The IOM report should be receiving more attention

The Institute of Medicine's new 450 page report, "Better Care at Lower Cost", is an excellent analysis of the problems of our current healthcare system, and the ways to resolve them.

But what I find the most surprising about the IOM report is what it didn't do: it didn't create major shockwaves in mainstream media, as some of IOM's previous reports have done. IOM's 1999 report on medical errors, "To Err is Human: Building a Safer Health System", continues to be referenced today; last year's report on EHR safety also caused quite a stir.

Perhaps the lack of attention for the new report stems from the fact that much of the information in it isn't really news, at least not to those in the healthcare industry. We know that healthcare is "too complex and costly to continue business as usual," as IOM points out. We also know that the current payment models emphasize volume over quality, and that electronic health records and other health IT tools offer significant opportunities to share health data and improve care.

But at the very least, the numbers should have raised more eyebrows outside of our insular world: IOM reveals that 30 percent of the money spent on healthcare in 2009--$750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems.

Repeat that number out loud: $750 billion.

Moreover, 75,000 patient deaths could have been prevented in 2005 if every state had delivered care at the quality level of the best performing state.

So why is this country not all up in arms about this? The pure scope of those losses should be enough to create a clarion call for change.

Perhaps it would help to publicize how the healthcare industry compares to other industries, since then people could more easily put the problem in perspective. One of my favorite sections of the IOM report was this comparison, which I'm paraphrasing here:

  • If banking were like healthcare, ATM transactions would take days, not seconds, as a result of unavailable or misplaced records;
  • If home builders were like healthcare, each plumber, carpenter and other contractor would work with different blueprints and very little coordination;
  • If shopping were like healthcare, product prices would not be posted, and prices would vary widely within the same store, depending on the source of payment;
  • If the auto industry were like healthcare, warranties to pay for defects would not exist;
  • If the aviation industry were like healthcare, each pilot would be free to design her or her own preflight safety checklist--or not perform one at all.

What's so odd is that our healthcare world really isn't that insular. Healthcare has been a front burner issue in recent years. And people in all industries, all walks of life, obtain treatment when necessary. So are people not getting the memo, so to speak?

Maybe we as patients are so used to lesser quality performance that we're willing to tolerate it? Or is it that we feel we don't have choices?

I think not. I'm not waiting days to get cash from my local ATM, and I'm not buying a sofa without knowing its cost, including any delivery fee. I'll go into the bank. I'll shop in a different store.  

The IOM is a venerable institution. People listen to it. Let's use its report as a wakeup call for those who continue to sleep. - Marla

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