Virginia Mason’s “lean” approach cuts costs, improves quality – report says
A new approach to health care in which insurers pay for the quality of, not the quantity of, care can substantially cut costs, improve outcomes and boost patient satisfaction, according to a report released by Seattle’s Virginia Mason Medical Center.
Virginia Mason has won a reputation for innovation in particular for its adoption of the “lean production” techniques first developed by the Japanese car manufacturer Toyota.
The Toyota approach emphasizes a relentless elimination of waste, errors and inefficiency and is credited with making Toyota one of the highest quality car makers in the world.
Costco, Nodstrom, Starbucks and King County and the insurer Aetna joined in the effort
In an initiative launched three years ago, called the Marketplace Collaborative Project, Virginia Mason joined with the local employers Costco, Nordstrom, Starbucks and King County and the insurer Aetna to improve the quality of and reduce the cost of common medical conditions that account not only for high medical bills but also high costs due to days off work and disability.
Virginia Mason promised to provide care only of proven value for these conditions and to provide it quickly.
For their part, employers and the insurer agreed to adjust reimbursement rates so that the medical center would not be perversely punished for providing lower cost but higher quality care.
Medical bills are often bloated with unnecessary tests and procedures that may do little good and, in some cases, actual harm
Currently, it is standard practice for insurers pay healthcare providers based on the number of services they provide whether or not the services are effective. As a result, medical bills are often bloated with unnecessary tests and procedures that that boosts healthcare providers’ income but may do little good and, in some cases, actual harm.
The collaborative identified 10 “high healthcare spends” that drive up employers’ health costs. There were: prevention and screening; back and neck pain; knee, hip and shoulder pain; type 2 diabetes; depression, breast disease; headache; respiratory disorders (asthma, sinusitis and cough); abdominal pain; and chest pain.
Virginia Mason promised to work to get patients in on the same day they called for an appointment, to only provide care that was based on the best evidence and to provide that care at an affordable price, and to achieve 100% patient satisfaction.
For back pain, for example, the medical center formed a Spine Clinic team that sought to provide “same-day access” to a physical therapist and a physical medicine physician, to limit the use of expensive MRI scans to those patients who symptoms indicated such scans would be useful, and to enroll patients in a therapy program that quickly gets them back to work.
On average patients had 4.4 visits for care, half as many as is typical for the area.
In an annual report available online, Virginia Mason says it was able to provide same-day appointments to 2,000 patients in 2007, up from 500 in 2004, to cut the number of MRIs by a third, while at the same time achieving patient satisfaction ratings of 4.9 on a 5-point scale.
On average patients had 4.4 visits for care, half as many as is typical for the area, and patients were back at work sooner, losing on average 4.3 work days compared to the area average of 9.0 work days, the report says.
According to Aetna’s claim data, the cost of care dropped as well. Whereas, Virginia Mason’s costs were five percent above the area’s average at the beginning of the program, by 2007 they had fallen to nine percent lower the area’s average for back pain care.
These savings don’t count the money employers save by having their workers back on the job more quickly.
To learn more:
- Read Virginia Mason’s report on the Collaborative and its other initiatives on the Center’s “VM Works” Web page.
- Read the Wikipedia entry on Toyota’s “lean production” techniques.
Category: Health-care Policy, Hospital News, Virginia Mason
Subscribe
If you enjoyed this article, subscribe to receive more just like it.
LocalHealthGuide is a health news and information web service for Seattle and the Puget Sound Region. We are independent and unaffiliated with any hospital, medical association or insurer. If you have questions or if your group has an upcoming event that you would like us to cover, please let us know by going to our "
Add to Google
I do not think much of VM “lean” system.
On August 2, I went to see my VM doctor about ankle pain. That doctor referred me to a second doctor, who I saw me on August 18, two weeks later.
That doctor, who, after looking at an x-ray, told me I have arthritis, prescribed Diclofenac an anti-inflammatory, and referred me to a therapist.
After just one visit, the VM therapist decided that I could do certain exercises on my own.
But my pain persisted.
Then, I visited a shoe store, and the owner listened to my symptoms. He said, he wasn’t a doctor but it sounded like a torn tendon.
The only way to determine that was with an MRI. I then called my VM doctor and requested an MRI.
Approval was given, but it took 2 weeks and several phone calls before the results were relayed to me.
The test confirmed that I had a torn tendon, not arthritis.
It was not until 10/14/2008, more than two months after my first visit, that I was seen by a surgeon.
Now, insurance complications have arisen and because of the long delay in care, I’m going to have to wait until next year for my operation.
This new “lean” method of care may be of value to employers and insurance
companies but it was definitely not of value to me, the patient.