In a time when reducing operational costs are at the forefront of every Point of Care Coordinator (POCC) or lab manager's mind, understanding how to understand and present the indirect worth of a test is critical.
Recent history has been filled with reports of financial woes. Healthcare and the laboratory have not been exempt, or even shielded, from the effects of the economic recession. Like all industries, healthcare has reduced staffing and expense and continues to focus on expense reductions.
In these frugally focused times, it can be difficult to build a strong enough case to add new tests, especially for point of care.
With a little additional leg work, determining the anticipated indirect cost benefits is a snap by presenting the evidence-based medicine.
Do Your Research
Where would a person begin to look for cost benefits of evidence-based medicine? During a review of literature about a proposed test, many vendors will provide copies of leading research papers, also called white papers.
These papers may be carefully selected by the vendor to validate their product and improve sales potentials. With additional Web browsing, additional white papers can be located and reviewed.
While the immediate focus may be how the test will relate to other lab tests, key information to catalog will be the study size, study location, the improvement in mortality and morbidity, decreased inpatient stay, decreased need for other tests or invasive procedures and decreases in medication.
Think back to your days in college--the research papers and rules. Always look for sources with the greatest industry presence and reputation. Review all materials and categorize them as "pro" or "con." The point is to be able to provide an overview of industry benchmarks and a list of resources. A single page of bullet points can carry great weight (Table).
Build Political Support
|TABLE: OVERVIEW EXAMPLE
Proposed X Test
Current published studies: 15
Findings: A literature review reveals 10 clinical studies found a positive correlation between having a charted result for Test X within 60 minutes and positive patient outcomes.
Positive Patient Outcomes:
- Reduction in CT scan use by 75% in patients presenting with possible AMI.
- Reduction in IV anticoagulation use by 43%.
- Reduction in patient stay by 1.2 days.
- Improved mortality and morbidity scores by 0.4.
Primary Study Locations:
- Mayo Clinic, 1,000 patients, AMAF funded
- Cleveland Clinic, 788 patients, Glaxo funded
- University of Texas, 500 patients, AMAF funded
- American Heart Foundation. April 2009. "AHAF Finds Key to Saving Hearts." Available at: www.amaf.org/Saving Hearts.pdf.
- Short, M. July 2008. "Test X Use in AMI Patient Assessment." JAMA. Available at: www.jama.org/123asb.
Determining the indirect cost benefits may not stop with research. Using your relationships to learn more about patient care practices within areas that might use the test are also vital.
Having a conversation with nurses and physicians to understand their work flow and practices can uncover other savings. Including your peers in the discovery can also build political support for your proposal. They, too, might have discovered information about Test X and have thoughts about its use.
Imagine learning that Test X would reduce the number of phone calls a nurse would need to make to a physician. While the savings of 10 minutes may seem insignificant, when you multiply it by the number of patients who Test X would apply to, it could total an hour per day per nurse and physician.
During that time, their focus could be on other patient treatment activities. This is a snowball--one savings leads to another. Focusing on one additional patient care need can improve patient outcomes, decrease stays, reduce medication use, improve the mortality and morbidity scores, and increase the reimbursement rate for the organization.
While it sounds too good to be true, this is how big changes occur through a series of small steps.
Sharing your discoveries with your peers can help improve their department's bottom line as well. If a nursing unit could save the equivalent of one nurse per day by improving the clinical information and reducing the time to action, shifting those staffing resources to other tasks also saves.
While this may not be a direct result of the cost per test, it is a result of the addition of Test X to the point of care testing program. Likewise, the physician might be able to perform rounds on patients earlier. This would lead to earlier discharges and increases in the time available to see additional outpatients.
The end result is a reallocation of resources, reduced operational costs for the organization as a whole, improved patient and physician satisfaction and improved revenue streams.
Being able to demonstrate these indirect cost benefits with the support of nursing and medicine will build a solid case and the greatest potential for success.
Ginger Baker is POC project manager, TELCOR, Lincoln, NE.