Balancing Outcomes with the Cost of Healthcare

In healthcare, the sweet spot is the perfect balance of healthcare spending and patient outcomes. It’s the place of equilibrium that features just the right type and degree of patient care while avoiding the cost and potential harm of unnecessary interventions. Some providers have learned that balancing both clinical and economic concerns must begin on the most basic level—with a check of the patient’s blood health—and implementation of effective patient blood management (PBM) strategies.

The Society for the Advancement of Blood Management (SABM) defines PBM as “the timely application of evidence-based medical and surgical concepts designed to manage anemia, optimize hemostasis, and minimize blood loss in order to improve patient outcomes.” These proactive strategies are critical to reducing the incidence of red blood cell (RBC) transfusion, which the American Medical Association and The Joint Commission have identified as one of the five most overused procedures in medicine.

Blood transfusion has been associated with higher rates of mortality and morbidity as well as increases in length of stay, readmissions, hospital-acquired infections, and other complications.* These effects jeopardize reimbursements and drive up the cost of care for both providers and patients. And yet, transfusion continues to be perceived as a beneficial treatment in many instances when guidelines recommend more restrictive practices—used, perhaps, out of habit even though data show that up to 60% of transfusions are either inappropriate or, at best, not demonstrably effective.

Along with behavioral norms and other barriers to acceptance of clinical guidelines, transfusion overuse likely stems from the complex nature of calculating the direct and indirect expense of blood utilization. Industry reports, however, point to staggering costs. In fact, it’s estimated that U.S. hospitals spend over $10 billion per year on RBC transfusion, and can pay more than $1000 in direct and indirect costs for each unit of blood.

PBM professionals work to reduce blood-related expense and improve patient outcomes by limiting transfusion in favor of a more conservative approach that relies on anemia management, coagulation optimization, and blood conservation modalities—strategies with demonstrated efficacy in both surgical and non-surgical phases of care. Anemia, for example, is prevalent in hospitalized patients and considered an independent risk factor for readmission, prolonged length of stay, and increased mortality. Left untreated, anemia can reinforce existing illnesses, which in turn can reinforce the anemia and prompt transfusion, introducing the possibility of acquired infection and other complications. Identifying and treating anemia, especially in the pre-operative phase, can mitigate the likelihood of compounding risk factors and increase the likelihood of successful clinical outcomes.

As the cascading effects of blood health become better understood, many providers are broadening their perspective on the role of blood in illness and treatment, especially transfusion. It’s a back-to-basics approach with a proven ability to achieve balance between healthcare spending and clinical outcomes.

* Petrides M, AuBuchon JP. To transfuse or not to transfuse: An assessment of risks and benefits. In: Mintz PD, ed. Transfusion therapy: Clinical principles and practice. 3rd ed. Bethesda, MD: AABB Press, 2011