Who doesn’t want to reduce inefficiencies while also improving patient care at the same time? It’s hard to dispute the value of a Diagnostic Management Team (DMT) in theory. But in reality, hospital administrators need to be able to see a measurable return on investment to truly get on board with the concept.
DMTs operate by assembling a group of healthcare experts to regularly evaluate patient histories, interpret clinical data and make recommendations to treating physicians that become part of the patient files. This multidisciplinary expert-driven narrative informs treatment decisions with the goal of improving patient outcomes and promoting more judicious use of hospital resources.
The biggest selling point of the DMT lies in its ability to streamline care and lower the incidence of medical mistakes by reducing the over- and under-utilization of hospital tests. In 2015, the National Academy of Medicine endorsed Diagnostic Management Team consultative services as a way to reduce medical errors in the American healthcare industry.
“A DMT provides major cost savings for a small investment, mostly in the experts of a specific clinical area to lead the team,” said Dr. Michael Laposata, Professor and Chairman of the Department of Pathology at the University of Texas Medical Branch in Galveston. “It’s simple to provide information on reducing overutilization of tests. However, a bigger problem is the underutilization of laboratory tests, which results in delays in diagnosis or missed diagnoses, producing major expenditures and poor outcomes.”
Dr. Larry Van Horn, a health economist and Executive Director of Health Affairs at Vanderbilt University, says staying viable is a challenge for many hospital administrations in the face of significant issues such as declining reimbursement, the need to keep up with new technology, and changing delivery methods.
Shifting gears from the clinical point of view to understand hospital operations from a business perspective is the key to making a strong case for DMT support.
“Regardless of what happens with healthcare reform and third-party payment, bringing down your cost structure and being more efficient in your use of resources will always be a good thing,” Dr. Van Horn explained. “To have the kind of clinical impact you want to have on patients, the ability to align with the business side of the hospital and put things in terms that resonate with CEOs and COOs is going to make you much more effective.”
Dr. Van Horn and Dr. Laposata worked together to establish and evaluate a coagulation-focused DMT at Vanderbilt back in 2010, the first of several such groups to form across multiple service lines within the organization. Tasked with finding ways to measure the effectiveness of the coag DMT, Dr. Van Horn was able to demonstrate quantifiable outcomes using an Interrupted Time Series system.
“I had to come up with the ability to tell a story that executives in the hospital would believe that said the efforts of this Coag DMT initiative had impact, punch and real tangible value,” he recalled.
By definition, the Interrupted Time Series is an analytical approach that examines observations made before and after a specific intervention is put in place to determine a cause and effect.
The Vanderbilt Coag DMT, for example, tracked resource use and length of stay (LOS) for patients with pulmonary embolism (PE) or intracranial hemorrhage six months before and six months after the DMT began by using existing data gathered through charge capture systems.
“The goal of hospital administrators is to get admissions, get patients in and out as quickly as possible, and be as efficient as possible in use of resources to generate good outcomes,” Dr. Van Horn pointed out. “If they can do things to reduce the length of stay and lower the number of inputs, they’re better off.”
Using Interrupted Time Series metrics, Dr. Van Horn was able to demonstrate a 33 percent reduction in median LOS and a 25 percent reduction in median charges for PE patients, as well as a 25 percent reduction in median LOS for patients with intracranial hemorrhage. With a one-day LOS reduction carrying average values of anywhere from $1,000 to $1,500, these are measureable results that make the C-suite sit up and take notice.
By graphing his findings, Dr. Van Horn visually indicated reductions in LOS and resource use for both patient groups post-DMT intervention through shifts in distribution tied to the event.
All hospitals have charge capture systems tracking information that can be used for an Interrupted Time Series analysis.
“You have to get access to the detailed charge level files in your facility through the department of finance,” Dr. Van Horn said. “Start with the CFO; from there, talk to people in the department and explain that you want to better understand the resources used by patients while they’re in the hospital.”
Dr. Van Horn also suggests consulting with supply chain employees, who can be helpful because they purchase inputs that are used during a hospital stay, and are finely attuned to the information flow of data sets at a granular level.
With so many moving parts in any healthcare organization, the question of knowing how much you can safely attribute to the DMT comes down to a matter of ruling out other influences that could potentially sway outcomes during that specific time frame.
First, you’ll want to make sure there are no other corresponding factors happening while DMT intervention is in place — for instance, a new doctor joining the staff, the opening of a new facility, or updates to existing equipment. With all other things being equal, it’s logical to attribute a change in results to the DMT intervention.
If there’s any question as to the DMT’s effectiveness, Dr. Van Horn suggests pausing it for a month or two to see what happens. If trends and metrics revert back to where they were before the intervention began, it’s safe to say the DMT is causing the effect.
The end result? A win-win for both clinicians and administrators.
“It’s clear that better management of clinical cases resulting in accurate and rapid diagnoses provides major savings,” Dr. Laposata added. “And, the revenue associated with providing such information is minimal.”
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