On July 17, anesthesiologist leader and ASA member Jeff Balser, President, CEO and Dean of the Vanderbilt University Medical Center, appeared before the Senate Committee on Health, Education, Labor and Pensions. His message on the future of health care focused on reducing health care costs, eliminating waste and improving value for patients. I want to share with you some of the key points he made during his superb testimony:
- The largest single cost is waste:
- It consumes more than 1 out of 3 health care dollars (about $1 trillion).
- Biggest source of waste… sloppiness:
- Problems with communication among providers.
- Shortcomings in decision support:
- Failure to share labs and radiology exams between doctors.
- Efficacious use of drugs proven to have no effect on long-term outcome and non-use of some drugs.
- Reducing variability and drug costs:
- Drug costs are rising at an average rate of 10% per year over the past decade.
- We have lots of choices in determining therapy and need a better way to make a decision that is not overwhelming the decision tree process.
- Our clinicians need systematic options for determining tests and drugs patients need.
- Our leaders need to have drugs on formulary that allow us in real time to determine what the most cost-effective drug is for that particular clinical setting.
- We need technology to help physicians make the right decision and at the right time and right place.
- We make most of our decisions out of habit, and the variability that increases costs is unconscious and unsupported by evidence.
- Decision support WILL eliminate unconscious, habit-produced variation.
- Anti-Kickback and Stark Laws:
- These laws were designed to prevent abuse and protect public dollars from being pushed to unnecessary care.
- Maybe we need to take a look at these systems and develop financial incentives that support clinicians using the most cost-effective clinical practices.
- Improving care coordination:
- 5% of individuals account for half of U.S. health care spending.
- Reducing variation is effective in cost savings for most patients; we need distinctive, focused strategies on patients who are overutilizers.
- The largest group of overutilizers have complex and often chronic medical conditions (i.e., diabetes, vascular disease, hypertension, etc.).
- Children need care coordination and “medical homes”:
- Children’s care is often fragmented, leading to low quality and increased utilization of acute care services.
- 1% of children are medically complex but account for one-third of all pediatric spending.
- Introducing a medical home care coordination model at Vanderbilt has shown an 89% reduction in hospital days, 75% reduction in readmissions and 63% reduction in emergency center visits. Pretty impressive.
- We need to incentivize and help build programs like this.
This is just a brief synopsis of his testimony, which was outstanding. Other issues he eloquently addressed were end-of-life care and the costly care associated with adults with chronic disease.
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