the risk of dying. Yet that information didn't get translated effectively to the broader industry, and for years hospitals continued to spend money on costly interventions that weren't as effective as this everyday, over-the-counter drug.

"Healthcare and finance are the same things," said Krumholz. "If you're spending money on treatments that have no value, we've got a problem. Every time (patients) were given this treatment late, they missed an opportunity to improve outcomes. And by the way, they're also wasting money.

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"Imagine having a board in charge of a company whose principal product is not in any way quantified," he said. "It's the outcomes produced that are the fundamental products of the industry to which we're devoted. Every day you're making choices, but you have no perspective on what's actually being achieved. We all prop up the organizations without any knowledge of how they're performing."

Data, said Krumholz, is the most effective way to combat the problem -- specifically, the free-flowing exchange of data between the clinical side and the finance side. He called this concept "data lakes," the idea that data is flowing in and out from different places. Unfathomable amounts of data are being generated, and this data -- concerning such things as the efficacy of aspirin -- is the means to a future where outcomes and finance are intertwined.

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"This is going to give us a chance because the only way forward is to work smarter," said Krumholz. "Healthcare is not like any other industry. People's lives are at stake. We have to insist on evidence. We cannot be great individually unless we're great together."

Twitter: @JELagasse