EBM12: Can EHRs make docs aware of costs?
CHICAGO—EHRs may help physicians understand the costs associated with certain unwarranted practices, said Andrew D. Auerbach, MD, MPH, during an Oct. 5 presentation at the CMIO Leadership Forum: Transforming Healthcare through Evidence-Based Medicine.
It takes a long time to translate clinical research into clinical practice, explained Auerbach, a professor of medicine at the University of California, San Francisco. On average, it takes 16 years to translate a biomedical innovation from bench to bedside, and it is unknown how long it takes to have some practices performed effectively and appropriately, he said.
To speed adoption, he recommended consciousness-raising, changing social norms, counter-conditioning, self-efficacy, training and system change.
Also, in today's healthcare environment, there is an increased focus not just on the clinical outcomes but also on adding value or reducing costs associated with care. EHRs have the potential to make transparent some of the costs of performing certain procedures, according to Auerbach.
Physicians first need to be made aware of the cost structure in their settings. To help elucidate this, Auerbach explained the types of costs in healthcare:
Where do EHRs fit in this spectrum of costs? Over the short term, Auerbach said they have limited impact on reducing variably costed items. Efforts to reduce utilization of costly items often is offset by compensatory efforts to maintain revenue to subsidize fixed costs, and the goal will need to focus on reducing fixed and variable costs in tandem.
Implications over the longer term include the fact that EHRs:
Speaking to the efforts to target physicians for cost reduction, research has shown that in general they are educational in nature and result in a “slight decrease” in utilization patterns—and effects do not differ whether they are IT-based or not, according to Auerbach.
Despite some of the discouraging data, he concluded that physicians, as part of the healthcare system, “have to expand their recognition that costs are important, and EHRs can help reinforce positive behavior and discourage unwanted behavior.” He added that EHRs can do this because they provide decision support compared with paper models and they have the flexibility to catch physicians who are veering off-path from appropriate practices.
Thus, they set “firm-ish guardrails” for unwanted practices, according to Auerbach, and actually have the potential to measure what the pathway is doing to provide clear feedback.
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.
It takes a long time to translate clinical research into clinical practice, explained Auerbach, a professor of medicine at the University of California, San Francisco. On average, it takes 16 years to translate a biomedical innovation from bench to bedside, and it is unknown how long it takes to have some practices performed effectively and appropriately, he said.
To speed adoption, he recommended consciousness-raising, changing social norms, counter-conditioning, self-efficacy, training and system change.
Also, in today's healthcare environment, there is an increased focus not just on the clinical outcomes but also on adding value or reducing costs associated with care. EHRs have the potential to make transparent some of the costs of performing certain procedures, according to Auerbach.
Physicians first need to be made aware of the cost structure in their settings. To help elucidate this, Auerbach explained the types of costs in healthcare:
- Fixed costs don’t vary over ranges of output, such as buildings and equipment paid for once or salaried personnel already factored into the budget. For instance, a PET scanner is “expensive, but it is paid for once. The cost of upkeep, space and the PET technician don’t vary substantially as more people use it,” he said.
- Variation costs change as the volume of series increases, related to some medication and material costs. For instance, reducing the number of CT scans may reduce the amount of contrast purchased and used.
- Marginal costs: Outside of healthcare, this relates to the costs of producing an additional product, which decreases with each additional unit. In healthcare, this usually isn't the case. Instead, it relates to cost per unit output fixed until maximal capacity is reached. For instance, an additional PET scanner or PET scan is not priced lower than the first one. “Replacement options are generally not of lower cost,” said Auerbach, pointing to an Xa inhibitor vs. warfarin.
Where do EHRs fit in this spectrum of costs? Over the short term, Auerbach said they have limited impact on reducing variably costed items. Efforts to reduce utilization of costly items often is offset by compensatory efforts to maintain revenue to subsidize fixed costs, and the goal will need to focus on reducing fixed and variable costs in tandem.
Implications over the longer term include the fact that EHRs:
- Can be used to automate human tasks;
- Can be used to eliminate the need for fixed-cost items;
- Must provide clear cost and utilization data; and
- Can overcome barriers or innovate on old models, such as physician awareness and health technology acquisition committees.
Speaking to the efforts to target physicians for cost reduction, research has shown that in general they are educational in nature and result in a “slight decrease” in utilization patterns—and effects do not differ whether they are IT-based or not, according to Auerbach.
Despite some of the discouraging data, he concluded that physicians, as part of the healthcare system, “have to expand their recognition that costs are important, and EHRs can help reinforce positive behavior and discourage unwanted behavior.” He added that EHRs can do this because they provide decision support compared with paper models and they have the flexibility to catch physicians who are veering off-path from appropriate practices.
Thus, they set “firm-ish guardrails” for unwanted practices, according to Auerbach, and actually have the potential to measure what the pathway is doing to provide clear feedback.
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.