The First Step to Recovery for Healthcare Is Standardization

They say you can’t improve it unless you measure it. I say you can’t measure it unless you standardize it. No industry is less standardized than healthcare. Pick anything in healthcare. From how a physician does surgery to a paper form on a clipboard that a patient fills out in a doctor’s office. Not even the pens are the same.

Lack of standardization makes everything in healthcare difficult to improve because you can’t measure it.

One of my occasional side hustles is ghostwriting case studies, client success stories and white papers for healthcare organizations. To an assignment, each cites standardization of data, equipment, processes or technology as the secret to whatever clinical, financial or operational goal they want to meet. I know and now you know that I’m not making this up.

So, I’m not sure what five researchers from the Oregon Health & Science University, American Board of Family Medicine and the Robert Graham Center expected to find when they looked at how much states spend on primary care.

The researchers reported their full findings in a 108-page report published by the Agency for Healthcare Research and Quality. They published a four-page version of their findings in JAMA Health Forum. I read the four-page version but checked a few facts in the 108-page version.

Here are the juicy parts:

• Only 11 states publicly reported how much their state spends on primary care.
• Only two additional states intend to do so in the near future.
• Nine of the 11 states reported primary care spending as a percentage of total healthcare spending in their state.
• Five of the nine used a broad definition of primary care in their calculations, e.g., including more primary care specialties like OB/GYNs and advanced practice providers like nurse practitioners, which raised that percentage.
• Four of the nine used a narrow definition of primary care in their calculations, e.g., excluding more primary care specialties like OB/GYNs and advanced practice providers like nurse practitioners, which lowered that percentage.
• Ten of the 11 states reported primary care spending by commercial payers.
• Ten of the 11 states reported primary care spending by their state Medicaid programs.
• Eight of the 11 states reported primary care spending by Medicare Advantage plans.
• Two of the 11 states reported primary care spending by traditional Medicare.
• The range of primary care spending was 3.1% to 10.2% of total healthcare spending, depending on who’s counted and who’s paying.
• No one knows what the 39 other states and the District of Columbia are spending on primary care.

“We cannot determine if spending actually differs across states, time or in response to policies because there is no standard method of measurement. This weakens a potentially powerful tool to promote and monitor investment in primary care,” the researchers said.

Further: “A standard definition of primary care spending and a transparent way of documenting state-specific decisions is essential for monitoring and improving primary care investment. Standardization will enable policymakers and researchers to understand better how primary care spending is affected by new policies and incentives and, ultimately, how this spending is associated with health outcomes.”

Standardization first. Measurement second. Improvement third.

It’s a simple market lesson that healthcare refuses to learn.

Thanks for reading.