Feb
4
TO FIX OUR HEALTH CARE SYSTEM WE MUST ADDRESS ITS MOST FUNDAMENTAL FLAW: “YOU GET WHAT YOU PAY FOR”
Millions of lives will be improved in the process, says physician-researcher
As a primary care physician and researcher, I believe that the most fundamental challenge in reforming healthcare is recognizing that our system rewards physicians by the number of patients they see each day (encounters) and by the procedures they perform. As a result we have a medical system that is very good at delivering encounters and procedures, but remarkably less capable of improving the health of individuals. The concept of “quality care” is oft spoken but, in reality, ignored. The result is that Americans are getting from our health care system what they’re paying for: encounters and procedures rather than “measurably improved health.”
This is a troubling reality on professional, ethical and public policy levels. It is my conviction that the only way we can improve patient health and reign in escalating healthcare costs is by reforming the way physicians and clinicians are compensated.
Today primary care provider compensation is based on the false assumption that all encounters provided — or measures of quality — are equal. (Even when “pay-for-performance” reform measures are incorporated, compensation is still linked to encounters. This is akin to redesigning a car without considering the type of fuel it will use. Instead we must recognize that the difficulties and relative costs in helping patients choose a healthier future are particular to the individual. The failure to recognize and quantify this fact has been the root cause of resistance to quality and the evolution of value based compensation.
Electronic health records, impressive computing power, and advances in predicting the probable health future of individuals have created the circumstances which allow the public and private sectors to pay for measurably improved health. In other words, we are now able to create payment relationships which align compensation with what is desired of the healthcare system: objectively improved health. Once this model of compensation is wide spread I imagine it will unleash the amazing force of our market economy to improve the health of the American Public.
Payment for encounters and procedures, regardless of the impact on survival or avoidance of future diseases, will further confound efforts to improve the health of the population at large and make the deficit worse through uncontrolled growth in healthcare costs. As a member of the non-profit Western Clinician’s Network (WCN), I am developing an approach using predictive analytics to calculate the contribution by provider and patient to the changes in health outcomes. WCN is compiling the determinants of a patient’s ability to choose a healthier future, and creating unbiased measures of the provider’s impact on these outcomes. While our work is being conducted with community health center patients, the results apply to the entire healthcare industry.
The immediate benefits of our research will 1) help the primary care health home movement to evolve; 2) focus resources for patients with specific diagnoses (e.g. chronic diseases such as diabetes; Hypertension; Heart Disease etc.); 3) aid practices in redesigning compensation relationships with third party payers and Accountable Care Organizations; and 4) cause a profound shift in the practice of medicine and unleash an untapped capacity for innovation, quality improvement, and cost reductions.
The challenge for lawmakers is to finally embrace the fundamental tenet of economics and begin to design a healthcare industry that is properly aligned with that which every person ultimately desires: measurably improved health.
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Carl Heard, MD, is a self-described “horse and buggy” doctor practicing medicine in his beloved Nevada. A graduate of the Medical University of South Carolina, Charleston, S.C., Dr. Heard completed his residency in Family Practice at the University of California, Irvine and also earned his Masters in Medical Management from the Marshall School of Business at the University of Southern California. In addition to his research activities with the Western Clinician’s Network, Dr. Heard serves on the agency’s Board of Directors. Western Clinician’s Network is a non-profit 501(c)(3) organization. It was founded in 1992 to provide education, training, peer support and research in order to improve primary care and public health.
Feb
4
Heavy Equipment and Medicine
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Heavy Equipment and Medicine
Offered for Publication in WCN Newsletter, July 2011
All Copyrights reserved
Just a few days ago I was performing a routine Commercial Driver’s License Examination for a patient, and had the luxury of time to get to know him better. We struck a conversation about his work. He and his colleagues are in the process of creating a method of using multiple sources of data about the heavy equipment they manage to predict the probability of failures. They visit sites, and acquire data on bull dozers, earth movers and other extremely valuable pieces of equipment.
The information acquired is analogous to that which we acquire in medical practices: vital engine component performance; frequency of oil changes and its chemical analysis; maintenance records; break down/system failure reports; age of equipment and other objective measures of equipment “health.”. These are similar to blood tests, cardiograms, etc. These managers of valuable equipment are challenged with technical obstacles, such as integration of information from multiple sources, and the variations of operators. They ultimately strive to accurately estimate the costs of maintenance, and the breakeven point for taking equipment off line and planning for replacement.
The advantage is that they have a less complex set of metrics, and are able to work in an ethical environment driven entirely by economics. In spite of these advantages their effort parallels the recent developments in healthcare. We are finally getting to a point that data acquisition is inherent in the work we perform in healthcare through electronic health records. The analysis of this data is the next wave of technological opportunity that will revolutionize not just health care but also heavy equipment management, and virtually every information intensive industry in the world.
The accumulation of data and its use to estimate future problems is in general called predictive analytics. An over simplified description of predictive analytics is the accumulation of data, the warehousing of data (collecting, organizing and “scrubbing” of multiple sources of data) and then the analysis of that data to predict the most likely future. It is intuitive to consider this in machines, where mechanical failure rates are well documented through lab testing of a limited number of systems. In healthcare this seems practical, but given the exponentially larger number of variables seems an impossible task.
In part an analogous process of predictive analytics is inherent to the intellectual processes of healthcare professionals. Professionals acquire data through examinations, diagnostics and laboratory tests and create a diagnosis, prognosis and treatment plan. The ability to accurately predict the future (prognosis) is one area where we as people could dramatically benefit from the experiences of heavy equipment managers. When we accept that the “peripheral brains” provided by predictive analytics can enhance our abilities, we can finally expect that we will get closer to the error rates currently enjoyed in the airline industry, or many others we have come to expect to perform as promised. Even to the point of accurately understanding the costs and expected benefits of aggressive management.
Understanding the progress made in managing expensive and mission critical equipment will lead us in Medicine to practice more effectively, and to aid pts in understanding the risks and benefits of a wide and growing array of options. Ultimately we will finally be able to understand the contributed value of preventive care, and the benefits of routine examinations, or oil changes. The most expensive and mission critical equipment in the world is in our hands, and it is time we used the same technological advantages that the mining industry currently and routinely incorporates.