Patient Harm Monitoring: There’s No Value-based Care Without It

Overview

As healthcare pivots from fee-for-service to value-based care (VBC), the spotlight is on providing quality care at reduced costs. To achieve this, hospitals are increasingly adopting innovative strategies and programs, tactics and tools. A game-changer in this evolution is real-time adverse event, or patient harm, monitoring – which enables measurement and management.

By proactively identifying patient harm while patients are receiving care, hospitals can reduce or even avoid what is considered “low-value care” and, consequently, unlock material value on their VBC journey.

In this article, we explore the multifaceted benefits of patient harm monitoring and its transformative potential for health systems aiming for optimal patient outcomes and cost efficiency.

Five Dimensions of Value: How Patient Harm Monitoring Transforms Healthcare

1. Clinical Value. Pascal VPS, with its cutting-edge analytics, allows health systems to detect serious harm incidents often overlooked. Research, including studies conducted by Bates et al, and Pascal’s own client data has shown that implementing VPS can lead to a reduction of over 25% in overall harm, elevating patient safety and the overall quality of care. A striking fact from CMS suggests that around 29% of oversedation-related harm arises from inadequate monitoring^[1]The Joint Commission Sentinel Event database, emphasizing the importance of vigilant oversight.
2. Financial Value. When hospitals reduce patient harm, they are also reducing excessive length of stay (XLOS), which the landmark Bates et al Harvard study published in The New England Journal of Medicine most recently showed equates to 5.1 days – in line with other peer-reviewed published and real world evidence. This results in 3x-5x ROI per year, making a robust business case for patient safety initiatives and VBC strategies.

Both the Bates et al article and Dr. Don Berwick, in his accompanying editorial, observed that,

“The harder you look, the more harm you find.”

This means it comes down to leadership: do they want to find harm? Will they budget to enable their teams to find harm? Will they evaluate the impact of superior clinical and financial outcomes? Or is it simply too hard to calculate the negative impact on fixed and variable costs and prefer to launch some other new initiative?

3. Regulatory Value. CMS has announced a shift from claims-based measures such as the PSI-90 to EHR-based hospital harm measures. CMS has promulgated the first three, and it’s broadly expected that another 12-15 are in the pipeline. Now trigger-based adverse event detection not only enables health systems to improve outcomes but using the same data in the same workflow avoids CMS penalties and maximizes reimbursement.

Value-based care aims to optimize healthcare resources while maintaining high-quality care. Adverse event monitoring helps hospitals achieve this by reducing unnecessary healthcare costs associated with adverse events. By actively monitoring and addressing adverse events, hospitals can prevent complications, avoid unnecessary readmissions, and minimize the overall cost burden on the healthcare system. Additionally, monitoring enables hospitals to identify areas where resource allocation can be optimized, leading to better cost management and improved efficiency.

4. Legal Value. Pascal enables health systems to do VPS within a PSO, ensuring a “culture of safety” supports a non-punitive environment as we work to use this new method to learn the true measurement of harm and to reduce it through intervention, improvement, and advanced analytics. Pascal protects more significant harm findings of takeaway #1 from legal discovery or subpoena in our PSO and doing so eliminates legal liability in identifying harm as compared to traditional PSO models. Furthermore, this technology-enabled method identifies potentially compensable events (PCEs) within 24 hours of the patient harm occurring, opening up significant opportunities to reduce financial liability, legal expenses, and indemnity payouts.

5. Experience Value. All of the aforementioned dimensions improve patient experience. Pascal is well positioned to enable hospitals to use near real-time or real-time patient safety and risk information directly with patients and their families. This might take the form of initiating CANDOR or CRP programs with AE Outcomes – improving patient experience – or even, as Pascal did with Robert Wood Johnson-sponsored pilot at Mass Gen Brigham – share real-time outcomes and insights directly with patients and their families.

Conclusion

In the era of value-based care, is it possible to achieve value-based care while ignoring the evidence and real world data showing that health systems are not only finding 10x the level of serious harm with a trigger-based method but reducing that greater share of harm found by over 25%

Pascal’s view is, “No” – it’s not possible to claim to have high value care while ignoring the 95% of patient harm missed by the “See something, Say something” approach, i.e. event reporting.

Hospitals must embrace innovative approaches to improve patient outcomes while effectively managing costs. Adverse event monitoring, measurement, and management provides hospitals with a powerful tool to achieve these goals. By proactively identifying and preventing adverse events, hospitals can enhance patient safety, optimize resource allocation, and improve overall quality of care.

As hospitals continue to adapt to the evolving healthcare landscape, integrating robust adverse event monitoring systems will undoubtedly play a vital role in their journey toward delivering high-value care.