Solutions to high cost of healthcare elusive, but not an impossible dream

Karen Cheung-Larivee

 Karen Cheung-Larivee

It's a dream that providers, payers, patients, politicians and pundits alike share--controlling healthcare costs.

At a healthcare conference for journalists in New York City last week, it was self-evident that providers have a right to pursue the best care for patients without facing penalties for doing the right thing.

That's the mantra of The Commonwealth Fund. The independent foundation believes in a world where the healthcare system confronts all costs--not just for Medicare and Medicaid--a world where doctors see poor patients without fear of pay cuts, a world of a "high-performing health system."

The idea is simple. Pay providers differently; not less.

A recent Commonwealth Fund paper proposes that the healthcare industry could save $2 trillion by 2014--and not by cutting payments to hospitals or physicians, but through improved efficiency.

The "solution," so far, has been for insurers and lawmakers to either increase deductibles for patients or cut provider reimbursements.

"The first two are easier to do, but it inflicts a lot of pain," Commonwealth Fund President David Blumenthal, M.D., said at the Society of American Business Editors and Writers (SABEW) conference.

"We can't get where we need to be by simply cutting payment to providers," Blumenthal said, since reduced reimbursements could compel providers to reject Medicare and Medicaid patients.

Congress is grasping at straws to control Medicare and Medicaid costs. Much like provider groups, the Commonwealth Fund recommends permanently fixing the sustainable growth rate formula.

"Congress has been stuck in constant revision of physician payment," Blumenthal said about the scheduled 27 percent cut to providers slated in the next 12 months.

However, a new Congress starting this week could signal renewed efforts to repeal the SGR.

Healthcare is on track to make up a fifth of the gross domestic product, but the government has proposed a goal of 18 percent of the GDP. Healthcare spending in the U.S. exceeds that of every other country. What does the most expensive healthcare system on the planet have to show for its money? Not much. Higher-spending hospitals don't necessarily have better quality. That's why improving efficiency is so important.

According to Blumenthal, the key to that goal is health IT. "It would potentially break the log jam we have in fighting policies," Blumenthal said.

Blumenthal, is quite possibly one of the nation's greatest cheerleaders for electronic health records--the physician shepherded Partners HealthCare through the growing pains of electronic health records implementation and ushered the Boston health system into a new era of health IT.

"You need to have an almost superhuman commitment from leadership," he added. But these days, it's a lot easier to garner executive support for IT initiatives.

"It's no longer necessary to convince the leadership they have to increase efficiency and quality. They are going to live or die to save money and meet quality targets," Blumenthal said. "You no longer have your CFO fighting changes because they are afraid of reducing volumes or radiology."

During the session, Blumenthal responded to a question from FierceHealthcare about physician support for EHRs. Hospitals don't have to tie EHR use to individual physician payments as incentives, he said. "Physicians have been rarely excited about change … but they have an intrinsic desire to do job better."

Not convinced yet about the magical powers of health IT?

Although Blumenthal cited Epic as the EHR system of choice, any EHR system should utilize clinical-decision support tools, in which evidence-based medicine to help guide care decisions. The information systems that prompt action could tell physicians what tests to order, for instance. Best practices, therefore, are "not on shelf in some journal, but on their computer when they're delivering care," according to Stuart Guterman, Commonwealth Fund vice president.

That's the power of the EHR.

I'll venture to say that physicians these days are excited about change. They want to do their jobs--caring for patients. They don't want to spend their time, pawing at computer screens when technology is more of a hindrance rather than a help.

A medical student friend of mine, who I saw after the SABEW conference, even told me that she is picking her residency based on the hospital's EHR system. Although not the sole factor in her decision for residency, anecdotally, she said that it was a major reason.

"Some hospitals don't have a very good EHR system," she told me. In the same breath, she said that even the transition to EHRs would be a deterrent in her choice. "If they are moving to one system, you don't want to be there for that,"

It's been noted a thousand times before, but I'll say it once more. Health IT isn't a silver bullet, but it is the mechanism for change.

The dream of health IT and reduced costs is getting closer to reality. It has to. - Karen (@KCheungLarivee / @FierceHealth)