For years, advocates of quality and patient safety have argued that better adherence to best practices and standards of care can not only improve care, but reduce cost. But in an era where declining and changing reimbursement is a top concern for all hospital leaders, the charge to improve quality while saving unnecessary expense has never been greater.


At a panel discussion in Washington, D.C., Thursday, hosted by the American Hospital Association, health care leaders and front-line clinicians attested to promising results from the field on several key patient safety concerns, including health care-acquired infections, readmissions, and elective preterm births.

Maulik Joshi, AHA senior vice president and president of the AHA's Health Research & Educational Trust, discussed early findings from HRET's participation in the Centers for Medicare & Medicaid Services Hospital Engagement Networks initiative. HRET is one of 26 HENs in operation. The HEN's early successes, said Joshi, include a 50 percent decrease among participating hospitals in elective births before 39 weeks, a marked drop in cases of catheter-associated UTIs (CAUTI) and a 10 percent reductions in readmissions by participating hospitals. All told, Joshi said, HRET's HEN has created annualized savings of roughly $74 million.

"It shows the work you can do in a short period of time working together," he added

Jonathan Perlin, M.D., chief medical officer for HCA and an AHA board member, discussed the imperative of reducing elective preterm births, noting that in the last 25 years, the average length of pregnancies has declined by 10 days — with many observers pointing to preterm elective delivery as a key factor. At HCA, a new "hard stop" policy helped reduce the rate of early elective delivery from 15 percent to 4 percent. In turn, Perlin said, those reductions free up neonatal ICUs for unavoidable complications.

"If everyone followed this process and achieved benchmarks, our country would save $1 billion of avoidable expenditures," Perlin said.

Carolyn Clancy, M.D., director of the Agency for Healthcare Research & Quality, was also on hand, and talked up an AHRQ-led, 1,100 hospital neonatal ICU project that led to a 58 percent reduction in central-line associated bloodstream infections, which prevented an estimated 41 lives and saved $2.2 million in costs. The key, Clancy said, was careful adherence to best practices.

"This shows that dramatic results can be achieved when you have a proven method of improving quality of care," Clancy said.

Cost savings, of course, often come from reimbursements to hospitals, physicians and other providers. AHA President and CEO Rich Umbdenstock asked the panel how they balance the impetus to improve quality with the financial imperatives of their institutions. All of the panelists argued that in an environment quickly shifting from fee-for-service to fee-for-volume, the business case for quality has never been greater. Martin Padgett, president and CEO of Clark Memorial Hospital, Jeffersonville, Ind., summed it best, though, noting that if hospitals can save time spent dealing with avoidable readmissions and infections, they will be able to concentrate on bigger-picture concerns.

"We believe with reducing infections and readmissions, we can focus on well care," Padgett said. "While payment may not be there yet, it's moving."