Ohio Hospital Puts Docs On The Spot To Lower Costs

An aspect of the Affordable Care Act is meant to rein in exploding health care costs. To do that, the law has created hundreds of experiments in which hospitals have volunteered to participate. Our Planet Money team went to one hospital in Ohio that's trying to get doctors more involved in understanding hospital economics.

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DAVID GREENE, HOST:

Now, one goal of the Affordable Care Act is to rein in the skyrocketing amount the nation spends on health care. To figure out the best way to do that, the law has created hundreds of little experiments, in which hospitals around the country have volunteered to participate.

Lisa Chow of NPR's Planet Money team went to one hospital in Ohio that's trying to get doctors more involved in understanding hospital economics.

LISA CHOW, BYLINE: Here's one of the new things they're doing at Summa Akron City Hospital. They're sharing data with doctors about how much their cases cost.

DEIRDRE BAGGOT: So, in your packet...

CHOW: Deirdre Baggot, a health care consultant, has been flying here for the last several months, hosting meetings like this, the entire cardiac surgery team sitting around the table - doctors, nurses and administrators - comparing numbers: How much medication did one doctor use, compared to another? How many lab tests did this doctor order versus that doctor? A topic tonight: tardiness - specifically, surgeon tardiness. Bob Hunter is a chief administrator for the group.

BOB HUNTER: Figure three looks at percentage on-time starts.

CHOW: Operating rooms are the most expensive rooms in a hospital. So when surgeries are running late, that means a very expensive room is sitting empty. In this packet in front in them, each surgeon sits and stares at a number next to their name: what percentage of their surgeries start on time. Baggot turns to Eric Espinal, whose surgeries start late 43 percent of the time.

BAGGOT: So, Eric, if you looked at this and saw how you compared, in terms of on-time starts, to your peers, what's your impression, or is this actionable? What are your thoughts when you look at this data?

DR. ERIC ESPINAL: Well, I guess I need to know what defines the on-time start. I don't know how that number is reached.

CHOW: This meeting gets a little uncomfortable. Eric Espinal and another surgeon push back and say it's not our fault these surgeries are running late. It's other people on the team, to which a nurse, Amy Christman, replies her staff is ready at seven in the morning, when the first patient is supposed to be rolled into the OR.

AMY CHRISTMAN: It is a team thing. If we all have to be here, shouldn't our surgeon have to be here, too?

CHOW: Michael Firstenberg, whose surgeries start late 62 percent of the time, says we're waiting for you guys.

DR. MICHAEL FIRSTENBERG: We call in. We tell them that we're here. We tell them that we're available. And yet individuals still feel the need to delay the ship from taking off.

CHOW: At this point, Jacob Cohen, an anesthesiologist, jumps in.

DR. JACOB COHEN: I'm sorry, Mike. But, I mean, in terms of reality on a regular-day basis, I can't put the patient to sleep because we don't have a surgeon - maybe in the house, but maybe not answering a page.

CHOW: Deirdre Baggot, the consultant leading this discussion, says these conversations often get a little chippy. It's scary showing doctors data that say they're not doing as well as they could.

BAGGOT: The first time I did this, I had hives.

CHOW: But ultimately, at the end of these conversations, behaviors change.

BAGGOT: Physicians are innately competitive. So, I know after session one, that change will happen. It happens the minute they leave the room, because they were always the top of the class, and they want to do that here.

CHOW: Ken Berkovitz is a cardiologist at the hospital. He says doctors here know what it's like to be compared on quality. For example, they know how many of their patients have to be readmitted because of complications. But they've never been compared on costs.

DR. KEN BERKOVITZ: I can tell you, for the physicians in general, yes, it's uncomfortable.

CHOW: Berkovitz says for him the data reveals he was giving his patients more expensive drugs, and that the other doctors had already adopted equally effective lower-cost drugs.

BERKOVITZ: And what's brought me to change is looking at the data. And I probably would not have changed so quickly had I not had the data shared with me.

CHOW: There are some questions about this approach. Do you want your doctor weighing the costs of everything? And sometimes the story that the numbers tell isn't clear. For example, you could have a surgeon who takes a lot longer in the operating room, costing a lot more, but his patients do better afterwards. Baggot is aware of that danger. But right now, she says, things have gotten to the point where more doesn't mean better. And cutting costs and improving outcomes, she says, often look exactly the same. Lisa Chow, NPR News.

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