Sunlight is the Best Antiseptic

October 2015

“Sunlight is said to be the best of disinfectants,” wrote former Supreme Court Justice Louis Brandeis over 100 years ago. It is generally appreciated that the ultraviolet light of sunlight can indeed serve an antimicrobial effect upon open or contaminated wounds. In a metaphorical sense sunlight can be viewed as exposing people, issues, events, and secrets to public examination; it disinfects that which is being withheld from general scrutiny.

In recent years and certainly in recent weeks, sunlight is being cast upon the outcomes of hospital care in the United States. Mpirica, Consumer Reports, U.S. News and World Reports, ProPublica, and the Consumer Checkbook are a select few of those attempting to direct sunlight on the results of hospital care and even specific surgeons. Each hope in their own way and with their own methods and consultants to better inform the public about the outcomes of care in specific venues.  In doing so they are trying to empower consumers to make better decisions in the selection of personal or family care. The accuracy and the effectiveness of these numerous efforts will be the source of public discussion in the upcoming months, and the debate itself will have its own “sunlight” effect. This discourse will include input from healthcare providers about the shortcomings of healthcare outcome assessments made by those outside of the profession.

At MPA Healthcare Solutions, we view the current disinfection process as healthy for providers in the long-run. The reality of contemporary medicine is that clinicians and hospitals do not know the ultimate results of the care they provide. For example, how many are monitoring how shorter lengths-of-stay are impacting post-discharge outcomes?  How does a healthcare system measure post-discharge outcomes when readmissions and emergency department visits often occur at hospitals other than the facility that performed the procedure? The shadows also obscure the rate of post-discharge deaths as well. How many providers are aware that there may be a higher death-rate post discharge than the inpatient mortality for certain procedures?  Is the infection that occurs after the hospitalization any less of a complication than the one that is recognized and reported during the inpatient stay? MPA believes it is unacceptable to define quality by only measuring events that occur under the fluorescent lights within the hospital.  It’s not fair to the patient or to provider doing their best to provide great care.

At MPA Healthcare Solutions, we can focus on bringing all of the data that is available into the sunlight for analysis.  Our use of objective metrics of risk adjustment for inpatient deaths, inpatient prolonged length-of-stay (instead of trying to count coded complications, 90-day post-discharge deaths, 90-day Emergency Department visits without readmission and 90-day readmissions with exclusion of unrelated events.  More importantly, MPA supports actionable quality improvement through dynamic modeling and reporting that links changes in your care processes to clinical outcomes of care.   We would love to discuss with you what we can do.

Donald Fry

Donald E. Fry, M.D. is Executive Vice President for Clinical Outcomes Management at MPA Healthcare Solutions, Adjunct Professor of Surgery at Northwestern University, and Professor Emeritus of Surgery at the University of New Mexico School of Medicine. At MPA Healthcare Solutions, Dr. Fry provides clinical leadership in analyzing and evaluating clinical performance, guiding quality improvement, and creating incentives for coordinated, cost-effective care.

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