Dr. Atul Gawande has an insightful article in the latest issue of The New Yorker magazine. You can read the entire article by clicking here.
He explains that the reform package clearly recognizes that the current healthcare payment model, based on the quantity of care rather than the value of care, cannot continue. But it is not that simple.
Recently a children’s hospital in Boston changed the way it handles treating patients with asthma. The hospital offered a number of new preventative measures that helped treat kids in their own homes and alleviated the need in most cases for hospitalization. A year later the hospital readmission rate for these patients had dropped 80 percent! But asthma is the hospital’s leading source for admissions and empty hospital beds could threaten to bankrupt the facility. Dr. Gawande explains that so far neither the government nor insurance companies have any solutions.
That is where hospitals come in to play. Hospitals will need to provide the roadmap for regulators and show them how this can work. Dr. Gawande says:
The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving healthcare innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.
That’s the one truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success. We are the ones to determine whether costs are controlled and healthcare improves—which is to say, whether reform survives and resistance is defeated.
Keeping patients well and lowering healthcare costs is the ultimate goal, but we will also need to find a way to offset some of the financial loss that hospitals and physicians will experience. We (those in healthcare) will be the pioneers. Don’t be mistaken, they are looking to us for direction and answers.
Kester Freeman blogs regularly at Action for Better Healthcare.