SALT LAKE CITY — There's no shortage of rankings in the world of health care.
Some of them are valuable. Some of them not so much.
But when University of Utah Health Care earned the top spot in a national ranking of academic health care systems Thursday, officials at the organization took notice.
"We take it very seriously," said Dr. Vivian Lee, CEO of University of Utah Health Care. "If you talk to any of my counterparts across the country, they will know their ranking."
That's because unlike other rating systems that attempt to quantify a hospital's reputation or other subjective measures, health care services company Vizient uses quantifiable metrics — like safety, timeliness and effectiveness — that "really do correlate with what we would consider 'quality' in the health care system," Lee said.
The U. beat out prestigious academic medical centers such as the Mayo Clinic Hospital in Rochester, Minnesota, and Cedars-Sinai Health System in Los Angeles for the top spot in Vizient's ratings.
The health care system has made strides in recent years — and a name for itself nationally — through a project that began as an attempt to answer a seemingly simple question four years ago.
It's one of the most complicated questions you can ask in medicine: How much does your health care actually cost?
"Not the charges," Lee emphasizes. "But the cost."
Most of the doctors she asked didn't know how much it cost the hospital to take care of a patient with pneumonia or to care for a woman through the course of her pregnancy.
So the university created a computer program to measure the cost of drugs, supplies and services, down to the per-minute cost of using the operating room or emergency department.
"Almost everything" they found out was surprising, Lee said.
A report published in the Journal of the American Medical Association earlier this month detailed the hospital's findings in three areas — joint replacement, lab testing and sepsis management.
For example, after hip and knee joint replacement was identified as a high-volume procedure associated with big variability in costs from person to person, doctors focused on a group of patients who were not up and out of bed on the day of the surgery — an outcome they believed was important for recovery.
They soon realized these were patients whose procedures had been scheduled late in the day, after most physical therapists had already left work.
The health system changed the physical therapists' schedules. The average length of stay of a joint replacement patient dropped by more than a day. Over the course of the study, joint replacement costs fell by 11 percent.
In an editorial accompanying the report, Harvard Business School economist Michael Porter called it “an impressive and important step forward, not just for the University of Utah Health Care system but for the rest of U.S. health care.”
The Affordable Care Act is accelerating a sea change away from a system in which doctors are paid for every procedure they complete and toward a system in which hospitals are paid a lump sum for an entire course of treatment.
Now, it's up to the doctors and hospitals to figure out how to replace a hip or knee in the most cost-effective way possible — which means the U. is asking the right questions, according to Porter.
He highlighted how the program discovered some standard procedures varied significantly in cost from patient to patient.
Some of it, Porter said, was due to differences between patients. But much of it was due to differences in the doctor's preferences and habits.
“There is much to be done and the road is long, but the report by Lee and colleagues points out how the path begins,” he wrote.
Lee said one of the most overlooked aspects of health care reform may be involving physicians in the conversation.
"If you start showing them data that suggests maybe they're average or maybe even below average, they are very motivated to improve," she said.4 comments on this story
The effort, now in its fourth year, has resulted in a flood of requests from other health care systems to visit the U., with teams coming from as far away as Singapore to see the results, Lee said.
The university will soon add more patient-reported outcomes to the system.
What Lee really wants to know is: Are you walking again? Is your depression better? Are you able to participate in social life? Do you feel like your quality of life has improved?
"That, I think, should be the holy grail of 'quality,'" she said.