Health Care System Must Reward Quality of Care, Outcomes

Posted August 13, 2009 at 12:44pm

Health care reform is imminent. Legislation is being introduced, and all parties with a vested interest are preparing to fight for their needs. But as our country and our leaders head down this path, do we know the destination? We know that we need reform, but do we know what that reform should look like?[IMGCAP(1)]The administration’s talking points, the Senate and House proposals, and the reports stemming from the Republican Party’s attempt at its own plan are all encouraging in that they underscore collectively that the status quo is not sustainable. If the priority of effective health system reform becomes a political football, coming legislation will not address the root issues of cost, access and quality dilemmas, and we will continue to treat what needs to be a major operation with Band-Aids and smiles. America’s health care is the world’s benchmark when functioning at its best. We have incredibly well-trained professionals with access to the latest technology. However, we produce inferior comparative morbidity and mortality results to other developed nations, at double the cost. We waste too many dollars on misuse and overuse of technologies. We also increase preventable costs by failing to provide the best care for uninsured and underinsured patients when they first need it. Ours is a nonsystem that aspires to become far better, despite our accomplishments. Ironically, the best care in America is not the most expensive. Poor care, which often means overtreatment, inappropriate treatment or delayed treatment, is more costly from both a financial and philosophical standpoint. If we want to bend the steeply rising cost curve downward, there are realistic and proven approaches that systematically improve quality, outcomes and costs, while still preserving choice of doctor, hospital and coverage, and protect the patient-physician relationship from corporate or government intrusion. Payment incentives for doctors that reward better prevention, higher quality, and transparently reported outcomes are a practical and feasible solution. But here’s the worry: Will the coming reform proposals really tackle these issues?Right now we have a window of opportunity. Improving quality is how we will both improve outcomes and reduce unnecessary costs. Physicians order the vast majority of health spending and must drive this process in Congress. Payment incentives that give the profession the resources and encouragement to produce this kind of sea change must be central to health system reform. It’s not only electronic health records, clinical decision support and e-prescribing systems that are needed. It’s also payment incentives to produce a health system that has the highest quality at the lowest cost. Consider that 27 percent of Medicare patients discharged from the hospital with heart failure are readmitted unnecessarily in one month, and more than 50 percent in two to three months. This comes at a horrific cost to patients and the health care system. The American College of Cardiology and the Society of Thoracic Surgeons already have developed disease registries capable of tracking and improving quality of care in hospitals across America to great benefit. But this kind of accomplishment is not encouraged or incentivized in today’s health care system. It must be so in tomorrow’s reformed system in order to measure our way to a more effective and evidence-based system.Physicians and consumer groups must drive the process of ferreting out the waste in the current system to improve quality and outcomes. Recent polling reveals that the vast majority of people — 86 percent — trust their doctor and/or patient-advocacy consumer groups to drive the health reform process. It is clear that those most affected by health care reform — doctors and their patients — are those who need to be leading the health care reform conversation. But it’s not too late to see that we can think beyond the primary priority of getting affordable access to care for all Americans accomplished. Let’s also get them, and all of us who currently enjoy such access, a system that measures and rewards quality of care and outcomes. Basing health care reforms on quality and driving down costs will allow us to provide more coverage and make available more resources for education, the environment and other critical societal needs. All of this is possible if we grasp the opportunity before us.Jack Lewin is CEO of the American College of Cardiology.