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(HealthNewsDigest.com) – Everyone agrees that the United States health care system is in need of reform that will reduce costs and improve the quality of care patients receive. Both eliminating waste and improving quality can lead to lower costs which allow the healthcare system to provide more affordable coverage for people.
So, if we all agree something must be done, how do we go about it?
Here’s where history can help. If we look at successful health care reform efforts over the past 20 years, we can learn from those models and employ the core components required to achieve both lower costs and improved quality of care.
Past models reveal commonalities that could be the keys to successful U.S. health care reform. The commonalities lie in two critical and interrelated undertakings for each successful model: (1) accurately accumulating data to determine areas for waste reduction; and (2) aligning hospitals and physicians. The models reviewed demonstrate that physicians can drive clinical quality and significant savings when hospital and physician priorities are aligned.
By studying these examples, we can begin to build a pathway to a new model for successful reform.
Comparative data are critical
As part of the national discussion around health care reform, government and industry have called for comparative data that will allow them to make more informed decisions around cutting costs, eliminating waste and providing better outcomes for patients.
Physicians control more than 80 percent of the costs related to patient care, but they are not actively involved in efforts to improve cost efficiencies. Data on outcomes, costs and productivity measures for high-cost drivers in hospitals –such as cardiac and orthopedic surgery – can help hospitals and physicians determine areas for quality and cost improvement..
The goal should be to provide information to assist the physicians in understanding the differences in practice patterns and how these differences affect cost and quality. This is the first step to providing a foundation to improve the hospital’s clinical and economic performance.
The Importance of Physician Leadership
According to the Boston University School of Public Health, “Doctors are the key to cutting costs because their decisions affect 87 percent of personal health spending.”1
For centuries, we have defined medicine as the science and art of maintaining and restoring human health. And just like artists who have unique styles and interpretations when creating sculptures or paintings, physicians employ distinctive care delivery. In fact, most people do not realize that each physician delivers patient care in a unique manner, even for the same type of patient with the same clinical diagnosis and procedure needs.
In the surgical arena, physicians complete a “preference card” in order to indicate what tools and supplies they want for an upcoming patient procedure. Like an artist who chooses his preferred materials in order to create a work of art, a physician also takes pride in his or her individual process for delivering care, including which products and supplies they prefer in order to achieve the best possible outcome. After all, physicians are trained to deliver personal, high quality care to their patients.
Unfortunately, this is where the hidden costs reside that add up to significant waste throughout the U.S. health care system. While the personal touch of physicians can be important to patients, their personal preferences significantly drive up the health care costs.
Most physicians learn the hands-on aspects of patient care while interning with more experienced physicians. Therefore, practice preferences are passed from one physician to another, but are not uniform among physicians, hospitals, patients, and procedures. In fact, each individual practice has not been studied to assure that it results in the highest quality patient care with the best allocation of resources required.2
Further masking the hidden costs of health care is our current health payment system, which calls for the hospitals to pay for the products and services administered to patients even though the physicians determine what products and services they use for each patient procedure. These products and services constitute the majority of costs for patient procedures. Therefore, physicians control the majority of costs associated with patient care, but, in most cases, due to the current payment system, physicians have only a limited knowledge or understanding of the total cost of care for their own patient procedures.
Additionally, physicians specialize in highly technical procedures, taking personal responsibility because they assume the ultimate accountability for patient outcomes. Therefore, health care reform efforts to reduce costs and improve patient care must include physician leadership. Only physicians have the knowledge to decrease costs without compromising quality of care.
Significant Impacts on Cost Reduction, Quality Improvement
Without first being armed with data that will allow us to accurately measure the diverse ways care is delivered to patients with the same clinical conditions, we will not be able to uncover the hidden costs of health care – costs that could be redistributed more effectively and improve access to health care for millions of Americans.
Without identifying the variations in physician practice patterns, including product and service utilization for like procedures, we can’t engage physicians in the critical decision making for improvements. Physicians therefore must lead efforts to improve care methods and delivery. By accumulating and benchmarking cost and quality data, physicians can determine which delivery methods produce the best patient outcomes in the most efficient manner.
At the national level, we must initiate some type of hospital-physician alignment model for creating common goals for both the hospitals and physicians. No matter what model we choose, we have proven through years of work that motivating physicians to share in risk and reward creates better outcomes for patients and improves costs for the health care system. Years of research have demonstrated that hospital-physician alignment models create effective partnerships between multi-disciplinary health care providers to provide the best possible patient care at the highest level of efficiency.
Small Steps, Not Sweeping Changes
Health care reform should be small steps of change that are known to improve quality and decrease costs. Just as patients are diagnosed and treatment prescribed, health care must not look for one giant answer, but instead find incremental steps that bring real value. Using factual data to influence treatment decisions and the hospital-physician alignment models have demonstrated better care to patients, greater savings to payers, lower hospital costs and better payments to physicians. If these models had already been implemented, our health care system would be saving significant sums by decreasing day-to-day waste that does not affect the quality of care delivered to patients.
There are forms of change that will bring value to the payer, the hospital, the physician, and especially to the patient. Sweeping changes would be dangerous, but benefit-based changes assure that patients will have access to quality care. Initiating important steps, such as securing comparative data across procedure types and assuring that physician and hospital goals are aligned will help us to decrease the cost of health care. How do we know that? Because for the past 20 years, these programs have delivered measurable, meaningful and positive results.
About the author
Joane H. Goodroe, Senior Vice President of Innovation, VHA Inc., and founder of Goodroe Healthcare Solutions, is credited with helping to change the landscape of the health care industry by developing innovative solutions that allow hospitals to reap long-term rewards. Her goal has always been to empower those who are on the front line of delivering patient care and provide them with the tools to improve clinical quality and reduce costs.
NOTES:
Sager, Alan and Socolar, Deborah. “Health Costs Absorb One-Quarter of Economic Growth, 2000-2005,” Boston University School of Public Health. Data Brief No. 8-9 February 2005
Goodroe, Joane. Testimony before the Subcommittee on Health of the House Committee on Ways and Means, October 07, 2005
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