HEALTH CARE Outcomes, Not Cost

from Florida Times Union ..

President Barack Obama gets it.

Without controlling health care costs, he said recently, the nation's financial problems cannot be brought under control.

At issue are high costs. The United States spends a more on health care per capita than other industrialized nations, but outcomes don't match the expenditures.

Specifics have been reported by the Dartmouth Atlas project and published in the New England Journal of Medicine.

For instance, some hospitals tend to spend much more than others, but get basically the same results.

And health care spending varies by region, as well, the Dartmouth project reported.

For instance: Seniors in Miami spend twice as much for Medicare health care than seniors in a high-cost city like Honolulu.

The contention that health care is rising faster due to technology doesn't wash, the researchers report.

"Researchers note that care is often better in low-cost areas," they reported on the New England Journal Web site.

So why does medical care cost so much in certain areas?

"Physicians operate under the rules of a system that is rigged to reward high-cost care," wrote Julie Bynum, a physician and assistant professor of Medicine at Dartmouth Medical School.

The system is fueled by discretionary decisions by physicians, influenced by local availability of hospital beds, imaging centers and other resources, and rewards for using high-cost procedures.

San Francisco, a high cost city, still had half the annual cost increases as Miami.

If the annual growth in costs for Medicare were reduced to the average in San Francisco, Medicare could save $1.42 trillion and "turn the deficit into a health surplus," the researchers said.

So how do we make these changes? The rules of the system have to change, from one that rewards procedures to one that provides incentives for patient care.

The Dartmouth researchers say that physicians have an opportunity to lead; physicians usually are making the key treatment decisions.'

So how do low-cost regions behave?

They foster more organized systems of care and payment reforms are made.

Replace the incentive to build up expensive treatments with bundled payments and shared savings.

There needs to be incentives for primary care in which the physician is the advocate for the patient as in the medical home model, bundling payments for acute care and adjusting prices to reflect value, suggests the Commonwealth Fund Commission on a High Performance Health System.HIGH-PRICED SYSTEM"Under the current payment system, physicians cannot afford the time it takes to help patients understand why a test or procedure is not needed. "Hospitals lose money when they improve care in ways that reduce admissions, and they lose market share when they don't keep pace in the local medical arms race. "In this race there are no financial rewards for collaboration, coordination or conservative practice."

Source: Slowing the Growth of Health Care Costs -- Lessons from Regional Variations, by Elliott S. Fisher, Julie P. Bynum and Jonathan S. Skinner, in The New England Journal of Medicine.
content.nejm.org/cgi/content/full/360/9/849

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