Why Are We Ignoring the Common-Sense Solution?

Dee Donatelli, RN, BSN, MBA, Sr. Vice President, Provider Services, Hayes, Inc.

As clinicians, hospitals, and consumers look ahead to 2014 and the full implementation of healthcare reform, much discussion centers on ways to achieve clinical quality improvements and cost savings. Achieving certain quality measures won’t be easy, but I’m sure we can all agree that our runaway healthcare expenses need to be corrected. The question is, are we ready for the changes that are necessary to rein in costs and realize high-quality health outcomes?

In the ongoing process of executing the Affordable Care Act, I believe some providers have overlooked the most common-sense solution: Integrating scientific evidence into healthcare decision making, especially our purchasing decisions. The consequences of this failure have been overuse, misuse, and even (in some instances) underuse of the supplies, products, devices, services, and interventions healthcare providers use to deliver care to their patients.

In my previous columns, I’ve advocated for such an evidence-based approach, and some organizations are already doing it. What I want to flesh out in this issue are the reasons more hospitals and healthcare systems aren’t embracing such an easy solution. A host of factors create barriers to evidence-based value analysis (EBVA), but in my perspective, one of the biggest problems is a lack of understanding about the value of scientific evidence compared with physician preference or opinion. Most value analysis professionals, myself included, haven’t been trained to critically evaluate and apply evidence to the value analysis process. As a result, our attempts at EBVA become stymied by multiple roadblocks, such as:

  • Strong physician preferences for certain products or management approaches due to physician training and familiarity with the products.

  • Misleading and biased information communicated in the media.

  • Influential relationships that exist between manufacturers/pharmaceutical representatives and clinician users over which we have little control.

  • Competition among practitioners and hospitals, coupled with the desire to gain a marketing advantage, which is often driven by patient expectations and demands.

  • Conflicts of interest that result when physicians receive royalty payments and consulting fees from companies and higher professional fees associated with using certain products or providing certain procedures.

  • Defensive medicine, especially with regard to ordering diagnostic tests.

  • Local patterns of care and peer pressure.

  • Hope and belief that something newer and more high tech must work better than an older approach.

Nod your head if you’ve been guilty of allowing any of these factors to influence your purchasing decisions. Hospitals can’t afford to wait any longer to start systematically incorporating evidence into their value analysis processes. Already, academic scholars, healthcare reformers, and consumer advocates are questioning the way we make decisions in healthcare. Consider, for example, Selling Sickness [http://sellingsickness.com], an alliance between patients and professionals that is calling for the enactment of several reforms intended to improve public health and safety and save money. Some of these reforms include comparative-effectiveness research that evaluates drugs and devices against appropriate controls, rapid identification and removal of unsafe or ineffective products, and access to raw clinical trial data so that independent analyses can be performed.

It’s time to move beyond a cost-based, SKU approach to systematic selection and utilization that includes patient outcome and safety data. Using this type of evidence will enable your institution to replace confusion with clarity, subjectivity with objectivity, waste with savings, and mediocrity with clinical excellence.

Ms. Donatelli has more than 30 years of experience in the healthcare industry, with expertise in the areas of supply chain cost reduction and value analysis. Before joining Hayes, Ms. Donatelli was Vice President of Performance Services at VHA, Inc., where she provided executive leadership and direction for VHA’s consulting services, including Clinical Quality Value Analysis. She is a Certified Material Resource Professional (CMRP) and a Fellow of the Association for Healthcare Resource and Materials Management (AHRMM). She the current president of AHVAP, the Association of Healthcare Value Analysis Professionals. Dee can be reached at ddonatelli@hayesinc.com for questions or comments.

Hayes, Inc. (http://www.hayesinc.com), an internationally recognized leader in health technology research and consulting, is dedicated to promoting better health outcomes through the use of evidence.