healthcare value analysis
By Mary E . Potter , RN , BS , CVAHP
Healthcare Value Analysis Basics Provide the Grounds for Successfully Navigating the Path and Avoiding Pitfalls
Adhering to the basic principles of healthcare value analysis can help you avoid the pitfalls of product selection .
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As healthcare value analysis becomes more integral to balancing patient outcomes and financial viability , the need for a standard process for identifying products and services that will meet , but not exceed the requirements is greater than ever . Adhering to the basic principles of healthcare value analysis can help you avoid the pitfalls of product selection .
Pitfall
1
We have a process , but it is not always followed .
When you are experiencing non-compliance to the process , review the basics , have you established a Charter , is there a policy in place , have you created and clearly communicated the expectations to your leaders ? More importantly , do you have the support of your executive team ? Can you rely on them to remove barriers and support your decisions ? Is your process patient centered ? Clinicians are more likely to support initiatives that take into consideration the impact on the patient : the product quality , safety , and the impact on patient experience . Take time to make sure everyone is on board .
Pitfall
2
How do we know whether we should move forward with a product evaluation ?
This question is all about methodology . A selling point for new products is often the claim that it will “ reduce infections .” In the operating room ( OR ) setting the claim may be that use of the product will “ save time .”
To decide whether to approve or reject moving forward with a request , the first step is to identify the need / opportunity . What do you need to achieve that you aren ’ t able to achieve now ? If the claim is reduced infections , meet with your infection preventionist to learn what your current rates are . Do reports support there is an opportunity for improvement ? Have you incurred Centers for Medicare & Medicaid Services ( CMS ) penalties for healthcare-acquired Infections ( HAIs )? Your finance representative can help answer this question .
Is there an opportunity to reduce variations in outcomes and reduce costs through standardization and improved contract compliance ?
If the claim is to “ save time ” meet with the subject matter experts ( SMEs ) to determine whether this objective is realistic . How do your procedural times compare with current industry standards or with you industry peers ? Will reducing time result in decreased full-time employees ( FTEs ) or make scheduling of additional procedures possible ?
If the proposed product does not satisfy a legitimate need , do not move forward with the request .
Pitfall
3
How will we know whether a product is acceptable ? Should we use a rating system ?
Once you determine the need is legitimate , before moving forward , establish the “ measurable value .” SMEs will compile a list of the requirements and characteristics the product / equipment / service must have to be deemed acceptable and identify the measureable value .
Are there randomized , controlled , peer-reviewed studies supporting improved patient outcomes , improved safety , or cost reduction ? Establishing valid evidence and identifying the product requirements provides you with the tool to evaluate one product or several competitive products .
Rating systems often inject preference and subjectivity into the decision process . If you plan to use a rating system there must be clearly defined levels of achievement or acceptability . In place of a rating system , you might choose to simply evaluate each requirement with a “ yes ” the product satisfies the identified requirement ( s ) or “ no ” the product does not satisfy the stated requirement ( s ). If a product does not satisfy the identified requirements , reject it .
Pitfall
4
What if there is a suspected COI ( conflict of interest )?
The Patient Protection and Affordable
Care Act of 2010 requires drug , device , and biologic companies to publicly report nearly all gifts or payments they make to physicians beginning in 2013 . Beginning on Jan . 1 , 2021 , reporting entities are now required to collect data about payments made to physicians and teaching hospitals as well physician assistants , nurse