Every Country Is Struggling With The Cost Of Healthcare - TBE Responds To A Request To Visit Colombia

March 23, 2020


One of my responsibilities at Terumo Business Edge is to find new ways to provide customers value in any cardiovascular program. We are all familiar with the definition for value in healthcare; a low-cost program with high quality outcomes. No one can dispute the importance of these deliverables, but finding the components programs are successfully implementing to achieve value is often lacking. Finding these actionable events or components has been my mission over the past several years.

When Gary Clifton, our Vice President, offered me the opportunity to work with three Terumo customers in Medellin and Bogota Columbia I had to pause. This was the country Colombia not the city, and contrary to what many think, these cities are safe for US travel and represent excellent healthcare delivery.  We know the healthcare delivery model, payers and physician/hospital incentives play a significant role in driving value. I looked up the Columbian healthcare delivery model and was surprised to find similarities between the US and Columbian model. For example, in both markets the physicians and hospitals are primarily paid in a fee for service model. In both countries the government is the primary payer for cardiovascular disease. The Columbian government is the payer for 97% of all Columbians, but keep in mind the cost structure for healthcare is a fraction of the cost in the US. The importance of this information to me was physicians and payers have similar incentives in both health care structures – this trip was looking more interesting to me.

All three hospital cath labs we visited in Columbia had amenities of a US cath lab. The labs were outfitted with flat panel technology, IVUS, FFR and advanced mechanical circulatory support equipment. There were some notable differences such as no presence or an EMR or PACS system so you can imagine DVD’s and paper documentation was the standard.

Below I listed out care differences at these three hospitals that surprised me and added to my thoughts on value-based care:

SPACE FOR PATIENT CARE IS MINIMALISTIC AND MOVEMENT IS GREATLY REDUCED.

Their rooms for prep and recovery are small. This use of space reduces patient transfer time, distance and staffing resources. Assuming privacy is maintained maybe the large rooms in US hospitals are out of vogue? 

INTRAPROCEDURAL SEDATION IS THE EXCEPTION.

Patients receiving traditional diagnostic and interventional coronary procedures do not receive any sedation. This is powerful to observe as this is a significant diversion from the customer expectation in the US; not to mention how this changes the culture and conversations in the procedure room. Sedation practices for other procedures such as electrophysiology are similar to those in the US. This sedation practice seems to improve patient safety and reduce nursing time at this facility. Interestingly, it would seem if no sedation is administered this should lead to lower length of stay. However, most diagnostic patients have a similar length of stay to the US market, while same day discharge was less than 10 percent in the Columbian sites we visited.

PATIENT SAFETY ACTIVITY WAS ROUTINE.

Despite no regulatory or registry requirements patient safety awareness was high in the sites we visited. The procedure rooms had white boards with allergies, labs, and safety concerns for all to see. The staff were well versed in key safety indicators. It was great to see these activities embraced without regulatory requirement.

PHYSICIAN PRACTICE WAS HIGHLY SPECIALIZED.

The only physicians practicing in the interventional rooms were interventionalists. These physicians were also rarely assigned roles outside of the procedure room. This model promotes maximum capacity of the capital equipment and ensures proficiency of the operator.

I learned a great deal observing and interviewing the interventional cardiology team in Columbia. These Columbian programs provide novel value-adds that are deeply implemented and were broadly observed. The opportunities above are not easy to achieve, but mostly I would argue the identified practices drive a value proposition in a system. I wish you and your program the best as you work to increase quality and decrease cost.

About the Author

ANNE BEEKMAN
Sr. Manager, Care Pathway

Contact: anne.beekman@carepathway.com

Anne Beekman has extensive experience in new program development in interventional cardiology, peripheral, EP and structural heart as well as cost management, staffing model updating and office-to-hospital efficiencies. She has also opened and managed multiple cath and EP Labs, Prep and Recovery Departments and CCUs with a focus on process improvement and expense reduction. The past two years, Anne has been focused on redesigning PCI and device programs, helping teams understand the need to own the cost of care and be responsible stewards of the health care dollar. Recently she has been dedicated to improving safety in cath labs by reducing radiation dose to providers, staff and patients and has been the lead on two successful ACE accreditation reviews. Anne has a Bachelors in Nursing and is credentialed as a Nurse Executive by AACN.