PHILADELPHIA--When practice guidelines or pathways take financial
considerations into account, they may be termed clinical financial
pathways (CFPs). This technique was developed by Kent Giles, MPPM,
vice president of development at PhyMatrix, a physician management
company headquartered in West Palm Beach, Fla, and is currently
being utilized by PhyMatrix to reduce unnecessary medical costs.
Developing CFPs involves seven steps, Mr. Giles said at the Association
of Cancer Executives meeting (see also page 20): Select a disease
process, form a knowledgeable team, clarify the current state
of medical knowledge, develop the pathway, assign costs to each
process, implement the pathway, and monitor the results.
During development of the prostate CFP, he said, the team found
that one urologist was using three surgical trays per radical
prostatectomy to access the three instruments he needed, since
the hospital routinely placed only one of these instruments on
the surgical tray.
This practice, which added $425 in unnecessary costs for extra
sterilization and wasted anesthesiologist and surgeon time, was
eliminated with implementation of the CFP, and the patient's time
under anesthesia was reduced by 30 minutes, ie, a quality enhancement.