How Much Does an “Ounce of Prevention” Cost in Healthcare?

The issue is the efficacy of prevention versus correction, to which the latter appears to be more prevalent in healthcare.

Over the past couple of years, I have been concerned that the healthcare industry seems to spend more time, money, and effort on correction instead of prevention.

Our entire healthcare system focuses more on treating disease and illnesses, although there is a much stronger push towards preventative medicine. In my present roles, I have seen this concept of correction in clinical revenue cycle far surpass that of prevention.

There are several major industries that have put in place processes of prevention. These included the following:

  1. The airline industry – just one of the examples are the mandate of checklists before, during, and after every flight and pre-flight plans should a problem occur. For example, if an engine should fail while the plane is taking off, there is already a predetermined flight plan to follow to get the plane back on the ground.
  2. The automobile industry – specifically the “Toyota Way.” This is Toyota’s unique approach to lean management and quality. The goal was to create a learning enterprise with management principles summarized by the following:
  • Philosophy
  • Process
  • People and partners
  • Problem solving.

Prevention does not happen overnight. It takes planning and a process. One of the biggest areas where correction is the pre-eminent process is denials management. How would one go about denials prevention? We are better than “scrubbers,” and artificial intelligence. If we utilize these tools properly, they can serve as our prevention. Start with a problem-solving process.

All these steps can be used in utilization review, CDI, and coding and other areas of healthcare. Think about it this way and in a simple stepwise direction:

  • What are you trying to achieve?
  • Define your problem.
  • What solutions have you tried before?
  • What worked and what didn’t?
  • Identify your root causes.
  • Develop your plan.
  • What are your indicators of success?

I once had a CEO that looked to see how many ways can things go wrong from the point of an order placed for a complete blood count (CBC) to the point where the result appeared on the chart. He came up with over 300 possible areas/events. That is one simple event in a hospitalization.

Multiply that by all that happens in a hospitalization and trying to get it all summarized on a UB-04. One might say that healthcare is too complicated. Really! How complicated was it to put a person on the moon?

Let your outputs determine your outcomes.

Will you focus on correction or prevention? It’s a process, and a process is a series of events leading to a desired result. For my hospitals I will be focusing on prevention.

What about you?


John Zelem, MD, FACS

John Zelem, MD, is principal owner and chief executive officer of Streamline Solutions Consulting, Inc. providing technology-enabled, expert physician advisor services. A board-certified general surgeon with more than 26 years of clinical experience, Dr. Zelem managed quality assessment and improvement as a former executive medical director in the past. He developed expertise in compliance, contracts and regulations, utilization review, case management, client relations, physician advisor programs, and physician education. Dr. Zelem is a member of the RACmonitor editorial board.

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