Quality care not tied to financial return

The search continues for a "business case" for improving health care quality.

By Andis Robeznieks, AMNews staff. May 5, 2003.

It's been said that those in charge of improving the quality of the nation's health care are the people in the back offices of hospitals and government buildings using old computers and working on shoestring budgets. And until improvement in quality leads to a corresponding measurable improvement in finances, that's likely how it will stay.

A research team led by Sheila Leatherman, adjunct professor of health policy and administration at the University of North Carolina at Chapel Hill, and Donald Berwick, MD, CEO and president of the Boston-based Institute for Healthcare Improvement, sought to erase the notion that quality doesn't pay by setting up five case studies that would establish a "business case for quality." All five failed to do so.

A popular definition for quality health care is providing a patient with the right medicine, treatment or test at the right time. The researchers, whose report was published in the March/April issue of Health Affairs, defined a business case for quality as a situation in which an entity invests in a quality improvement intervention and realizes a financial return in a reasonable amount of time.

Leatherman said the case studies did show that savings were made, but not in a form that would please corporate accountants or shareholders.

"The entity that makes the initial investment doesn't reap the return on the investment," she said.

Nevertheless, Leatherman believes that the movement to improve health care quality, with its emphasis on prevention and management of chronic diseases, eventually will produce a financial benefit for primary care physicians. "If [quality improvement] was pursued to its logical and desired outcome, it really moves some of the monies for reimbursement and payment upstream."