Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktIf we look at the cost of medical care (rather than the cost of insurance, which affects about 1/7 of the bill the patient pays) we can identify several huge problems, and we have done so here many times.
To recap: we have identified non-exigent care for the poor in ERs, fee-for-service rather than for results, end-of-life care, nursing home care, shortage of providers, malpractice (both the huge cost of bad medicine and the lesser but real cost of defensive medicine), the monopoly pricing of “new” pharmaceuticals in the USA and the closing of foreign markets to us, and the failure to integrate and computerize record keeping, thus requiring the patient to reinvent her history from time-to-time with every provider. Forgive me if I left out a biggie.
While ACA is primarily an insurance “reform”, it contained some provisions that were pilots aimed at some of these fundamental medical costs. Here is a report on one aimed at moving to fee-for-results, and also reducing actual malpractices, and what it looks like. It is a hopeful report.
Why Health Care Will Not be the Same
Filed under: aca |
All Things in Moderation 
From the article: “A health-care system must figure out what counts as quality care, the metrics by which it ought to judge its doctors and hospitals. It also has to decide who gets what share of the savings.”
There’s a ton of work in this area — and it’s a slog. MedPAC discussed this a few weeks ago. But there are various group that establish the measurements and it’s hopelessly complex. Are you going to measure process, outcomes or both. What’s the time frame for penalizing a readmission? 30 days? 60 days? What if there’s a post acute care provider involved. Who gets the bundled payment? the hospital? how do you risk adjust to account for “sicker” patients. will you include an outlier policy? and so on.
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Good paying work for NVH?
It does sound like a lot of moving parts, I agree.
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I just make sure that my clients have a voice at the table, as the other alternative is being on the table.
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Missing from this article are three things which are key. Is healthcare improving for the patients? How do patients feel about the change? Is it costing them less money? Some of the things that taken as gospel in this are that the current fee for service model means that you are getting services you don’t need. While I am sure that happens and can be attributed to, for lack of a better word, greed, my particular doctor (who does not deal with insurance and is strictly fee for service) does not benefit if she sends me to some other specialist. When I do see specialists, they communcate really well with the sharing of information.
I have not participated in a Kaiser-type system so I can’t really speak to that other than what I hear from those who have – which is generally positive but not always. For me it is a matter of me being comfortable with a particular doctor – something that a Kaiser setup limits to some extent.
What this is going to do is eliminate your local doctors office. For your medical needs, you will need to go to the local Walmart Medical Group, where you can get everything you need.
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“how do you risk adjust to account for “sicker” patients. will you include an outlier policy? and so on.”
One could argue that the risk (of sicker patients) will be spread evenly amongst facilities. Of course, if I were a business owner of one of these, I might try to somehow limit the number of these patients in order to boost my results score.
Or one could argue that if I have a certain issue, I am going to head to the facility that has the reputation of the best care for that particular issue…a Johns Hopkins or a Mayo clinic for instance. How do you account for the fact that some places deal with certain medical issues better than others…for any number of reasons. they attact better doctors and nurses, they have more resources, they are run better… Will we have these places that specialize anymore. What is the incentive for doctors or medical facilities to try new things and techniques if undoubtedly some of them will put a dent in your results numbers?
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” . What is the incentive for doctors or medical facilities to try new things and techniques if undoubtedly some of them will put a dent in your results numbers?”
A reasonable question. Anecdotally, I worked for a startup a number of years ago that licensed a software model from Mayo that managed patients’ meds more efficiently. In the old model, a lot of meds with shorter shelf lives were thrown away. The new model used more of a just-in-time model to reduce waste.
My understanding is that Mayo has an internal department that is constantly reexamining internal processes, looking to improve efficiencies & outcomes. When it makes sense they license the ideas to others, generating income in addition to realized savings.
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Brian, when it comes to running your buisness, this makes perfect sense. It is what a number of companies try to do with business processes. My company and project attempt to do it but the startup costs are expensive and there is an overhead associated with it. I am not entirely sure that it saves money. We do it because in order to bid on a number of contracts, it is required that we achieve a certain level of certification. I am not sure we would do it were it not required.
But I was thinking more along the lines of medical treatments. There is more risk in trying new techniques and medical procedures than using the current best practices. The fee for service model allows doctors to experiment and encourages them try different things (one might argue the efficiency of that) because their paycheck is not affected by outcomes (for the most part…). With a fee for outcome, there is a disincentive to innovate because it may very well be detrimental to your wallet.
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