If I was forced to pick the most important driver of the improvement in the quality of health care in the U.S. in the last 40 years, it would be the advances we’ve seen in technology. Clearly, these advances have created much safer procedures and processes for patients and their families, many less-intensive and less complicated techniques for physicians and their teams and significant reduction in poor clinical outcomes.
Some of the more obvious examples of these improvements include:
•Better eye sutures so cataract surgery can be performed in 10- 20 minutes as an outpatient procedure as compared to the three-week mainly bedfast hospital stay with sand bags placed on both sides of the patient’s neck to minimize movement. A major complication of that kind of surgery and recovery included strokes in elderly patients.
•Use of laparoscopic surgery for gallbladder removal resulting in a short outpatient procedure and return to work and normal activities in four to seven days. This compares to a week-long hospital stay after an open right subcostal incision procedure, four days of which the patient had severe pain and nausea with the inability to return to work for four to six weeks.
• Proctoscopies done with a hard metal scope, which had to be carried out only by surgeons because 1 in 1,000 cases resulted in a perforated bowel. Now these bowel examinations are done with flexible scopes with little chance of a significant complication.
• Arteriograms done through the femoral artery as compared to those done through the carotid artery, causing numerous vascular compromise incidents.
Based on these few examples—and I believe there are many more--I have always said the “good old days” were not so good. Clearly, technological advances have created much brighter and better days from many perspectives. But, unfortunately, there is a dark side to technology.
As the equipment became safer to use, the ability for more providers to do more procedures in less acute locations has occurred. Procedures once done only in a hospital can now be done in doctors’ offices, ambulatory surgery centers, specialty hospitals and even convenient clinics. This increased availability in multiple settings by multiple providers has resulted in an overuse of these procedures often driven by revenue enhancement (What’s best for me?) vs. quality care (What’s best for the patient?). In addition, many of the highly-reimbursed procedures have been moved out of hospitals, resulting in extremely low income levels and making the survival of some hospitals almost impossible.
Because of this knowledge, Obama and Congress, who are driving health care reform, believe if the revenue overuse was replaced with evidence-based quality guidelines for use, billions of dollars could be saved while simultaneously improving quality. They are right. The question is, do we as health care leaders have what it takes to eliminate this dark side of technology and replace it with only the best use of this technology for the right patient and the right time at the right cost?