Health Affairs November issue tackles the biggest issue in health care today..the real challenge, obscured by the silly discussion last summer of death panels. And what is this issue? Value based insurance or insurance paying only for the most effective care. That doesn't mean that other care is not available - it is only available at a price because while it might be the right choice for you to make, it is not proven and is a personal choice.
Of all the choices that we currently make as a society that are so counterintuitive to the science - not paying for prevention, not having universal coverage for children, not paying for all primary care- this makes the most sense. As a society, we put our scarce resources where we know they work and we invest in science and let individuals pay for care that is not justified by science but in a miracle situation might help them.
I might pay for certain things...or I might ask for the real deal and save myself the suffering.
Interesting questions this will raise about our approach to science.
Monday, December 13, 2010
My doctor visit
An hour and a half into the visit, my doctor repeated for the fifth time "you can blame Obama for this". She was referring to their new Epic system that was taking hours to enter new patient history information. I was amazed at what a speedy typist my doctor was! But even that didn't speed things up. By the eighth "Obama" and "they did this to get several thousand dollars", I was worn out. My physical exam had yet to be started and I was feeling increasing nervous about what would have gone on my chart if they hadn't blocked the "other" field.
I did get out of there with a number of nicely typed prescriptions and the confidence that this system was here to stay...but I had to wonder about the design of the system - after doing research I applaud the blocking of the "other" option...(I digress, but over 30% of my sample in a recent study at a leading academic medical center matched on "other or unknown"...they were an early adoptor!) Are we investing in permanent systems that are slow and not intuitive for how physicians work. Did my extra time with the doctor go into typing and even less communication? Will this work with a hand-held device like an ipad that you can easily flip the pages with a finger to find your information?. My medical home just became a victim of the computer that has invaded all interactions in my own home. I am a huge supporter but I wonder....
I did get out of there with a number of nicely typed prescriptions and the confidence that this system was here to stay...but I had to wonder about the design of the system - after doing research I applaud the blocking of the "other" option...(I digress, but over 30% of my sample in a recent study at a leading academic medical center matched on "other or unknown"...they were an early adoptor!) Are we investing in permanent systems that are slow and not intuitive for how physicians work. Did my extra time with the doctor go into typing and even less communication? Will this work with a hand-held device like an ipad that you can easily flip the pages with a finger to find your information?. My medical home just became a victim of the computer that has invaded all interactions in my own home. I am a huge supporter but I wonder....
What next
Today we learned that one of the challenges for individual mandates in the health reform bill is deemed unconstitutional. While the challenges continue, those of us on the provider side need to move forward - knowing that increasingly, less money is coming into the provider networks and more is asked of the providers. Costs will skyrocket for business this year while healthcare organizations will not see the increase. What does that mean for most organizations?
In general providers need to make the daring switch to more and more managed care while hoping that their cash cow subspecialty services continue to pay off in the short term. "Its the transition stupid" to steal a line from the political folks...and to steal a really bad line (apologies to those who are still sensitive), "size does matter" in this issue! For those stand alone small community hospitals, all the challenges do is delay your dealing with the inevitability that your size does matter and that you can't invest fast enough to grow outpatient. Build it and they will come is not a strategy that will do anything in this environment...but use capital.
So as you read the starts and stops in health reform...know that there are several things you can hang your hat on.
1. Business will not pay more, so the focus on cost cutting will be severe.
2. Cost cutting will start with high coverage plans
3. The hospital will indeed become less lucrative over time and the outpatient network to support inpatient volume is sizable.
4. Readmissions will cost you dearly. Focus like a laser on them and how to back fill them.
5. When you realize you can't start looking at capacity!
And have a happy holiday season...January may be worse!
In general providers need to make the daring switch to more and more managed care while hoping that their cash cow subspecialty services continue to pay off in the short term. "Its the transition stupid" to steal a line from the political folks...and to steal a really bad line (apologies to those who are still sensitive), "size does matter" in this issue! For those stand alone small community hospitals, all the challenges do is delay your dealing with the inevitability that your size does matter and that you can't invest fast enough to grow outpatient. Build it and they will come is not a strategy that will do anything in this environment...but use capital.
So as you read the starts and stops in health reform...know that there are several things you can hang your hat on.
1. Business will not pay more, so the focus on cost cutting will be severe.
2. Cost cutting will start with high coverage plans
3. The hospital will indeed become less lucrative over time and the outpatient network to support inpatient volume is sizable.
4. Readmissions will cost you dearly. Focus like a laser on them and how to back fill them.
5. When you realize you can't start looking at capacity!
And have a happy holiday season...January may be worse!
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