Reflections on the VBHD Seminar

Andy Hung-Yi Lee, MD, MBA
Resident in Emergency Medicine BWH/MGH
PGY- 1

01/31/2020

Maximizing Value by taking into account both Outcomes and Cost
is a major theme of the course and for the future of healthcare. 

The first time I was introduced to one of the key concepts of the course, that Value = Patient Reported Outcomes / Cost, I really wasn’t sure what to make of it. It goes against most of what I’ve been taught and what I’ve experienced. As clinical providers our goal is usually to maximize clinical outcomes, irrespective of cost. It also wasn’t intuitive that the value of our care is determined by how patients perceive the change in their quality of life, which isn’t necessarily what is optimal medical management.

Over the next three days, as we worked our way through multiple cases, we saw how different institutions across the country dealt with the drive towards value. For certain providers, it was all about reorganizing hospital operations around core disease processes. Other providers, especially those in surgical specialties drilled down to key value-generating activities and refocused them to have providers practice to the top of their license while eliminating waste. And from a more macro perspective, some successful organizations made use of powerful network effects and efficiencies while others strategically chose niches within the complex reimbursement system to thrive.

But what does all this mean for EM physicians like me? In the emergency department, it can be difficult to determine what constitutes value and how to measure success. Is it about shortening wait times? Is it about delivering the most cost-efficient care without compromising outcomes? What metrics should be measured? What this course provided is not the answers to these questions, but frameworks with which to seek the answers ourselves.  It has certainly made me think more about how patients perceive the care we deliver and whether the metrics we routinely measure such as length of stay, rate of left without being seen, daily throughout, are what truly matter to patients. Even now, as I work on a project involving MGH ED transfers to community hospitals, the frameworks we discussed in the course are helpful in better understanding this complex process. Going forward, I will certainly make good use of these concepts and learnings as I strive to improve how we deliver care to the patients that we serve.