From Volume to Value to Volume Again?
As the health care field continues to shift its focus from volume to value, leaders from three major academic health systems are asking surgeons hospitals to minimize the number of patients who undergo certain surgeries to prevent complications linked to insufficient practice.
Dartmouth-Hitchcock Medical Center, the Johns Hopkins Hospital and Health System and the University of Michigan Health System recently initiated the “Take the Volume Pledge” among the 20 hospitals that comprise the three health systems to define a minimum annual volume threshold for hospitals and surgeons for 10 surgical procedures:
- bariatric staple surgery
- resection for esophagus cancer, lung cancer, pancreatic cancer and rectal cancer
- carotid artery stenting
- complex aortic surgery
- mitral valve repair
- hip and knee replacement
“What’s remarkable isn’t that these leaders asked hospitals to focus on volume as a way to improve patient outcomes, but that they are doing it in 2015,” Ashish K. Jha, M.D., M.P.H., wrote in a Journal of the American Medical Association Forum article. “This story also reminds us of the nation’s inadequate efforts to measure quality meaningfully and the price we pay in lives lost and patients harmed,” added Jha, a professor of international health and health policy at the Harvard T.H. Chan School of Public Health and a practicing internist at the Veterans Affairs Boston Healthcare System.
A recent U.S. News & World Report analysis conducted as part of a new set of hospital ratings, Best Hospitals for Common Care—which aims to evaluate how hospitals perform on common conditions and procedures—found that hospitals that perform low volumes of certain surgical procedures put patients at higher risk than hospitals with teams experienced in performing those surgeries.
In its analysis, U.S. News found that overall, patients who underwent knee replacement surgery in the lowest-volume hospitals were nearly 70 percent more likely to die than patients treated at centers in the top quintile. Patients who underwent hip replacement surgery faced a nearly 50 percent higher risk of dying, and patients with congestive heart failure and chronic obstructive pulmonary disease had a 20 percent increased risk of dying.
Other risks posed by having surgeries performed at low-volume hospitals also include patients having to return more often after joint replacement for revision surgery due to infection or mechanical failure.