Conference Presentation POSTER PRESENTATION
How to make the best use of limited resources; Keep the cost low, & quality high ?
With the advent of insurance & third party Administrator concept “managed care” is Unfolding
However the costing system of this “care” has been totally neglected. In the absence of standardization like “Health related groups” or diagnostic related groups”, How can the relative pricing, coupled with optimal quality be ensured ?
“Developing Integrated Care Pathways to achieve benefits for both TPA and the participating hospital”
It is both a tool and a concept with much to offer.
“Integrated care pathways are structured multidisciplinary care plans which detail essential steps in the care of patients with a specific clinical problem. They have been proposed as a way of encouraging the translation of national guidelines into local protocols and their subsequent application to clinical practice. They are also a mean of improving systematic collection and abstraction of clinical data for audit and of promoting change in practice.”
How do Care pathways translate into benefits at large :
Benefits to the TPA
By developing a care pathway treatment gets standardized, So standard cost packages for clinical procedures can be developed. Extra costs get eliminated because the pathway is designed with efficient targets eg. Number of tests required/length of stay etc.
Zero effort is spend on ascertaining validity of procedures and tests.
Communication frequency with hospital is reduced because the authorization process gets streamlined.
Rather than going through all documentation (amounting to hundreds of claims a day) only those handful claims need review which have “Variances” i.e. treatment/tests performed extra to those approved of on the care pathway.
Benefits to the participating Hospital
Since a treatment protocol is pre-printed, it greatly reduces paperwork and documentation and eliminates variations in treatment.
The pathway is based on evidence based medicine / guidelines therefore it ensures best treatment option.
Consumer protection cases can be eliminated since risk management tools are inbuilt in the documentation and legal requirements are taken care of.
Cost-reduction can be achieved by streaming the process of treatment from reception to discharge.
Since the care pathway costs are already approved, authorization process become a very simple task, and the resources, can be saved.
It enhances communication between the multidisciplinary care team and the patients because of excellence of documentation.
It is a learning process for the junior doctors because of the pre-printed treatment guidelines, this also makes handing over very efficient and effective.
A "win-win situation"- Two case results
1) (1) BMJ 2004;328:664 (20 March) “Hospitals that follow heart attack guidelines save lives”
Study Results-“ There was a 25% lower risk of dying within a year after discharge if hospitals followed national guidelines and taught their patients how to follow those standards at home and in another-for every 10% increase in adherence, mortality fell by 11”.
2) (2)Before and after “congestive heart failure” care pathway implementation in Canadian- USA Hospitals.
Summation
TPA-Facilitates great reduction in workload, efficient & effective practice with great output.
HOSPITAL- A care pathway is a boon for the hospital because it streamlines the work, reduces cost, reduces any risk of consumer litigation and at the same time, makes dealing with the TPA very simple easy.
It is unique in being a clinical & a management tool. There are no compromise in either case.
