Let’s set the stage with a couple of industry quotes.
“We’re sorry, but we have no idea how we perform on the procedure you are having. We can’t tell you if our physicians use the best treatments—the treatments shown in the literature to be the best … but trust us, we have some great physicians, and we deliver great care. We just can’t prove it.”1
“Putting a single, predictable price tag on a medical procedure allows a hospital to position these services as ‘branded products’ and to compete on cost and quality. The common element is the necessity to leverage both cost and quality data to craft an evidence-based economic and clinical value story that the organization can share with payers and employers.”2
The above quotes capture the essence of the hospital C-suite’s dilemma today: persistently driving toward greater value while dealing with the pervasive and pressing issue of first defining and then actually measuring quality and cost, the two major components of their value statement.
So what is emergency medicine doing to become the primary driver and answer for today’s hospital executives? Whether an employed, contracted, or an academic practice, emergency medicine can become the epicenter of answers for disruptive innovation and positive change in every hospital.
There needs to be a concerted effort by the specialty to tighten up its own house first. According to Kanzaria et al, “over 82 percent of respondents believe too many diagnostic tests are ordered in their own emergency departments.”
Before tackling the issue of emergency medicine becoming the answer to this C-suite dilemma, it is first important to note how emergency medicine will not only not become an answer but alternatively can persist as a center of problems for hospital executives. There needs to be a concerted effort by the specialty to tighten up its own house first. According to Kanzaria et al, “over 82 percent of respondents believe too many diagnostic tests are ordered in their own emergency departments.”3 Some degree of intraphysician variability is acceptable. However, it is imperative that we reduce wide variation in patient treatments and diagnostics. W. Richard Bukata, MD, medical director for The Center for Medical Education, Inc., discusses practice variability specifically regarding computed tomography scans and plain X-rays.4 Stephen Klasko, MD, MBA, president and CEO of Thomas Jefferson University in Philadelphia, provides valuable perspective here: “Doesn’t it stink that Nick Foles has a better idea of whether a screen pass will work in a given situation than I do of knowing whether a cancer drug will work?”5 This is prime time for evidence-based medicine.