by Patrick Pevoto, MD, MBA

The Colorado Medical Society’s vision is to be a leader in making Colorado the best state in which to provide and receive the safest, highest quality and most cost-effective medical care. Said a different way, it is vital that our patients can receive the right care in the right setting at the right time. At its core, this is a value proposition on providing value – but how is the concept of value defined, especially in health care? How does one evaluate others as well as self in this realm?

The University of Utah Health has been working on the definition of value for well over a decade. This consortium came up with a general formula, with the help of Michael Porter from the Harvard Business School, which is: Value is the sum of quality and service divided by the cost incurred. These factors are further delineated as follows.

  • Quality – many health care entities have departments totally devoted to the measure of this metric. Many of us have participated in peer review, protocol creation and other areas further defined by the type of practice in which physicians engage.
  • Service – most organizations rely upon patient, employer and physician surveys to attempt to place weighted value on how health care is provided.
  • Cost – includes everything from the cost of goods and services to other more ethereal concepts such as “opportunity cost,” the loss of potential gain from other alternatives when one alternative is chosen.

When I was enrolled in the MBA program at the McCombs School of Business at the University of Texas at Austin, I chose an elective on quality. Our class discussed Six Sigma concepts and the many ways businesses attempt to define, then provide, high quality in their respective organizations. My project for the semester involved a study of all OB-GYN physicians in my hospital as it pertained to patient care around the provision of laparoscopic hysterectomies. I perused the data for each physician in the areas of morbidity and mortality (outcomes), length of stay, and overall costs.

I was amazed at how the top-ranked physicians had more streamlined preoperative and procedural practices that I had not quite adapted; I was continuing to do things based on “the way I was trained.” How eye-opening and humbling it was for me to recognize my own deficiencies.

Health care is categorized as a service industry. Metrics surrounding the provision of service mostly involve surveys completed by the participants in the process: patients, physicians and employers. While this method is the most objective way to tease out data, it is fraught with many inconsistencies. For example, how highly is a patient going to rate the service received if their individual needs (that they defined) were not met? In addition, on any given day the care can change depending on things like wait times, triage based on need and other factors that cannot be effectively quantified.

The factor of cost seems to be weighted by business and governmental organizations focused on the bottom line. Physicians have been singled out the most in this regard, yet many of the financial costs in health care are not directly under physician control. As one example, physician-driven care as opposed to care driven by non-physician providers in the system has shown to be lower cost in relation to number of studies/tests ordered. And, of course, social determinants of health and commercial determinants of health have a tremendous influence on our patients, and the quantity and cost of their care.

I would challenge all Colorado physicians to look for ways to improve care in these three areas – quality, service and cost – thereby increasing value. Be open to doing things differently. Answer that consult requested expediently and communicate findings and recommendations with timely chart entry and verbal feedback.  Continue to use evidence-based decisions in the care provided, even if change in these areas is uncomfortable. Invite questions (yes, even Google-researched patient questions) with your patients. I think you will find that it rarely will add more than three to five minutes to a visit, and it will reduce the phone calls after hours.

Above all, continue to participate in organized medicine’s attempt to advocate on your behalf. Call your representatives when that Code Blue alert reaches your inbox. Fill out member surveys so we take your pulse on issues. The Colorado Medical Society exists to represent physicians as they strive to increase value in the provision of health care to our patients; please reach out as needed to provide or receive assistance.

Categories: Communications, Colorado Medicine, President's Letter