The Case for Metrics in Improving Access

So often hospitals think of growth in terms of dollars and sense.  When a hospital administrator evaluates opportunities to expand their services, the metric that frequently carries the most weight in deciding whether to commit funding to a project is a financial one, like return on investment.  

This isn’t necessarily wrong.  Even for nonprofit systems that are seen as the stalwarts of their community and provide millions of dollars in charity care year-over-year, the old truism “margins = mission” is still relevant.  In order to fulfill even the most high-minded mission, hospital leadership must be financially responsible and take caution in committing funds to any venture that may lose money, as it will inevitably hold larger consequences for the entire system (whether in terms of credit ratings, solvency issues, community perceptions, etc).  

However, as frequently reported in the press, we know that there still exists a substantial need for better and more consistent care across populations and different socioeconomic classes.  Notably, the Agency for Healthcare Research and Quality (the “AHRQ”) produced their annual National Healthcare Disparities Report earlier this year and noted several troubling (and continuing) trends around quality and access to care, with a few noted below (p.4):

  • Blacks and American Indians received worse care than whites for about 40% of core measures
  • Hispanics received worse care than non-hispanic whites for about 60% of core measures
  • Poor people received worse care than high-income people for about 80% of core measures

The report goes as far to state that “health quality in American is suboptimal.  The gap between best possible care and that which is routinely delivered remains substantial across the nation.”  

Like so many other health reports we’ve seen recently, Georgia does not fair well when compared to other states.  The AHRQ scores Georgia as “weak” as it relates to overall healthcare quality, notably in the areas of acute care and chronic care measures. (We did though fare better in preventative measures being rated this year as “strong.”)  Care by clinical area in Georgia also shows poor results, as diabetes, heart measures, and respiratory disease measures point to weak or very weak performances.  (For specifics in each of these areas, I encourage you to visit AHRQ’s website for a wealth of information on Georgia and the other 49 states.)

The first step for any healthcare provider is to recognize their potential quality gaps and variations in care and commit to taking an active role in lessening these disparities in their local communities.  How one goes about exactly doing this is debatable.  Unlike financial metrics that are clearly defined and readily used in healthcare, metrics on quality and access are not as frequently employed or understood.  In particular, measures for access can vary significantly from provider to provider–what set of metrics one provider may use to measure performance can be entirely different from another.  This should not serve as an excuse for inaction though but a call to sharpen our thinking and agree on a collective action to tackle these large issues.  

Using metrics to both better understand and begin to correct the problems of healthcare disparities in Georgia is only one of many steps that are needed to realize lasting success.  Yet, such efforts will inevitably go a long way to help providers think more broadly on the non-financial reasons for their systems’ growth and help defend those decisions that don’t just improve the bottom line.  

One comment Add your comment

Marko

October 27th, 2012
4:17 am

Hey Amir,Kyle, of Panacea, has been helping me in the way of best cotactning the DMV area artists. I was just hoping your schedule was open enough for a phone-in interview on my radio show. It is titled ManWomanBoogie and focuses on hip hop and jazz. The show runs Fridays from 8-10PM on 90.7 KJHK, Lawrence (Kansas). Let me know if this holds any interest to you.lstall@ku.edu

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