The organization I’ve picked is Massachusetts General Hospital (MGH), which is situated in Boston, Massachusetts. Mass General consistently ranks well when looking for the best hospitals in the US. They offer some of the most cutting-edge facilities available for medical care. They have several multidisciplinary care teams renowned internationally for their innovations in various specialties, including cancer research, neurosciences, digestive disease, orthopedics, transplantation, and many more. Even though Mass General is the top hospital in Massachusetts, the state still has to solve critical challenges before fully supporting MGH’s potential. These problems include cost containment, affordability, and health equity.
Metric Analysis
Measurements are essential in many ways; thus, MGH pays much attention to them. They collaborate with other groups to fully comprehend any health challenges in their community.
Analysis Interpretation
It is crucial to guarantee that everyone has access to healthcare, regardless of cost. The Center for Health Information and Analysis disclosed in an annual report earlier this year that healthcare spending had risen and surpassed the threshold two years earlier, even before the COVID-19 outbreak. This rise from 2018 to 2019 was 4.3%. According to the Centers for Medicaid and Medicare Services, payments in the value of care are one statistic that will positively link to the initiative. MGH places a lot of emphasis on service prices, which are far more than the average level of payment in the country. The expenditures associated with heart attacks, heart failure, hip and knee replacements, and pneumonia patients are more significant than the national average. The death rate at MGH is lower than the national average, even though the cost of these treatments is often higher than the norm. Heart attack fatality rates at MGH are 11.6% compared to the national average of 12.3%, with an average cost difference of almost $2,500.
Validity and Quality
It is vitally essential for Massachusetts General Hospital to be able to employ several metric measurement kinds. Utilizing many approaches will make it simpler to ascertain how existing problems will turn out and to use the results to improve the accessibility and affordability of healthcare for their patients. According to an AHRQ article, effective measures support continuous improvement efforts and tables to highlight the system’s strengths and shortcomings, enabling a more targeted allocation of time and resources to fix the system’s flaws in healthcare delivery. Progress towards time, cost, quality, process complexity, and outputs are monitored using the process metric. Cost metrics are crucial knowledge that enables a decrease in care costs while focusing on labor savings, budget expenditure management, and expenses per service.
Insights and Opportunities
Within MGH, several areas might use quality improvement. MGH has upgraded an ACO even though it complies with all hospital spending trends and regulations that apply to other US healthcare companies (Accountable Care Organization). The relevance is preserved by focusing on the financial concerns of both patients and providers. Numerous studies have indicated a correlation between ACOs and reduced expenditure growth when compared to the results without the ACOs in existence, which is why it is hoped that these alternative payment models would enable the delivery of care and spending growth to halt. Information on the sustainability of change is acquired by adopting techniques that allow for a decrease in healthcare spending and a reduction in the cost of care.
Opportunity for Improvement
Explanation
Cost containment and receiving financial assistance for their patients are the areas of MGH that I have picked for development. Due to large deductibles and out-of-pocket maximums, most individuals still need help paying the price of medical care even when they have insurance. Due to the growing usage of testing equipment, machinery, and cost control over the previous two years and the coronavirus epidemic, the problem has only become worse.
The CEO of BCBS Massachusetts, Andrew Dreyfus, claims that costs have gotten out of control and will only worsen in the future.
Tool Selection
Finding and developing the best plan of action to enable patients to receive assistance with the price of healthcare services would be the most excellent way to address this problem. Allowing patients to set up manageable payment plans to pay off any healthcare debt gradually and effectively without placing too much of a strain on their finances would be a fantastic approach.
Collaboration between the hospital and the patients would be possible, significantly raising patient satisfaction levels. To prevent patients from receiving “surprise billing,” MGH has been evaluating several approaches. A long-term solution may be created for the hospital and the people I serve by suggesting a data-driven approach based on the underlying problem.
Patients are starting to experience all-time high levels of worry and anxiety due to the rising expense of things and the high degree of inflation, even simply in terms of staying healthy. Because of my present position, I have directly witnessed individuals refuse medical care such as x-rays, bloodwork, or even sick visits owing to the price involved, but even more personally because of my health difficulties, which is why I picked this area of improvement. I worked for Yale New Haven Health and had to go to the hospital because of a medical ailment. Even though all of my physicians were “in the network,” I was nonetheless liable for $48,000 of a $144,000 bill when I was discharged. If I had known this beforehand, I probably would have left against medical advice to avoid such debt. I argue that many people forego required care to avoid precisely the circumstance I am presently in, and I do not hold them responsible for doing so. This approach, which allows the patient to participate in the procedure, will guarantee a favorable result for all parties concerned. Many more people would be in better health if stakeholders and leaders of these healthcare organizations could work together successfully to achieve a shared organizational aim of reducing the cost of treatment for their patients.
Problem-Solving Framework
In my opinion, the Plan Do Study Act technique would be the most excellent foundation for addressing this issue with cost management. To determine what can be done and what has worked and what has not, PDSA would use both internal and external patient input. One of the leading causes for concern is that many patients have already reached and will soon reach a stage where they will either be unable to afford or find any aid for paying for their medical expenses.
Patients and staff members of the healthcare system would be able to identify which areas require the most improvement and where adjustments are made to be most successful by using PDSA.
Gathering data over time and visualizing it allows for the creation and identification of several approaches for system improvement. These data points include the number of patients, the length of hospital stays, and patient satisfaction. Once these patterns are identified and plotted, a team may find that this is their most effective tool. It is essential to recognize that maintaining the link between high performance and adequate quality is crucial when assessing quality improvements.
Recommendation
Initiative
Frameworks for issue-solving are crucial in healthcare delivery systems. The PDSA approach would be the best framework for problem-solving at MGH. Using the technique, the company can assess how the essential data is improved and how those improvements would advance the organization’s objectives.
Plan: Communication plans must be created with the assistance of organizational leaders to forge new connections and strengthen existing ones. Healthcare costs may be better understood by asking the managers and department heads of finance for information on the essential procedures and diagnoses (Heart attacks, heart failure, hip and knee replacements, and pneumonia).
Do: Patients will be able to express their thoughts on the cost of treatment that the organization is charging and whether or not it is reasonable for their present financial status by responding to questionnaires sent to them following a medical visit.
Study: It is possible to assess whether any changes should be made to the current plan to increase patient satisfaction and achieve the organizational goals by using the data gathered from the patient surveys and the analysis findings. It is possible to focus on and manage supply and demand inside the company by comparing the financial data acquired to national averages.
Act: All patients’ access to care may be improved by cooperation with other regional and national healthcare organizations and targeted plans to boost patient services in an outpatient environment. By creating improvement plans, expenditures reining in and communication procedures can be improved, lowering healthcare expenses.
Evaluation Method
One Month: To increase patient access to stated information, the organization must gather trustworthy information on service costs. Not only is this information required to prove the value for money, but it also facilitates making well-informed choices.
Three Months: Fair rates are created to compete with mentioned organizations within this business by implementing a system of other organizations that can give similar services to patients. The commonwealth fund claims that the law promotes the implementation of the patient-centered medical home, which emphasizes care continuity and care coordination started by the primary care physician. Furthermore, it is crucial to provide greater access to evidence-based care, chronic care management, and preventative care management.
Six Months: At this point, plans must be created to combine all educational materials acquired from consultations with organization personnel and employees from organizations that provide services comparable to the company’s. Much information is obtained by using collaborative techniques and efficient communication techniques.
Twelve Months: The company should have a comprehensive grasp of the HCUP (Healthcare Cost and Utilization Project) databases after one year of using the plan, do, study, act methodology. The Nationwide Inpatient Sample (NIS) is a national hospital inpatient care database accessible to all payers in the United States. This service is used by policymakers and researchers alike to detect, track, and evaluate trends in the healthcare sector regarding use, cost, access, quality, and results.
Data Collection
Although healthcare organizations have access to various data-gathering techniques, MGH must concentrate on the importance of standardization and public and private enrollment entities. To assist in the modification of practice management systems as well as electronic health record systems to ensure that all data is correct and consistent, and in place across any departments and units within the organization, it may be necessary to conduct extensive training of all hospital registration and administrative staff both on and off-site. Due to the breadth of the training, appropriate information on budget, types of services, and quality metrics must be given. The strategy we are adopting will be improved if Massachusetts General Facility makes an effort to comprehend the advantages that the hospital supplies.
Conclusion
It is essential to assess all healthcare quality measures to identify the most excellent chances for improvement efforts inside a healthcare organization since many companies experience health difficulties for various reasons. Because Massachusetts General Hospital is the most well-known hospital located in the heart of its largest city, they are faced with many problems and obstacles relating to health fairness, affordability, and cost control. It is necessary to assess priority areas for improvement by doing a plan to do a study act analysis at Massachusetts General Hospital since the cost of care and the value of treatment there are both above the national average on several levels for numerous different services. This approach would work best for Massachusetts General Hospital since it enables testing modifications and observing their effects on patient care costs. The evaluation’s findings will indicate what problems and concerns the organization needs to address in more detail.
References
About Massachusetts General Hospital. Massachusetts General Hospital. (2021). https://www.massgeneral.org/about/.
Hattis, P. A. (2017). Massachusetts and its Approach To Health Care Cost Containment Since Its Passage of its 2012 Law—Chapter 224. Tufts University Medical School. https://www.assembly.ca.gov/sites/assembly.ca.gov/files/Archives/paul_hattis_powerpoint _presentation_massachusetts_and_its_approach_to_health_care_cost_containment.pdf
Massachusetts General Hospital. (2019, September). 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. Boston. https://www.massgeneral.org/assets/MGH/pdf/community-health/cchi/20191016-CHNA- report.pdf
Massachusetts Health Policy Commission. 2021 Cost Trends Report. Sept. 2021. Available at: https://www.mass.gov/doc/2021-health-care-cost-trends-report/download.
Massachusetts Health Policy Commission. (2021, September 9). The new HPC report identifies key healthcare cost drivers and calls for immediate action to confront the Commonwealth’s pressing affordability challenges. Mass.gov. https://www.mass.gov/news/new-hpc
-report-identifies-key-health-care-cost-drivers-and- calls-for-immediate-action-to- confront-pressing-affordability-challenges-facing-the- commonwealth.
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