At Becker’s 16th Annual Meeting in Chicago, healthcare leaders participated in an executive roundtable sponsored by CSL titled “Unlocking Clinical and Financial Value Through Patient Blood Management.”
Chris Hood, PharmD, director, global commercial development, hematology at CSL, and chair-elect, SABM Industry Council, moderated a discussion about the challenges and opportunities that hospitals and health systems encounter when they deploy patient blood management (PBM) programs.
Here are four key takeaways from the session:
1. Culture change is one of the biggest barriers to PBM initiatives
At many organizations, clinicians love routine and have done things the same way for years. While new PBM practices require changes to behaviors, leading hospitals and health systems are making inroads and changing their cultures.
One participant explained that historically his institution always used two units of blood for every patient who needed a transfusion. However, that practice has changed and patients now get one unit of blood at a time. As a result, blood usage decreased across this medical center campus.
Another organization is focusing its change management efforts on the obstetrics patient population, with the goal that no one has anemia on their delivery day. “Ideally, no one should arrive without a normal hemoglobin,” he said. “But sadly, our data shows that about 40% of people still do. And those are patients who have multiple touch points before delivery.”
2. Protocolization can improve PBM adoption
To promote PBM practices, one health system built supportive relationships with patient safety quality officers in every clinical department. These individuals acted as physician champions and met one-on-one with late adopters.
“It took a while, but slowly physicians accepted the new program,” this participant said. “We never had to publicize data about late adopters because they decided to buy in. The learners in a group are fantastic for nudging the late adopters.”
Embedding prompts and triggers into the EHR is another way that organizations are protocolizing PBM programs.
To measure PBM success, health systems are tracking KPIs, such as the total number of transfusions, the number of transfusions that didn’t conform to guidelines, the incidence of transfusion-related complications like TACO and TRALI, and length of stay.
3. Financially focused education can help with change management
One participant noted that most clinicians have no idea what blood products cost. “In general, physicians would benefit from understanding price structures,” he observed. “I think it would generate more buy-in from them around reducing costs.”
According to Dr. Hood, blood products have an acquisition cost, as well as an activity-based cost. For example, fresh frozen plasma might cost $50-150 per unit, but the activity-based cost might be three times higher to account for blood bank storage, the time required for multiple nurses to monitor patients and other tasks.
4. PBM must be incorporated into an organization’s financial strategy
As health systems evaluate these programs, a best practice is to consider the organization’s strategic goals and payment model. In particular, PBM programs are beneficial when they add money directly to the organization’s bottom line and reduce readmissions.
One participant sees great value for team-based hospitals with few recovery issues, since PBM could increase DRG reimbursement on the back end. On the flip side, PBM programs could have mixed results at facilities with cost-based reimbursements that perform a lot of procedures. Reductions in costs could negatively impact the surgery outpatient rate, depending on the patient population.
“PBM improves the cost of healthcare,” she said. “It’s just a matter of how you frame it and build it into the financial strategy.”
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