Taking a lean approach to blood pressure measurement
May is National High Blood Pressure Education Month. Sponsored by the Centers for Disease Control and Prevention and recognized by the National Heart, Lung and Blood Institute, National High Blood Pressure Education Month raises awareness about the impact of hypertension and aims to reduce death and disability related to high blood pressure through professional, patient and public education.
One way many healthcare organizations are starting to make the BP measurement process more efficient is by adopting a lean methodology approach.
Minimizing waste through ongoing process improvements is not new to the healthcare industry. Lean management principles, including improving scheduling methods, enhancing revenue cycle and identifying patient flow bottlenecks, have traditionally been used by healthcare organizations to make operational tasks more efficient. What is relatively new is taking a lean look at clinical processes and workflows, where significant inefficiencies can reside.
In some ways, the most obvious opportunity is with BP measurement. It continues to be one of the most inconsistently and inefficiently performed tests in the clinical environment.
Using a lean approach, we can apply a new value equation to the BP measurement process that accomplishes the goals of improving outcomes and lowering costs by maximizing the difference between disease risk of untreated elevated BP and the cost and risk of treatment.
Under the context of identifying and eliminating waste within BP measurement, there are five important questions healthcare organizations and providers should ask:
• Can we be sure that we are only seeing BP patients that need to be seen?
• Is there a way to have all the necessary information at the point of care to start BP treatment?
• Can we make BP measurement more efficient at the point of care, even with the new guidelines?
• Can we eliminate the ordering of unnecessary tests or follow-up calls for patients that never actually had a BP concern?
• Is there a way to be sure our BP measurement is accurate across caregiver and clinic every time to avoid many of the known secondary wastes?
Short-Term and Long-Term Benefits
Eliminating waste and optimizing BP acquisition will deliver a number of short-term benefits. One such benefit is a direct financial reward: achieving a higher Merit-Based Incentive Payment System (MIPS) score by meeting the quality metrics tied to BP. Other indirect, short-term benefits include fewer labs to review, fewer medication-related issues with which to deal, fewer phone calls to patients, less time teaching patients, increased perception of clinical sophistication and professionalism and a more enhanced patient experience.
The long-term rewards offered by this approach are even more appealing. Improper clinical risk stratification of patients results in expensive resource consumption that may be of low value-add to improve outcomes. Opportunity costs associated with low value-add visits tie up room, staff and appointment times that could be better used for sick and acute patients. This could result in patients going to emergency rooms, urgent care or getting worse before being seen. In other words, resources will be freed up to tackle the problems for higher risk patients who would benefit from the intervention.
Healthcare organizations continue to use ongoing process improvements to realize significant operational efficiency gains. By taking a similar approach with clinical workflows, such as BP acquisition, healthcare providers can take steps that will help improve clinical outcomes and lower costs.
