I start out this editorial with a plea for advice – I’m on a quest to figure how to get my children to do chores.
Mind you, this has been an ongoing project for many years. My oldest is 21 years old, and the youngest is 12. I still haven’t figured it out. Apparently, all my witty ideas – incentives, competition, setting up checklists, establishing prize levels and whatever else – just haven’t worked.
I remember the glazed look on the oldest’s eyes as I explained a particularly incentive-laden approach about a dozen years ago. I got that “this ain’t never gonna work, buddy” look, and she was right – it never did.
Now there’s hardly any relationship between getting kids to do chores and taking steps to enable healthcare professionals to participate in reform approach. However, making reform complicated and convoluted materially reduces the chances that it will succeed. Keeping it simple means taking a direct line between an action and a resulting reward.
A couple of recent studies suggest that highly touted reform approaches may not hold the high potential that they have been assumed to have.
In one study, the Center for Studying Health System Change suggested that consumer-directed healthcare may not curb rising healthcare costs because physicians don’t pay enough attention to patients’ out-of-pocket costs. This is particularly true when it comes to uninsured patients, the study found.
And that study found that physicians still are making healthcare decisions without consulting patients. Thus, consumers, who are increasingly responsible for their own healthcare purchasing decisions under CDHPs, may not be able to reduce their own spending even if they want to, researchers speculate.
Another highly touted approach to reform, that of paying providers for performance improvement, also has been questioned by a study recently published in the American Journal of Managed Care.
That study contends that the incentives dangled before physicians in pay-for-performance programs may not be enough to motivate them to improve performance. Additionally, the improvements sought by such programs may be too generic to actually bring about substantial and meaningful changes in care delivery.
These findings should give policymakers and the industry pause for thought. A lot of proverbial eggs are being put in the reform baskets of P4P and consumer-directed healthcare. It would be a pity, if not a disaster, if all this effort turned out to be ineffective.
Healthcare reimbursement reform often has dipped its toes into concepts that potentially could provide beneficial results, but there’s a reluctance to really take a bold plunge that convinces everyone that those with the money are serious about inducing change.
There are some steps the healthcare industry could take that have proven benefits attached to them. For example, interoperable electronic medical records have strong potential to coordinate care, reduce medical errors and pare duplicative testing. If increasing efficiency and cutting costs is such a priority in healthcare, and IT has enabled this in every other industry, why isn’t there a gigantic push to achieve this in healthcare as quickly as possible?
In addition, it’s known that patients are often their own worst health enemies – they’re overweight, they smoke, they don’t get regular testing because insurance won’t pay for it and they don’t fill prescriptions because drugs cost too much. What if all players in healthcare cooperated to give Americans real and sizable incentives to take care of themselves? We can get millions of Americans to waste money on lotteries they’ll never win, but we can’t incent them to improve their self-care, saving their lives and saving the healthcare system billions of dollars?
The hard part is that while everyone gives lip service to these concepts, it’s hard to know who in the industry benefits the most, because, theoretically, those who benefit greatly should pay the most.
I’d like to suggest that it’s time for everyone to take on some of the pain. With the right, simple, spot-on incentives, there’s much to be gained.