Monday, March 31, 2008

Silverman Institute inaugural event

I just returned from celebrating the inaugural event of BIDMC's Silverman Institute for Health Care Quality and Safety. The Institute was created by a generous donation from our Board Chair Lois Silverman and her late husband Norman, and is the focal point for our quality and safety programs, as well as academic programs in that field. The event was also the inauguration of a new lecture series, entitled the Michael F. Epstein, MD Lectureship on Clinical Quality and Patient Safety, generously funded by numerous donors in honor of the hospital's previous chief operating officer.

Our speaker was Dr. Brent James, from InterMountain Health Care. He had a lot of useful things to say about the quality improvements in his system, but the focus of the talk was "Doing Well by Doing Good: The Business Case for Quality."

My main take-away: Within a very few years, we will face a hockey stick pattern of unfunded shortfalls in medical costs paid by the federal government. At that point, there will be four main options: (1) raise taxes; (2) decrease Medicare benefits; (3) shift funds from other programs, like education and national defense; and (4) reduce payments to providers. Which of the four do you think is most likely to be preferred by elected politicians? Number (4), of course. "The money is not going to be there. The business strategy of providers has to be based on managing the cost structure of clinical care." Improving the quality and safety of care is the most efficacious way of doing that.

So, quality improvement has to be a core business strategy for hospitals. Now is a good time to start and learn how to do this. As Brent notes, "It was not raining when Noah built the ark."

Dear hospital colleagues: Do we really need this reason, also, to reduce harm in our hospitals? Well, it can't hurt to be reminded that there is a financial case to be made, in parallel to the humanitarian aspects. Early adopters will do better when the rain starts to fall.

1 comment:

Anonymous said...


There's a fifth option-- take on debt. As much as politicians don't like raising taxes, they're not going to take on physician reimbursement (a politically difficult issue) until we're in dire straits. Looking at historical levels of debt relative to GDP, I suspect there's at least a few trillion in further debt spending related to health care before real reform will take place.