Quantifying Quality Care: The Financial Argument for Protecting Time for Quality Improvement Work by Infectious Diseases Physicians
Year: 2026
Type: editorial
Abstract: There are an increasing number of opportunities for clinicians to gain formal training and advanced skills in quality improvement (QI) methodology and patient safety (PS) skills [1], and excellence in these fields is increasingly recognized as a valid path to academic promotion [2, 3]. Unlike the closely related discipline of Dissemination and Implementation, the majority of QI work is completed at single centers with significant limitations to generalizability. This in turn limits opportunities for obtaining extramural funding to protect physician time for QI/PS work. However, the local return on investment for robust QI/PS work is often excellent, so reserving clinician time for these efforts can be a sustainable business decision for hospitals. Large systematic reviews have demonstrated the financial value that infectious diseases (ID) clinicians bring through antimicrobial stewardship [4] and infection prevention and control [5, 6]. Given the unique skillset of ID clinicians, faculty in our specialty can be particularly well-positioned for other QI and PS roles. Recognizing the value of this work, our freestanding pediatric hospital has invested in protecting time for an ID attending to compete QI projects that align with divisional and institutional priorities [7]. Here, we share some of our experiences in successfully leveraging this financial investment through diagnostic stewardship and improved revenue generation. ID clinicians are well-suited to champion diagnostic stewardship initiatives and serve as liaisons between the laboratory and their clinical peers, given the unique requirements of the pediatric ID fellowship that include education around utilization of diagnostic laboratory tests and that mandate programs facilitate interaction with the microbiology laboratory during training [8]. Molecular platforms are a growing area of diagnostic stewardship given their high cost, variable reimbursement, challenges around interpretation, and lack of impact on clinical decision-making [9, 10]. ID providers can lead efforts to reduce widespread use of tests such as broad-range polymerase chain reaction testing and plasma metagenomic next-generation sequencing. Locally, we have shown that use of these tests can be safely reduced and result in hundreds of thousands of dollars in direct cost savings yearly to the hospital [11, 12]. Other institutions have shown that lower cost but high frequency tests such as inflammatory markers are also prime targets for ID-led stewardship efforts [13]. It is well-established that patient outcomes are improved when an ID consultant is involved [14]. However, because of the procedural emphasis of physician compensation, much of the work in our field is un- or undercompensated. There are multiple billing codes that can account for the complexity of care and time spent on care not face to face with a patient that is at the heart of ID practice. At many institutions, implementation of these codes for division-specific practices is not a hospital-level priority, so billing improvement initiatives may need to come from within the division itself. One such code is G0545, which provides an extra 0.89 work relative value units per encounter to acknowledge the complexity of care provided by ID clinicians. This inpatient and observation code was released in 2025 following significant advocacy efforts by the Infectious Diseases Society of America. At our hospital, there was no institutional plan to implement use of this code into billing workflows. Thanks to the internally protected QI time, we were able to work with our revenue cycle team to rapidly incorporate it into our local workflows. Ultimately, it increased our division's inpatient and observation revenue by more than 20% [15]. Similarly, ID providers are among the most heavily approached for informal consultations (“curbsides”) [16], which are undocumented and uncompensated. Since 2019, billing codes have allowed for reimbursement of time spent not face to face with a patient. Our hospital did not have an available workflow to capture this effort, but the time protected for internal QI work allowed for a pilot within our division [17]. This successful workflow was subsequently scaled up to hospital-wide and has resulted in >40 additional billable encounters per week for cognitive work that previously was done without compensation [18]. ID providers bring a unique perspective that crosses hospital units and departments. Protecting time to allow them to leverage this knowledge into tangible change can not only improve the quality of care but also prove to be a sound financial decision, and we encourage other divisions to partner with their leadership to consider this investment. We further urge teams to publish and disseminate their efforts so our colleagues can continue to learn from one another to implement innovative approaches to quality improvement while also receiving the time and financial support of their institution. Financial support. There were no funding sources for this article.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofag521
Institutions: Northwestern University, Lurie Children's Hospital
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W7203975544