Chasing the Rabbit: Official Blog by Author Steven Spear

Paul Krugman (”Keeping them Honest,” NYTimes, June 5, 2009) is correct that the key to health care reform is to control costs.  He misses the critical method of how.

The basic problem is that Americans pay too much and get too little in return because care delivery is typically mismanaged.  Providers are organized by specialty and discipline–orthopedics, anesthesiology, nursing, rehabilitation, and not by value adding process–e.g,. knee repair, well births, diabetes management.

As a result, individual practitioners spend half their time and work compensating for malfunctioning systems rather than providing care and patients become the ’system integrators,’ trying to coordinate the pieces into a harmonious whole. This drives up cost and drives down quality.  Then there is the absurd reimbursement–paying for time spent and resources consumed, not value provided.

What is the alternative?

1: Measure performance and results (outputs), not just inputs.  Start with simple things like ‘never events’–hospital acquired infections, patient falls, mis medication, readmissions, etc.  Pioneers have driven these events to zero, and, as their care delivery has improved on safety it has gotten better on cost and access as well.

2: Publicize those performance measures.

3: Pay based on them.  Start by not reimbursing providers for ‘reworking’ their mistakes.  Then, let payers and patients choose providers based on where they’ll get the best combination of quality at the least cost as more sophisticated measures are developed.

The result? Work will flow to those who are best at doing it and away from those who squander resources thereby increasing costs and increasing suffering.

When one looks at the enormous disparities among providers now–some doing much more, for many more, with much less while others do much less but spend much more, it is no exaggeration to predict twice the care (and better care at that) at half the cost.

Related posts:

1. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
2. Spear on Bloomberg: What’s health care reform missing? Quality!
3. Krugman concedes main objection: In fact, more care needn’t cost more…
4. Provider Competition Key to Health Care Reform
5. Outcomes Measurement: The Linchpin of Healthcare Reform