September Wallingford, clinical nurse on Tower 15CD and advocate for value-based health care

September Wallingford, MSN, RN, a clinical nurse on Tower 15CD and operations director for Costs of Care, shares her perspective on the shift to value-based health care and the importance of interprofessional communication in creating value. Costs of Care is a nonprofit organization that curates insights from the frontlines of health care to help delivery systems provide better care at lower cost.

What is value-based health care? 

At Costs of Care, we define value as safe, high-quality care that is affordable and delivered as part of a positive experience for patients and families.

What inspired you to advocate for value-based care?

It’s no secret that the nation’s health care costs are spiraling out of control, for a number of reasons, and medical bills are one of the leading causes of personal bankruptcy. Everything we do for our patients costs money, and often, that care causes our patients to shoulder substantial out-of-pocket costs, whether in the form of higher deductibles and copayments or increasing coinsurance rates.

There’s said to be over $100 billion dollars spent each year on medical care that can be considered overtreatment or unnecessary. This means it didn’t need to be done in the first place. Perhaps it wouldn’t have changed the outcome or it could have been replaced with less expensive medical care for the same result, or it was something the patient and family didn’t really want.

And when you start to think about all of the examples you see every day of “overtreatment” or “unnecessary” care – daily labs, telemetry, X-rays, medications, CT scans, ultrasounds, etc. – you can’t help but want to get involved and create positive change.

Why is more care not always better?

Overtreatment and unnecessary care can cause patients to experience significant financial strain, missed work, increased anxiety and a cascade of interventions — all without a significant improvement in health outcomes. For example, a CT scan that wasn’t really indicated or clinically necessary may show an “incidental mass,” leading to a series of other tests. In the end, this may not result in any substantial change to the plan of care, except for increasing costs and stress and anxiety for the patient and family.

How can bedside nurses and Patient Care Services staff help create value?

Costs of Care focuses on improving value by changing how we deliver care.

We operate under the principle that those of us who are on the frontlines of care are best positioned to provide significant insights into how to better deliver care that leads to value. We should share our insights with leaders.

One way that you can help create value is when you see an ordered test, treatment or procedure in your patient’s chart. Ask yourself, “Does this add value to this patient’s plan of care?” If you have doubt that it adds value, then ask the same question to the ordering clinician to open up the conversation.

Can you provide an example of value improvement?

One example that sticks out in my mind is how a nurse leader in quality improvement at another hospital engaged a team of clinical nurses and physicians to review and revise their unit’s telemetry monitoring practice. Telemetry is a heavily over-utilized, often unnecessary treatment used in clinical practice, according to a Choosing Wisely guideline from the Society of Hospital Medicine. These guidelines state that continuous telemetry outside of the intensive care unit should only be used if clinically necessary, as it can lead to increases in cost of care as well as false positives.

Based on this recommendation, the team collaborated to decrease inappropriate telemetry use on their unit, resulting in better patient management. Due to the success of this unit-based project, the revised telemetry protocol was implemented hospital wide.

If you’re interested in learning more or sharing the value-improvement projects you’ve implemented, email swallingford@bwh.harvard.edu.