How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

Vegting, I.L.; Beneden, Marlou van; Kramer, Mark H. H.; Thijs, Abel; Kostense, Piet J.; Nanayakkara, Prabath W.B.

doi:10.1016/j.ejim.2011.07.003

Cited by 74 publications

(66 citation statements)

References 22 publications

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“…8 There is robust evidence that increased awareness of the cost of tests results in reductions in expensive test orders by physicians. 16,28,[32][33][34] Our lectures combined instruction on the cost of medical imaging with a thorough presentation of the ACR appropriateness criteria for abdominal imaging. Combining these topics was another key element of our educational design.…”

Section: Discussionmentioning

confidence: 99%

Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

Covington

Agan²,

Liu³

et al. 2013

Journal of Graduate Medical Education

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Background Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. Methods An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). Results There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P = .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. Conclusions A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system.

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Section: Discussionmentioning

confidence: 99%

Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

Covington

Agan²,

Liu³

et al. 2013

Journal of Graduate Medical Education

View full text Add to dashboard Cite

show abstract

“…[35] In summary, while the majority of lean healthcare studies is focused on improving the quality of healthcare services, only Vegting, van Beneden [28] has implemented lean approaches with a main objective to reduce the costs of healthcare services provided. With the help of aforementioned literature review, the main contributions of the proposed study can be stated as follows: (1) main focus is cost reduction while retaining the patient satisfaction level, (2) various lean tools are implemented to different processes of an hospital.…”

Section: Kaizenmentioning

confidence: 99%

“…Besides, Yousri, Khan [27] conducted kaizen studies in Goodhope Hospital to improve the quality of the service that is given to patients with femur fracture. Vegting, van Beneden [28] introduced several kaizens to reduce the costs of unnecessary diagnostic tests.…”

Section: Kaizenmentioning

confidence: 99%

Lean transformation to reduce costs in healthcare: A public hospital case in Turkey

Yurtkuran

Özdemir

Yurtkuran

et al. 2017

JHA

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Until recently, hospitals have adapted a series of quality standards to improve the quality of their services. However, these standards do not provide any cost reduction that is worth mentioning within which qualified personnel, material and indirect costs are already very high. To overcome this problem, lean production techniques have been integrated to the healthcare processes in the last few years. This study aimed to reduce costs by both improving and shortening the time of Social Security Instituition (SSI) based invoicing processes of a public hospital in Bursa, Turkey during the period of 2013-2014. To accomplish this goal various lean tools such as value stream mapping, poka-yoke, kaizen and standardization were presented and implemented. For validation purposes, montly SSI cuts, total income and process times before and after the lean transformation were analysed and compared. Furthermore, patient satisfaction surveys were carried out in order to investigate the negative effects of cost oriented lean studies. Results reveal that a clear improvement in total income is achievable, while maintaining the patient satisfaction levels. In this case, an eight percent improvement in SSI cuts resulting in a clear improvement on total income values has been obtained. Findings indicate that implementing lean tools on hospital processes is an effective way to reduce the healthcare costs while maintaining the patient satisfaction levels. The results of this study will stimulate the research in adopting lean techniques not only for patient satisfaction, but also for cost reduction purposes in hospitals.

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confidence: 99%

“…The drive to contain costs is focused not only on therapeutics, but also on reducing, often unnecessary, diagnostics. In this diagnostic field, studies have shown that doctors who are aware of test costs order fewer tests [5,6].Rational prescribing includes comparing the efficacy, safety, suitability and cost of treatment options, according to the WHO guide to good prescribing [7]. The WHO guide to good prescribing and the associated six-step guideline are internationally used to teach pharmacotherapy to future prescribers [8].…”

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confidence: 99%

Students and Doctors are Unaware of the Cost of Drugs they Frequently Prescribe

Schutte

Tichelaar

Nanayakkara

et al. 2016

Basic Clin Pharma Tox

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Given the increasing healthcare costs of an ageing population, there is growing interest in rational prescribing, which takes costs of medication into account. We aimed to gain insight into the attitude to and knowledge of medication costs of medical students and doctors in daily practice. This was a cross-sectional electronic survey among medical students (bachelor/master) and doctors (consultants/registrars). Attitude to costs was evaluated using a cost-consciousness scale. In open questions, the participants estimated the cost of commonly prescribed (generic/non-generic) drugs (including separate pharmacy dispensing costs). They were asked where they could find information about drug costs. Overall, a reasonable cost-consciousness was found. Students were less conscious of the cost than were doctors (15.56 SD 3.25 versus 17.81 SD 2.25; scale 0-24; p = 0.001). In contrast to this consciousness, actual estimated drug costs were within a 25% margin for only 5.4% of generic and 13.7% of proprietary drugs (Wilcoxon signed-rank, p < 0.001). The price of generic drugs was frequently overestimated (77.5%) and that of proprietary drugs was underestimated (51.4%). The dispensing costs were estimated correctly for 30% of the drugs. Most doctors (84%) and a minority of students (40%) were able to identify at least one source of information about drug costs. While doctors and students considered it important to be aware of the cost of drugs, this attitude is not reflected in their ability to estimate the cost of frequently prescribed drugs. Cost awareness is important in therapeutic reasoning and cost-effective prescribing. Both should be better addressed in (undergraduate) pharmacotherapy education.Approximately €200 billion is spent on medicines and drugs annually, about 16-17% of the total healthcare expenditure in the EU [1]. These costs must be controlled to keep health care affordable, especially in today's ageing society with its increased care consumption [2]. Besides the importance of pharmacoeconomics to society in general, it is becoming increasingly important for hospitals, doctors and individual patients. Depending on the country and type of medical insurance, patients have to pay certain costs (i.e. deductible excess in the Netherlands) [3], and doctors and hospitals are under pressure from health insurance companies and governmental institutions to take medication costs into consideration, for instance, by prescribing generic rather than proprietary drugs [4]. The drive to contain costs is focused not only on therapeutics, but also on reducing, often unnecessary, diagnostics. In this diagnostic field, studies have shown that doctors who are aware of test costs order fewer tests [5,6].Rational prescribing includes comparing the efficacy, safety, suitability and cost of treatment options, according to the WHO guide to good prescribing [7]. The WHO guide to good prescribing and the associated six-step guideline are internationally used to teach pharmacotherapy to future prescribers [8]. Currently, ph...

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How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

Cited by 74 publications

References 22 publications

Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

Lean transformation to reduce costs in healthcare: A public hospital case in Turkey

Students and Doctors are Unaware of the Cost of Drugs they Frequently Prescribe

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