Heard a mind-blowing presentation by Robert Mechlenburg, MD, Chief of Medicine at Virginia Mason Medical Center in Seattle. This is a medical center that has bought hook, line and sinker the Toyota “lean production” model to improve quality and lower costs. The Toyota LP model has two key parts: 1. Build in Speed (just what is needed, when it’s needed, and where it’s needed); and 2. Build in Quality (mistake proofing, stopping the line, evidence-based medicine). When combined the right way, both component lead to less waste and lower costs, as well as care that is better, faster and more affordable.
The marquee example of what they did involved back pain treatment.
Here’s the traditional patient care path:
Wait to See Primary Care Physicians (PCP)
Wait to see PCP again
Wait to get MRI
Wait to see PCP
Wait to see Specialist
Wait for referral to Physiatry
Wait for referral to Physical Therapy
See Physical Therapist
Here’s the new model based on applying the LP system:
Direct Referral to Physical Therapist
See Physical Therapist.
Here’s the Value Difference:
Cost to VMMC: 2005 – $2272; 2006 – $878
Paid by Employer or Insurer: 2005 – $2353; 2006 – $845.
Staff Needed: 2005 – 18.6; 2006 – 8.9.
Employee Work Days Lost: 2005 – 20; 2006 – 3.
Patient Satisfaction Score in 2006 (5.0 highest possible rating): 4.8.
Problem – in the old system, VMMC made money, and in the new system, they lost on every encounter. Answer, partners such as Starbucks increased reimbursement for physical therapy so that VMMC makes money in the new arrangement.
By my calculation, more than 60% of the payment under the old plan was sheer waste and inefficiency. How much more waste and inefficiency is there in medical care? VMMC says “a lot.” VMMC is applying this process improvement model everywhere in their system with some amazing results.
Do fantastic stories like this happen in Massachusetts? I’m asking seriously. I know Boston Medical Center had some great success a few years ago reducing ER overcrowding by improving patient flow. But these stories seem to me few and far between here in Massachusetts. Maybe they’re all over the place and our provider systems are just, well, shy…?
Hey folks, how about it? Aren’t we supposed to be better than Seattle and anywhere else? Let’s hear about it.