healthcare informatics

Healthcare Informatics: An Innovative Approach to Pre-Authorization At Mass General Hospital

Healthcare Informatics, April 3, 2014

Application aims to promote appropriate use and cut costs related to pre-authorization and unnecessary surgical procedures.

Healthcare spending in the U.S. is widely deemed to be growing at an unsustainable rate, and efforts are being made by policymakers to seek ways to slow that growth or reduce spending overall. A key target is eliminating waste—spending that could be eliminated without harming consumers or reducing the quality of care that people receive and that, according to the most liberal estimates, may constitute up to one-third of all U.S. health spending, amounting to hundreds of billions of dollars every year.

According to Creagh Milford, D.O., at the Boston-based Massachusetts General Hospital (MGH), demands placed on doctors in the clinic today such as meaningful use are challenging enough, but demands from payers or purchasers to actually provide data on the appropriateness of physician procedures to avoid the idea that doctors are overusing measures—and thus causing harm to patients—also exist.

Milford is an associate medical director at Partners HealthCare in Boston, a health system with two academic medical centers—MGH and Brigham and Women’s Hospital—with 6,000 doctors across the enterprise. There, he says, Partners has taken on financial risk throughout the system, and that includes assessing risk of a procedure before it’s done. The payers and purchasers of healthcare “are asking us to prove its level of appropriateness before we do it,” says Milford.  “There are few ways to do that other than using clinical decision support tools that help pre-populate many answers for the clinicians in a way that makes sense for their workflow.”

Read the full article: Healthcare Informatics, April 3, 2014