Measuring Clinical Effectiveness: SAMPLE RESULTS
Case Mix Adjusted Savings Achieved Savings
Savings calculated at the CEI-DRG level were summed by patient category. Savings per case in each CEI-DRG could not be simply summed to provide an overall savings estimate for a patient category. A weighted average was needed that reflected the case mix of patients receiving the drugs. Because the patients receiving drug 2 had already “achieved” the savings estimated for each CEI-DRG, per-case savings were multiplied by the number of patients who received drug 2 (n2) to calculate the achieved savings:
achieved savings = (d1 – d2) * V * n2
In Table 7, the achieved savings for CEI-DRG A was $50,000 [($7,000 - $5,000) * 0.5 * 50]. The achieved savings in each CEI-DRG could then be summed across all CEI-DRGs in a patient category. Dividing this sum by the total number of patients who received drug 2 produced a mean achieved savings adjusted to the case mix of the drug 2 patients. The total achieved savings for the patient category was $240,000, or $889 per discharge.
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Table 7 Sample Patient Category Savings (Loss) Calculations
| Total | Drug 1 | Drug 2 |
Per Case |
Variable |
||||
| DRG No. of | No. of Cost | No. of | Cost | Difference |
Cost |
Achieved |
Potential |
Maximized |
| Name Discharges | Discharges (d^ | Discharges |
(d,- d2) |
Savings |
Savings | Savings | Savings | |
| CEI-DRG A 500 | 200 $7,000 | 50 | $5,000 |
$2,000 |
$1,000 |
$50,000 |
$100,000 |
$100,000 |
| CEI-DRG B 500 | 50 $10,000 | 200 | $8,000 |
$2,000 |
$1,000 |
$200,000 |
$25,000 |
$25,000 |
| CEI-DRG C 500 | 50 $5,000 | 20 | $6,000 |
$(1,000) |
$(500) |
$(10,000) |
$(12,500) |
|
| Totals 1,500 | 300 | 270 |
$240,000 |
$112,500 |
$125,000 | |||
| Per Discharge |
$889 |
$750 |
$1,000 | |||||
| CEI-DRG = Clinical Effectiveness Initiative/Diagnosis-Related Group. | ||||||||
Potential Savings
In addition to estimating savings (or loss) already achieved, the CEI was used to identify potential new savings if additional patients used drug 2 instead of drug 1. One way to do this was to project a percentage of patients currently receiving drug 1 who could use drug 2 instead. This percentage was applied to the number of drug 1 patients (n1) in each CEI-DRG, and the result was multiplied by the estimated savings in that
CEI-DRG:
potential savings = (d1 – d2) * V * (n1 * S)
where S is the percentage of drug 1 patients who could be “shifted” to drug 2. In Table 7, the potential savings from shifting 50% of drug 1 patients to drug 2 in CEI-DRG A was $100,000 [($7,000 -$5,000) * 0.5 * (200 * 0.5)]. The potential savings in each CEI-DRG were then summed across all CEI-DRGs in the patient category. Dividing this sum by the total number of patients who were shifted from drug 1 to drug 2 produced a mean potential savings adjusted to the case mix of the drug 1 patients. The total potential savings for the patient category was $112,500, or $750 per discharge.
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Optimized Potential Savings
An alternative method of estimating potential savings of a change in clinical practice was to assume that change would take place only when a financial benefit would result. In that case, potential savings could be calculated using only those CEI-DRGs in which a cost savings resulted from the use of drug 2 instead of drug 1.
Using the values in Table 7 would result in an overall optimized potential savings of $125,000, or $1,000 per discharge. This alternative was included to provide a range of potential savings for participating hospitals. It was not intended to suggest that clinical practice decisions should be based solely on their cost-savings potential.
Departmental Savings
An obvious question arises when clinicians and administrators discuss CEI results: where did the savings come from?
Because the CEI calculates costs separately for each revenue center, these costs were used to examine the savings by department. For example, LMWHs are more expensive than UFH; however, they are more stable (and predictable) in their bioavailability over time, and less frequent laboratory testing is required. Therefore, pharmacy costs might be higher, whereas laboratory costs might be lower. Some savings might also have resulted from shorter lengths of stay because patients can be sent home while they are taking LMWHs but not while they are receiving intravenous UFH. canadian discount drugs
Figure 1 shows an example of total savings per case along with the savings per case from each department.
