The Business Case for Investing in Physician Well-Being

Tait D. Shanafelt; Joel  Goh; Christine A. Sinsky

Article | JAMA Internal Medicine

The Business Case for Investing in Physician Well-Being

by Tait D. Shanafelt, Joel Goh and Christine A. Sinsky

Abstract

Importance: Widespread burnout among physicians has been recognized for more than two decades. Extensive evidence indicates that physician burnout has important personal and professional consequences.
Observations: A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (e.g., return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization’s long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all U.S. health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization’s journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level.
Conclusions and Relevance: Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization’s ethical responsibility, it is also the fiscally responsible one.

Keywords: Physicians; well-being; ROI; Health; Welfare or Wellbeing; Ethics; Investment Return; Health Industry;

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Shanafelt, Tait D., Joel Goh, and Christine A. Sinsky. "The Business Case for Investing in Physician Well-Being." JAMA Internal Medicine 177, no. 12 (December 2017): 1826–1832. (doi:10.1001/jamainternmed.2017.4340.)

Recent Medicare legislation seeks to improve patient care quality by financially penalizing providers for hospital-acquired infections (HAIs). However, Medicare cannot directly monitor HAI rates and instead relies on providers accurately self-reporting HAIs in claims to correctly assess penalties. Consequently, the incentives for providers to improve service quality may disappear if providers upcode, i.e., misreport HAIs (possibly unintentionally) in a manner that increases reimbursement or avoids financial penalties. Identifying upcoding in claims data is challenging due to unobservable confounders (e.g., patient risk). We leverage state-level variations in adverse event reporting regulations and instrumental variables to discover contradictions in HAI and present-on-admission (POA) infection reporting rates that are strongly suggestive of upcoding. We conservatively estimate that 10,000 out of 60,000 annual reimbursed claims for POA infections (18.5%) were upcoded HAIs, costing Medicare $200 million. Our findings suggest that self-reported quality metrics are unreliable and thus, recent legislation may result in unintended consequences.

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Article | Operations Research | May–June 2018

Data Uncertainty in Markov Chains: Application to Cost-Effectiveness Analyses of Medical Innovations

Joel Goh, Mohsen Bayati, Stefanos A. Zenios, Sundeep Singh and David Moore

Cost-effectiveness studies of medical innovations often suffer from data inadequacy. When Markov chains are used as a modeling framework for such studies, this data inadequacy can manifest itself as imprecision in the elements of the transition matrix. In this paper, we study how to compute maximal and minimal values for the discounted value of the chain (with respect to a vector of state-wise costs or rewards) as these uncertain transition parameters jointly vary within a given uncertainty set. We show that these problems are computationally tractable if the uncertainty set has a row-wise structure. Conversely, we prove that the row-wise structure is necessary for tractability. Without it, the problems become computationally intractable (strongly NP-hard). We apply our model to assess the cost effectiveness of fecal immunochemical testing (FIT), a new screening method for colorectal cancer. Our results show that despite the large uncertainty in FIT's performance, it could be cost-effective relative to the prevailing screening method of colonoscopy.

Keywords: Markov Chains; cost effectiveness; medical innovations; Colorectal Cancer; Health Care and Treatment; Cost vs Benefits; Innovation and Invention; Mathematical Methods; Health Industry;

Citation:

Goh, Joel, Mohsen Bayati, Stefanos A. Zenios, Sundeep Singh, and David Moore. "Data Uncertainty in Markov Chains: Application to Cost-Effectiveness Analyses of Medical Innovations." Operations Research 66, no. 3 (May–June 2018): 697–715. (Winner, 2014 INFORMS Health Applications Society Pierskalla Award & Finalist, 2014 INFORMS George E. Nicholson student paper competition.) View Details

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