GUEST AUTHOR BLOG: What I Want From the Health-Care System by John Toussaint M.D., author of "Potent Medicine: The Collaborative Cure for Healthcare"
Why does health care in this country cost so much?
Is it the technology, the physician fees, the fancy new buildings, an aging population?
These are excuses.
In fact, studying health-care practices in 10 different countries over the last decade has led to this shocking conclusion, true everywhere in the world. As much as 40 percent of care delivery is unnecessary and wasteful and some of it might even be detrimental to your health. Patients fill out repetitive forms, run from laboratory to specialist, then wait weeks for results while conditions go untreated. Errors abound, over 100 million medication errors will occur this year in American hospitals. Waste clogs the system and removing it reduces cost and improves quality.
I am an internist but I’m also a patient. Now that I know how the system works (or doesn’t), there are three things I am looking for when I access care.
Don’t Kill me. It sounds like a joke but a recent study released by U.S. Health and Human Services shows 15,000 Medicare beneficiaries perish every year due in part or whole to medical errors. Some organizations in the U.S. and Canada are taking this bull by the horns. The leaders have instituted entirely different processes in their hospitals and clinics modeled after fail safe systems in manufacturing and aviation. The application of this operating system called “lean” is resulting in dramatic reductions in errors meaning fewer deaths. They have also formed a learning network for accelerating uptake of these lifesaving principles.(Health care Value Network www.createvalue.org) Not surprisingly, these same hospitals and clinics are reporting remarkably more efficient performance delivering lower cost care as well. In fact Thedacare, an integrated health organization in Wisconsin consisting of doctors and hospitals delivers overall costs to Medicare beneficiaries 25 percent below the average yearly per capita cost for the nation while delivering better quality at the same time.
Keep me healthy. Today the system only pays doctors and hospitals when I get sick. So if they wait long enough (for me to get sick) they’ll get their money. But what I’m interested in is doing everything right the first time so I don’t have to go to the doctor or hospital. This requires a different payment system. In Wisconsin we have been experimenting with paying doctors and hospitals differently, using a process of “bundled” payments for an entire episode of care such as joint replacement. I don’t get a dozen different bills from a dozen different providers. Instead it’s one bill and the providers figure out who gets how much leaving me out of it. This incentivizes everyone on the team to work together with my best interest in mind. We are moving soon to prepaid systems. This includes paying the doctors and hospitals an upfront payment to care for me which helps to ensure they keep me out of the hospital. This allows physicians to do everything they don’t get paid for today, such as chronic disease education, outpatient pharmacist intervention, home health visits, etc.
Don’t keep me in the dark. Finally, I’d like to know how many medication errors occurred yesterday in the hospital. I want to compare that to other hospitals . It would impact where I go for care. What if I need surgery? I want to know the surgeon’s name and the actual number of infections over the last year as well as other complications. Then, and only then, do I have the information I need to make the important decision of where I receive care. Public availability of this information is the only way I will ever know this.
Employers in Wisconsin have begun to educate employees using two public reporting websites. The Wisconsin Collaborative for Healthcare Quality is publishing physician performance information which allows comparison at the physician group level (www.wchq.org). The Wisconsin Hospital Association publishes outcome data by individual hospital on important indicators such as infection and mortality rates (www.wicheckpoint.org). Although not perfect, the information on these websites is what I am looking for when making decisions.
I want the health system to work for me not the other way around. I expect higher quality lower cost care with me the patient in charge of the decisions. That’s a prescription we can all live with.
John Toussaint is author, most recently, of "Potent Medicine: The Collaborative Cure for Healthcare" (ThedaCare Center for Healthcare Value, 2012) and is CEO of ThedaCare Center for Healthcare Value.