A recent study by CMEology found that continuing medical education (CME) can save significant healthcare costs. The authors used an educational activity about preventing bleeding-related complications from cardiac and thoracic surgeries for their analysis. The results suggest that even if only a small number of surgeons put into practice what they learned from CME, cost savings could be substantial.
CME has demonstrable value in helping to improve the care physicians provide and the treatment patients receive. Various studies have shown that CME has improved patient outcomes in areas such as multiple sclerosis, hypertension, COPD, ICU patients, improved taking of family history by physician assistants, Sepsis, healthcare-associated infections, and reduction in CT scans.
While such outcomes are more easily measured in longer life, less pain, or less adverse side effects, a pressing problem that has faced CME over the years is showing how such education can produce dollar savings in patient care.
The authors of the CME study note that studies have not typically evaluated the economic impact of CME because doing so requires extensive follow up that is both time consuming and cost prohibitive. To make up for this, CMEology created a sophisticated economic model to predict averted costs associated with CME in the absence of patient-level outcomes data.
The authors developed what they call an “Outcomes Impact Analysis (OIA) model,” to estimate the potential health care cost savings associated with a CME activity. Their report describes the OIA model and demonstrates its use to estimate the economic impact of a CME activity to prevent bleeding related complications following cardiothoracic operations.
The authors estimated the economic outcome of a CME symposium that promoted prevention of bleeding related complications and implementation of clinical practice guidelines for blood conservation. Presentations there addressed strategies for preventing intraoperative and postoperative bleeding and bleeding-related complications through practices based on evidence-based guidelines to enhance hemostasis, prevent blood loss, and decrease transfusion use.
The symposium was attended by 133 healthcare providers, 93.8 percent of which stated they were committed to changing their practice based on what they learned. The main barriers to blood conversation, as noted by providers, were cost, administration buy-in, and inertia.
In evaluating the economic impact of the symposium, CMEology chose as their outcomes: (1) prevention of bleeding related complications in cardiac and thoracic surgeries and (2) prevention of reoperations in coronary artery bypass graft surgery. The cost savings were estimated from the perspective of the healthcare provider.
The authors examined several cost studies in order to create their models and parameters. A study of 103,826 cardiac operations showed that the mean hospital costs were $12,128 higher in patients with bleeding complications than those without the complications. The additional average costs for thoracic operations was $15,899. The authors also examined nineteen studies for reoperations, and found the average additional cost of reoperations in coronary artery bypass graft surgery was $24,048.
The study used a Society for Thoracic Surgery’s Workforce Report to determinate that there were 1211 adult cardiac surgeons, who performed an average of 155 cardiac operations in 2009.
After defining their parameters, CMEology created a base case analysis, which assumed that 3 in 10 participants would return to practice and change their clinical practices as a result of CME learning in such a way as to prevent the bleeding complications or reoperations in 2 percent of surgeries within one year. Using their base case, the authors then used a one-way sensitivity analysis to evaluate the potential savings when the proportion of participants who prevented outcomes of interested varied from 1 in 10 to 5 in 10. The authors then analyzed the parameter uncertainty and calculated the mean and confidence interval for the estimated value.
The results suggest some large cost savings:
As the results above indicate, even a conservative estimate of 3 in 10 healthcare providers reforming their practice behavior shows significant cost saving. The study estimates that the costs averted in cardiac surgery bleeding complications would be $1,500,112. This number would greatly rise as the proportion of participants increased. The study found even greater savings for CME-trained thoracic surgeons and in surgeons who adopted practices to prevent reoperations.
The authors note that this model can also be used to optimize CME resources by identifying areas of educational need most likely to result in cost savings.
What does the $1.5 million figure mean in real terms? i.e. How much does improved CME save per surgeon or per hospital?