Across the country, physician executives (and, increasingly, their finance colleagues) are dialing up efforts to reduce unwarranted care variation—usually as a way to manage costs. There is a tremendous amount of published research documenting the widespread variation that exists nationally, but many physician leaders struggle to translate the academic literature into practical guidance that can help focus their institution-specific efforts.
In our work with physician executives, we’ve found there are two practical approaches for analyzing care variation at the health system level—the vertical approach, which analyzes opportunity by disease state, and the horizontal approach, which analyzes opportunity by utilization. I'm excited to announce two new resources available to Crimson Continuum of Care members that correspond to each.
Two approaches to tackling care variation
The vertical approach—the Care Variation Short List
The vertical approach focuses on identifying the biggest areas of opportunity by disease state or DRG. Most members begin with the vertical approach because it’s easier to engage physicians in improvement initiatives when the opportunity is presented in terms of the disease areas they treat.
Danbury Hospital in Connecticut is an exemplar of the DRG-based approach and was a past recipient of our Crimson Physician Partnership Award for their success using Crimson to identify high-variation DRGs and engage physicians in DRG-specific process improvements, all resulting in more than $6 million in cost savings.
Our colleagues with the Physician Executive Council are now making it easy for Crimson members to prioritize the highest-impact DRGs. Their "Care Variation Short List," which is being presented at the Council’s current national meeting series, highlights four clinical areas with the greatest opportunity across the Crimson cohort.
The Council's research team used Crimson cohort data to quantify variation by DRG, controlling for severity and geography, then vetted their quantitative analysis with some practical screens—like whether the identified areas were likely to yield ROI, improve care quality, or whether physician leaders could reasonably be expected to have an impact. They ended up spotlighting four high-impact areas: sepsis, heart failure, hip and knee replacement, and labor and delivery.
Not only has the research team identified these opportunities, they are also putting together playbooks that provide tactical guidance, case studies, and tools for improving performance in each of the four areas. The sepsis playbook has already been published, and the team will be releasing others in the coming year.
The horizontal approach—Crimson's Clinical Variation Analyzer
Another powerful way to evaluate variation is to look at opportunities in areas of clinical utilization that cut horizontally across diagnoses—imaging, labs, and pharmacy, for example. Crimson's new Clinical Variation Analyzer (CVA) provides national utilization benchmarks, coupled with quality data, to help physician leaders identify where utilization is truly appropriate—or not.
By "normalizing" the chargemaster descriptions used by 600+ hospitals, Crimson allows members to compare charge item use—starting with radiology charges—across individual physicians and hospitals within their own system as well as nationally, despite having completely different charge masters.
How? Using natural language processing and other advanced algorithms that recognize millions of different charge codes and match them to a known industry standard, Crimson staff map each member's charge master data. There is no additional fee, time commitment or data required from any member institution to receive access. For details on when your organization can expect to receive access to CVA, please contact your dedicated advisor.
The Clinical Variation Analyzer enables members to:
- Benchmark utilization of charge description master-level items against a cohort-wide database with billions of orders
- Analyze utilization by severity, APR-DRG, ICD-9 diagnosis, and ICD-9 procedure levels
- Assess quality (like complications of care or mortality) and cost (like length of stay) performance based on resource use
- Compare subspecialist performance to hundreds (even thousands) of physicians nationally
- Dive deeper into your data to learn about the volume of orders, volume of items use per case, and day of use