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8/21/2009
Toussaint and Ariens on health care reform

These two men from the Fox Valley know what they’re talking about. A significant excerpt of the article is included below, but read the whole thing. Ask your U.S. Senators and Representative to read the whole thing. This is not screaming and hollering and making untruthful, sensationalized claims about proposed health care reform legislation. This is the real deal.

(While you’re at it, if you’ve not read Dr. Atul Gawande’s piece in the June 1, 2009 New Yorker about radically different hospital cost paradigms, it too provides a terrific foundation for understanding how America’s health care delivery system simply must change.)

Dr. John Toussaint is president of the ThedaCare Center for Healthcare Value in Appleton, and Dan Ariens, CEO of Ariens Company, Brillion, serves on the Center's board of directors.

Unless we get serious about changing the way we deliver health care and the way we pay for care in this country, costs will only continue to escalate exponentially.

…. The way we now pay for care, whether through government programs or private insurance, rewards hospitals and physicians for providing more and more expensive procedures, with little attention to the quality and outcomes.

Realistic alternatives
The alternative to massive tax increases and further provider reimbursement cuts is a concerted effort to take waste and inefficiency out of the existing care delivery system.

…. ThedaCare, an integrated health-care system with four hospitals and 27 physician clinics in Northeastern Wisconsin, has radically redesigned patient care. Using quality improvement tools adapted from manufacturing, ThedaCare has reduced the total cost of inpatient care by 25 percent, improved quality and increased patient satisfaction.

Gunderson Lutheran, a multispecialty clinic and hospital system in La Crosse, WI, has had similar success. Health-care costs for Medicare beneficiaries during their last two years of life were half the national average, according to Dartmouth Atlas data.

Trillions in improvement
These real-life examples can add to real dollars saved. If all hospitals in American could redesign care and achieve results similar to ThedaCare, close to $400 billion could be saved on Medicare inpatient care alone in the next 10 years.

A 25 percent cost reduction on the non-Medicare side could lead to an additional $1.3 trillion over 10 years. If all Medicare patients were treated at Gunderson in La Crosse, it could generate annual savings of $200 billion or nearly $2 trillion in savings over 10 years.

The magnitude of the opportunity to remove waste and eliminate errors in the current health-care delivery system is staggering.

Essential reform ingredients
Changing Medicare rules takes an act of Congress, which rarely happens. If we must have another federal insurance program such as Medicare, how do we design it so that fatal flaws hampering Medicare aren't repeated?
Pay for health-care services based on the provider's ability to improve quality, reduce costs and improve access.

Improve the efficiency of the current delivery system by encouraging the use of improvement methods such as "lean." Lean is a set of manufacturing principles and philosophies that eliminate waste and errors and have proved to work in care delivery. This will improve quality, reduce costs and improve access.

Ensure that health-care cost, quality and value data is transparent and local. This can and is being done through local and regional health information authorities that can work directly with hospitals and physicians to aggregate and report useful and meaningful information that consumers can use to make more informed decisions about their health care and what it costs. Good examples of these efforts include The Minnesota Measurement Community and the Wisconsin Collaborative for Healthcare Quality.

Allow states to implement reform plans that make sense for their citizens. States such as Massachusetts and Wisconsin, which have programs that cover nearly 100 percent of their residents, should be allowed to continue with their statewide plans.
Now is the time
Many of us in the health-care industry agree that now is the time for health-care reform. Group Health of Puget Sound, ThedaCare, Gunderson Lutheran and 12 other healthcare delivery organizations in the U.S. and Canada have come together to accelerate and spread our learning on delivering better patient value.

The new debate regarding health-care reform in America should be about encouraging provider competition based on who can provide the best health-care outcomes for the population in the most cost efficient manner.

Jo Egelhoff, FoxPolitics.net

COMMENTS

Hmmm, let's let those who get paid obscene incomes manage our health payment system. Makes sense to certain folks I suppose.

Some years ago, my corporate employer entered into s "cost containment" agreement with local health providers and insurers. This agreement was touted with press releases and enveloped in the latest management craze, "total quality management."

The result: an major increase of administrative personnel in the health system(patient advocates, wellness counselors, etc.), replacement of office physician assistants with LPNs (who do do little more than take height, weight, pulse and blood pressure measurments)thereby increasing the time of my doctor spent on low level medical procedures (for which higher fees are charged), substantially higher annual insurance premiums, restricted choice of service providers, and sky-rocketing fees.

Last week I had a routine office visit with my in-network general practioner (GP). It was a 15 minute visit (not the more expense 30 minute visit. The office visit charge? $147.00. I also had a potassium shot (billed as "in-office surgery"). The charge? $235.00. In less than 15 minutes I was "examined" and given a simple injection to the tune of $382.00!

This is the quality/cost outcome of collusion between employers, insurers, and the medical establishment. When I sought to challenge the fees charged, I was told the fees were reasonable and acceptable under the structure agreed to by the parties in the cost containment program.

Well now, let's look at free enterprise in this scenario. Perhaps I should have gone elsewhere. All other in-network providers charge the same rates so that doesn't help. If I want to pay 20% extra out- of-pocket, I can go to an out-of-network provider. First, though, I have to get a copy of my health records (that's another bureacratic horror story). Then I must try to find someone who will share fee amounts publicly in advance (can't really estimate charges until they have a look-see at me and my records which means more fees to review my history).

Let's face it. Physicians (and the enire medical establishment) have no incentive to contain costs if it means holding down their compensation. (And medical establishment employees will tell you they deserve much higher pay for the critical work they perform. Look at business execs and entertainers and sports personalities which don't give life sustainng treatment for comparison.)

Absent some type of outside regulation, the system will never truly reform itself. Letting the foxes alone manage the chicken house is ridiculous.

Dennis (Fri Aug 21 10:35:08 2009)

"Lean" is a concept all hospitals are getting into. It often involves using cheaper equipment, or cutting staff. I notice he mentions "Theda Care has reduced the total cost of inpatient care by 25%". Reading between the lines, this means the HOSPITAL'S OWN costs, (which is not a bad thing, as we never get paid what it actually costs to treat a Medicare patient), which is why those with insurance get charged more--at least the insurance companies will pay.

BUT it does not mean the "system" is costing less! To truly cure the problem, ALL THIRD PARTIES SHOULD BE CUT OUT. This is whether that party is private insurance OR government. Or at least, insurance should be for catastrophic coverage only. Only when drs are paid like any other specialized tradesmen, will costs truly come down.

And, Dennis, you did NOT get a "potassium shot" at your dr office, or you'd be in extreme pain and possibly have gangrene at the injection site. Potassium is only given orally or via IV. It is more tightly controlled than even narcotics due to its irritating nature, and is NEVER EVER given intramuscularly.

So, if you indeed got potassium, you did not get a "shot"; you got it IV, and the charge is "cheap" compared to getting the same in ER.

I agree it seems out of line, but this is what happens when there is a third-party-payer system. We haven't had free market medicine in the US for over 60 years.

emily matthews (Fri Aug 21 16:55:41 2009)

Lean Manufacturing !
Well,as a Manufacturing Engineer, that is an area I specialize in.
The above Article says alot, but has no specifics, other then the "OlD" song of trying harder.
That my friends gets you no where.
So what would help ?
As a Prostate Cancer Survivor, Let me explain what I see.
Why do we need all the hospitals in the area to get Devinci Machines?
These robotic surgery units cost about 3 million as I understand it, and then they are only used on some days during the week.!
Why not one hospital and surgery from 6 Am to 8 PM at night!
This is significant for all of Medicine
We need to stop the insanity of hospitals competing with one another
You cannot play all the instruments in a Orchestra and expect to be the best at any of them.
We need to see the Medical community organize for efficiency, not convienience..sorry Docs, I know medicine is not a quick cure in most cases,but treating people with machines or offices that are only occupied for 6 hours a day is not cost efficient.
The dirty secret is that decisions are made on "how much more money can we make by having this machine" then by
"can we fully utilize this investment"

Henry Ford showed the Manufacturing world how to improve, and its high time that the medical community do the same.
Highly organized treatment does not mean "Less" quality, in fact, it can mean more.

Rich Carlstedt (Fri Aug 21 20:57:11 2009)

The question of OVER utilization continues to raise its ugly mug.
We have an embarassing wealth of MRI machines in the Valley. They cost millions to purchase, hundreds of thousands per year to maintain and have a relatively short shelf life. To get a reasonable ROI and "compete" with others who thinks they won't get over used?

I fell and broke my elbow about 6 weeks ago. I got an x-ray and a CT scan fot the bump on my head. I also complained about my wrist hurting. I was told to wiggle my fingers. Diagnosis, no problem with wrist.

The next day I had to head to my Internist (my GP) and have it X-rayed. It was broken. Two sets of deductibles, and I never did see a physician in the E.R. at AMC. I realize this is anecdotal, but my $2,000 trip to the ER got compounded by the poor diagnostic process. And the plural of anecdote is data.

The government can't even run cash for clunkers. How the heck will they run health care? But health care, if not broken, is or needs to be in ICU. Thank goodness we're at least now having the discussion.

Steve Wells (Sat Aug 22 04:41:35 2009)

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