Will Medicare Force Hospitals to Go Six Sigma?

I was driving to pick up my daughter from school yesterday when a story on National Public Radio (NPR) caught my attention. I only heard the end of the segment on the radio, but from what I could tell Medicare was forcing hospitals to change the way they do business by not paying for certain medical procedures.

Here’s the full story:

Starting in October 2008, Medicare will cease to compensate hospitals for treating patients having at least eight conditions, including common hospital-acquired infections, blatant surgical errors, and injuries that result from a fall. The reasoning is that these are not the primary reasons patients came to the hospital in the first place. Instead, these are a result of coming to the hospital (yes, going to a hospital can be detrimental to your health) and Medicare is essentially saying: "Your hospital processes are broken. Fix them. We’re not paying for your errors any longer."

Why is this so significant? According to Julie Rovner of NPR, Medicare (which is a federal program) "…pays about 40 percent of the nation’s annual hospital bills." This is going to significantly cut in the funding of almost every hospital in the United States.

Within the news story Nancy Foster - who is in charge of quality and patient safety issues for the American Hospital Association - is quoted as saying, "People may wake up in the middle of the night, need to use the restroom, not remember that the nurse instructed them to call for help first - or think they were OK, go to stand up and find out that the surgery they had has weakened them so that they are unable to support their own weight and fall to the floor and be injured. No one wants that to happen. We just don’t have a perfect strategy to prevent it."

I beg to differ with Ms. Foster. The fact remains that falls can be proactively prevented in hospitals. Fortune 1000 companies have entire organizations devoted to worker safety (typically under the Environment Health and Safety umbrella), and employees in this function have the sole purpose to prevent worker injuries. What is measured can be improved. Why can’t the same thing be done for patients within hospitals? It can.

Searching iSixSigma Healthcare revealed at least one example speaking to this point. In "Strategies for Improving Patient Safety in the Hospital" Carolyn Pexton describes how Charleston Area Medical Center (CAMC) took their post-operative surgical infection process sigma from 0 (yes, that’s zero; defects per million opportunities of 660,828) to 2.86, thereby improving their process by 91 percent. This is cause for a celebration and the results shared with as many other healthcare organizations as possible.

Should all hospitals go Six Sigma? Lucian Leape of the Harvard School of Public Health comments: "It’s clear that progress in patient safety has relied on altruism. It’s been largely accomplished by good people trying to do the right thing. And what we’re seeing is that that hasn’t gotten as far enough, and now we’ll go to what really stings in our society - which is money."

To me, it’s clear that Six Sigma - tied to the hospitals operating budget - is the answer. What has been done until now has not worked. It’s time for a change.

The January/February 2008 issue of iSixSigma Magazine will feature 3 of the top ten healthcare organizations in the United States, and how implementing Six Sigma is improving patient safety and results. If you’re not signed up for a subscription, take $5 off and sign up today. It could be a matter of life and death. :

A quick search of NPR.org revealed the story in detail which, if you work for a healthcare provider or healthcare providers are your customers, is a great read:
http://www.npr.org/templates/story/story.php?storyId=13872687

The audio can be heard at by clicking the icon at the top of the page. It’s worth a listen.

Press Release: Centers for Medicare and Medicaid Services Announces Payment Reforms for Inpatient Hospital Services in 2008