The quadruple aim is a set of guidelines designed to inform healthcare design and policy-making such that is does the most good in the most efficient and cost-effective manner. It has, as you might surmise, four precepts:
Improve Health Outcomes
Improve Patient Experience
Improve Provider Experience
Philosophically, you would be hard-pressed to find anyone that disagrees with these. But in action, it is often difficult to implement all four of these together.
Healthcare is a hydra
Healthcare is a system for improving the health of patients. Yet, it is also an industry that serves many masters. Think of the companies that do business under its umbrella, the providers who rightfully make their living therein, various strata of government who make policies that guide it, and countless other entities, like shareholders and financial institutions who have skin in the game.
With such a panoply of parties pulling for and protecting their interests, the aim of healthcare quickly gets muddled. Needs, goals, and desires overlap; sometimes they pull together and at other times they pull apart.
Quadruple Aim in action
While many policymakers, innovative startups, and legacy institutions strive nobly to accomplish the quadruple aim, many fall short of the mark. Most do so in good faith, finding that, not for lack of trying, it is difficult to please all the people all the time.
But there are ideas and initiatives that move the needle when it comes to the quadruple aim. An example that sprang into the zeitgeist due to the onset of the global pandemic is the rise of telehealth. Stuck at home but in need of care, the will of patients and providers found a way, and payers took note as a generally cheaper model helped ensure patients received the care they needed, providers found more professional balance, and health outcomes remained unaffected.
Another prime example is the rise of office-based procedures, which has been underway for decades. The roots of shifting sites of service stretch back to the origins of ASCs. Procedures of a certain nature, many realized, needn’t be performed in a hospital with all the rigamarole that comes along with it. Eventually, the logical next step was taken as certain procedures migrated to physician’s offices and clinics. Time and again, these procedures have proven to be safe, comfortable, convenient, and affordable. That’s why more and more procedures, like knee arthroscopy and balloon sinuplasty, are making the move.
Here’s why office-based procedures are truly the quadruple aim in action.
Hospitals are expensive. From staff to equipment to management to real estate, they have quite the overhead. ASCs less so, but there is still a significant investment required to service physicians across a spectrum of specialties. Offices and clinics cater to the physician(s) who make daily use of them. Office-based surgical suites can either be purpose built or converted from exam rooms by office staff or an outside agency, such as a trusted ambulatory anesthesia provider. Without the significant facility fee, office-based procedures routinely price well-below procedures performed in HOPDs and ASCs. Additionally, providers and patients save valuable time and travel expenses when procedures remain in-house rather than requiring an off-site location for execution.
Healthcare can be unsettling for some, especially when it requires traveling to an unfamiliar location that can, by its very nature, increase anxiety and fear. Office-based procedures, however, are undertaken in a known setting staffed by care providers that have a rapport and history with each patient. Scheduling, or, more precisely, scheduling errors are practically unheard of in the office, further driving down the anxiety that comes with tedious waiting or procedures being scrubbed and rescheduled. Patients arrive at the scheduled time, are treated on time, and get on with their lives.
Many of the procedures undertaken in the office are exploratory in nature and fall within the field of preventative medicine. Colonoscopies are more often performed in the office than not, and help gastroenterologists detect cancer and other GI disease before they progress to stages that require costly and, at times, risky interventions. The same is true of endoscopy and hysteroscopy. Further, the reduced cost of office-based procedures results in increased incentives and authorization from payers, which, in turn, increases access to these important preventative care measures. Put simply, reducing the cost of preventative care makes it more accessible and prevalent which reduces healthcare costs overall and increases health outcomes in general.
Exacerbated by the pandemic, physician burnout along with nursing shortages have shed light on a growing problem in U.S. healthcare. All too often, care providers are forced to choose between themselves and a job that can exact a physical and emotional toll. While office-based procedures are no panacea, they do return control to physicians and their clinical team. That includes controlling not just how care is delivered to patients, but where and when, and that convenience cannot be understated. Physicians can also grow their practices as office-based procedures offer an opportunity to significantly increase caseloads without increasing associated costs and taxing their schedule.
Portions of this piece on anesthesia and value-based care were originally published by Scope partner practice Mobile Anesthesiologists in Becker’s ASC review. It has been updated to reflect policy changes by CMS and changing landscape of non-hospital surgical care. While the backbone of value-based care is primary care and preventative medicine, inevitably surgical intervention is...
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