Managing the waste of over processing in healthcare using accountability through utilization reviews and information technologies

摘要

Sustainable performance in healthcare can be through proper patient care at the right cost, with proper utilization of resources and care procedures. In reality, healthcare has a lot of wasted resources and high costs. Unnecessary care may account for huge avoidable costs per year in US healthcare. High healthcare costs due to overtreatment are a difficult challenge to sustainable healthcare services. Lean Six Sigma principles can be employed to eliminate non-value-added wastes. This article focuses on some prominent mechanisms in healthcare policy that address over processing. Accountability can improve healthcare services while reducing unnecessary costs and patient length of stay. Accountability includes negative or positive consequences and justifications for actions that led to the outcomes. The article refers to accountability as having responsibility for one's actions. Accountable care organizations have been promoted by the Center for Medicare and Medicaid Services to share accountability across organizations. Additionally, government sponsored efforts promote individual accountability of physicians. Hospitals commonly implement accountability through utilization review of health-care services. Utilization reviews create a system of accountability for addressing over processing. Utilization reviews are a safeguard against unnecessary medical care. These reviews examine efficiency of care and focus on accountability of individual providers. A second mechanism used to address over processing is healthcare information technology (HIT) that provides infrastructure for processing pertinent patient information. Accountability through utilization reviews relies heavily on availability of healthcare data. Baldrige quality frameworks for healthcare emphasize the importance of measurement, information and analysis. Both clinical and administrative data are needed for determining the appropriateness of patient care and cost. It is important to consider how HIT relates to accountability through utilization reviews for improved performance. The article offers multiple contributions for managing healthcare performance and over processing. The research also examines performance implications of using both individual and cross-functional accountability through reviews. (95 refs.)