Sunday, August 19, 2012

Health Care Here. Further thoughts on changes.


“In our last discussion, Julie, we presented some ideas of ways by which health care delivery in the U.S. might be changed.”

“As is customary with us, Curmudge, the ideas were not original.  So shall we continue to share the words of wisdom of others?”

“Of course, but we must keep in mind the two schools of thought on the subject.  Some people believe that excellent health care should be provided to everyone; others believe that excellent health care should be available to everyone.  You and I belong to the second school.  We also feel that patients—with their physicians—should be free to make their own health care decisions, and that they can do it best if they have some ‘skin in the game.’  Recall that in our last discussion the last two examples reflected the second school of thought.”

“There are a lot more good ideas to be shared, Curmudge, but space is limited in our blog.  A really profound document to recommend is the Economic Outlook from Premier Inc. healthcare alliance.  Let’s share some of the high points presented in the Outlook by Harold D. Miller in his paper ‘A National Strategy for More Affordable Healthcare.’   Here are some of his observations:

‘Costs may be reduced by improving disease prevention; diagnosing and treating serious conditions at an earlier stage; avoiding unnecessary and potentially harmful tests, interventions, and medications; eliminating dangerous and expensive infections and medication errors; and educating chronically ill patients on how to manage their conditions to prevent costly hospitalizations.’

‘The country is too diverse for a single national solution.’

‘Providers and payors must remove the veil of secrecy that has shrouded cost, quality, and price information.’

‘The proposed “incentives” are just a new flavor of pay-for-performance based on the same fundamentally flawed fee-for-service system.  Two basic payment reform systems are episode-of-care payment (a single payment for all of the services associated with a single acute episode) and comprehensive care payment (a single risk-adjusted payment to cover all of the services a patient needs for a particular condition or set of conditions over a period of time).  These changes can only be accomplished in mutually accommodating ways involving providers and payors.’

‘We can control health care costs without rationing but only if we do it at the community level.’ “

“One should read the whole paper.  Getting closer to home, in his new book John Toussaint advocates designing care around the patient and not at the convenience of the physician, hospital, or nurse.  He also proposed payment for outcomes (as in keeping people healthy), and providing transparency of treatment quality and cost via the Wisconsin Collaborative for Healthcare Quality.”

“Even closer to home is at home, Curmudge.   Affinity Health System has been practicing Lean for over five years and is making progress in improving efficiency and patient safety and reducing waste.  One can develop a Lean culture locally irrespective of what is occurring at the national level.  So Old Guy, after all of our reading and writing about health care here and elsewhere, what do you foresee occurring in health care in the U.S.?”

“Foresee!  Do you expect me to have a crystal ball in my briefcase?  However, it’s clear that there is no shortage of good ideas about improving our flawed health care system.  What we need are a few philosopher kings to purge their parochial mindsets and reason together.”

Kaizen Curmudgeon

P. S.—An Alternate View

“What’s this P. S. stuff, Curmudge?  What’s up?”

“Well, Julie, no sooner had I typed the last word above when I found something interesting in John Goodman’s latest blog posting.  It is an article in the New England Journal of Medicine titled ‘A Systemic Approach to Health Care Spending.’  I recognized the authors as big guns in ‘big-government’ medicine.  Out of fairness, I felt that I should mention it.”

“I am amazed by the kindness of an opinionated old codger.  So what was in the article?”

“According to Goodman’s summary, the two most important proposals are: (1) market-wide negotiation leading to all-payer fees (every third party pays the same) and (2) a ‘global budget’ cap on the rate at which these fees can increase over time.  I suspect that these signify more stringent regulations for providers and payors.  Goodman says, ‘the proposal virtually guarantees that no provider is going to experiment, innovate, and try to find alternative ways of lowering costs, raising quality, and improving access to care.’ “

“And what do you say, Ancient Oracle?”

“Despite these guys’ prominence and power, I characterize them as faux philosopher kings.”

“And what might become of all this?”

“I shudder.”

K. C.  

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