Monday Musings

I just got back from the National Quality Forum meeting in Washington, DC. I’ll spend Mondays in April telling you what I learned about the conference, the theme of which was “Tackling Costs: The Quality Solution.”

The Kaiser Foundation estimates that the average American family will spend 25% of their income on healthcare. Bernard Tyson, Chairman and CEO of Kaiser Permanente, observed that the “cost shifting” of healthcare expenses to the American people has increased by 212% since the 1990s without any immediate benefit in healthcare quality to show for it. Inside the insurance industry, the payers are asking whether it is “quality” or “affordability” they should be providing because they are not sure they can do both. We are now seeing the emergence of insurance plans with deductibles so high, to most people their so-called healthcare insurance is really just a “catastrophic” insurance plan, and they are now getting less instead of more care.  Assuming your birth is uneventful, the majority of healthcare dollars are spent towards the end of life. Many insurers are now asking, “What about the care provided in between birth and ‘the end?’” There is a sense that we need to change the “fundamental narrative of the health care paradigm” and focus more on the “place in the middle” to actually improve quality of health. We are seeing big companies weigh in with initiatives like CVS and Walmart, creating a new space attractive to people which can provide a simple and trusted form of healthcare. The fact is that we need more work on the healthcare delivery system.

The sad fact is that out of control healthcare spending threatens the American Dream. While many clinicians worry that necessary services are going to be cut back, we could entirely change the nature of the conversation if all we did was get rid of WASTE! Fully half of all healthcare spending is waste, overuse, or misuse. CMS estimates that $72 million dollars are wasted PER HOUR.  Much of that is due to what is euphemistically called “over delivery” of healthcare services.

I will make the editorial comment here that CMS’ move to “package price” cellular and tissue based products (CTPs) and the pre-authorization of non-emergent hyperbaric oxygen therapy (HBOT) are both aimed at what CMS perceives as “over delivery” of those services – and I am not sure they are wrong. That is one of the reasons the US Wound Registry has launched “appropriate use” quality measures for both CTPs and HBOT.