KA-BOOM!!!
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“In Health Care, Cost Isn’t Proof of High Quality.” This was the headline of a story by intrepid New York Times health care reporter Reed Abelson in today’s NYT. Well, now it must be official. While many - including me - have been saying this for years, it’s now been published in the Times, and must, therefore, be true. Reed was writing about the findings of a recent study by the Pennsylvania Cost Containment Council, which found that the cost/price of heart bypass surgery varied by 500%(!!!!), while outcomes did not track with variations in expenditures. To quote the story - “Still, the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.”
This is why I keep pushing for a well funded, high performance Health Care Quality and Cost Council in Massachusetts. Some try to make this “transparency” discussion all about consumerism, and argue that no one would ever shop for a heart surgeon. This perspective misrepresents the value and utility of publicly available information. If the patient would like to see it - great - but the true audience for this information is the provider community itself, policy makers, researchers, employers and health plans. Bravo for the state of Pennsylvania for issuing the report, and three cheers to the NYTimes for writing about it. Let’s hope people in MA and New England see it, too.
Are you becoming a NYT kind of guy right before our eyes, Charlie? I’m kidding, of course. In all seriousness though, when I saw this article I thought of how well this went with your argument.
I totally agree with where you place the value of transparency-on the provider/implementation side-and go back to Barry’s previous post drawing the comparison to the Federal Reserve Board. While the findings and decisions of that committee are publicly available, their greatest influence is exerted over those in the financial community.
I do think, though, that the “average consumer” does play a crucial role in the development of an effective Health Care Quality and Cost Council, and that the program’s continued success will share a greater link with consumer/public education than is the case with similar government programs. I think it’s safe to assume that the average consumer (not just of healthcare, but overall) has a loose grasp at best of exactly what the Federal Reserve Board does and what it’s actions mean on an individual basis. However, in the case of a Quality and Cost Council, the consumer may have an easier time connecting point A to point B, so to speak, as healthcare is a more specialized market. As this article points out, even the ‘value’ of healthcare is far from universal. Past studies have shown that regional cost of living variances do contribute to regional discrepancies in healthcare cost. This is evident even within state borders, let lone on a national level. As many have pointed out, most people first consider how they will be affected before looking at the larger picture. If public opinion turns against such a council, it could seriously hamper the program’s effectiveness. That’s why I think that while the decision making process (all phases) should be left to the professionals, there needs to be a large effort put forth to educate the general public about exactly what such a council would mean to them, and why.
How can this Health Care Quality and Cost Council be effective if you won’t even respond to my previous question of who is on this council and who is responsible for putting people on this council? Again, this is a taxpayer funded council and we have zero idea of who is sitting at the table and who is setting the agenda. The Mass health law was set in motion by Jack Connors and Partners who received significant Medicaid rate increases as a result… not exactly looking out for the common taxpayer who is largely paying for the new law. If this council is comprised of people similarly looking out for their own financial interests why should we expect any real change from it?
Whether it’s Philadelphia or Pittsburgh, the Wyoming Valley or the Susquehanna Valley, the one thing these areas have in common is that they are all part of a state which has a wide variation of demographics, culture, and industry. If Pennsylvanians can come together to create such an effective means of analyzing health care data, New England & MA should be capable of doing the same.
Many have been talking about the lack of correlation between cost and efficacy for 15+ years. But for years and years no one cared. If we had seriously started dealing with this issue 10 years ago, can you imagine how much money and how many lives we’d have saved? And think of the opportunity cost: What else could we have done with that money?
It’s almost like global warming. We had to wait for the ‘problem’ to become a ‘crisis’ before as a species were able to begin tackling it.
But very happy that the cost/quality wave is finally breaking through to the mainstream.
There is a perspective on how to get quality healthcare for cost (alias, value) that we in the US could learn from what the Brits have tried to do.
A few years back, the National Health Service in England introduced a corporate governance process that was designed to ensure that public resources are spent to their best effect. This came on the heels of a study on waste and loss in the NHS, which found that anywhere from 12-25% of healthcare resources never benefit the patient. That figure is higher in the US–over 30%–according to the Dartmouth Atlas Study.
Every NHS hospital had its managers evaluate, with each other, the budget items they wanted the hospital to support. These “investment opportunities” were assessed for their likelihood to deliver the most benefit and their ability to avoid the most risk (eg, value). This allowed boards to compare which budget items would deliver the most value and decide where to spend money.
What the Brits had right was the notion that if you really want to drive value for money, you have to hold providers accountable for how and why they spend money the way they do before they spend it. That is, as a provider, when you decide to buy something or hire someone, you should expect a range of benefits in return. Rarely does anyone in healthcare track the extent to which expended resources deliver the benefits they promised.
The conversation in this country around Value Based Purchasing should include this notion of payers holding providers accountable for, and then rewarding, how much “value” providers deliver with their relative resources.
In other words, if payers thought more like “investors” who worry about whether money they invest delivers the results it was intended for, they could properly incentivize providers to set investment priorities and be rewarded for achieving them, instead of prompting them to find new ways to game the system and chase reimbursement for care that’s already been delivered.