Economic Downturn Opens Window to Health Care Reform
An attentive Medicine Grand Rounds audience listened to Arnold Milstein, MD MPH the first speaker in the Department of Medicine 2009 Symposium on Physician Accountability present his research on practical ways to increase efficiency in US health care. A system that’s on the verge of being unaffordable for the non-affluent, where biomedical miracles drive health care spending growth spending 2 – 3 percentage points faster than GDP growth.
Milstein is the Medical Director of the Pacific Business Group on Health and US Health Care Thought Leader at Mercer Health & Benefits. He is also an advisor to Congress on Medicare payment and part of President Obama’s team focusing on the ways to reduce spending without comprising quality of care. Public Relations Officer Rita Kennen talked with Milstein about how physicians can be more resourceful in delivering health care.
Could the depressed economic climate actually be a positive factor for health care reform?
Though distressing and painful, the economic downturn will provide an impetus for more robust health insurance reform and health care delivery reform than would otherwise be possible.
What cost cutting measures might be best accepted?
Transferring the financial consequences of flawed care to those best positioned to improve it. For example, I’ve encouraged federal legislation that would allow Medicare to pay hospitals and their medical staffs a fixed price for hospitalization and the 30 days following discharge. It would enable doctors and hospitals to benefit financially if they lower hospital readmissions due to preventable complications and suffer if the frequency of readmissions rises. Similarly, physicians who succeed in lowering the frequency of costly health crises for chronic illness patients should share in insurer savings.
How might less technology and better bedside diagnosis reduce costs?
As Dr. Abraham Verghese recently wrote, careful attention to physical examination findings can eliminate expensive testing. It’s also a pathway to greater diagnostic accuracy which lowers the cost of treatments aimed at erroneous diagnoses.
How much will electronic medical records (EMRs) save and at what point would savings off set the cost of technology and training?
Current estimates of national per capita spending reduction from adopting of advanced EMRs are in the range of 6-8%. Half of the savings would accrue by taking paper out of the system. The other half depends on EMRs being connected with each other; for example, if EMRs were connected throughout the health care system, it could eliminate a test or procedure that had recently been performed in an ER. However the biggest opportunity to reduce health care spending is by using EMRs as a platform to continually test better, leaner methods of delivering care.