4 essential elements of true health reform

I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:

Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in an earlier column – which basically pays more for doing more whether or not it is needed – to some kind of “outcomes” payment system.

There are many “outcomes” payment ideas – bundling, global, etc. – but they are all designed in theory to force providers to live within a certain budget for a given patient. Obviously, this is a huge culture change and will require many years – and many mistakes – to figure out.

But I think it is probably the most essential ingredient of true reform. (I would also include malpractice reform in this category; by switching to a no-fault system we would remove a large incentive to do unnecessary testing and treating.)

Electronic records. While I recognize there are many issues (privacy, compatibility, etc.) to be yet worked out before electronic records can become near universal in our hospital and personal healthcare, I believe it will be impossible to intelligently cut costs and improve safety without them. Imagine, again, the U.S. commercial airline industry in this country without computers able to “talk to each other” with the same language no matter the location.

Comparability data. And once such a computer system is widely in place, we can start making better use of “outcomes” data – i.e., data from studies that tell us what works best at the lowest cost.

Another name for this would be “cost effectiveness” data but those two words strike fear – understandably – in the hearts of doctors and patients who assume that means choosing the cheapest option regardless of quality concerns.

Right now there is a paucity of such data – in part because the “medical industrial complex” has often fought true comparison studies. But the need for such data will only grow as cost issues become paramount.

Primary care. Ultimately, all of the above will only work well in the setting of good primary care – meaning a place and professionals readily available, at least by phone, when a person thinks they (or a member of their family) might be sick.

The phrase so often used to describe this “place” today is “the medical home.” Obviously a “medical home” – like any home – can physically exist in many different kinds of settings ranging from a traditional office to a clinic to a setting in a hospital.

But the key ingredients of such a home, in my judgment, are the traditional three A’s: availability, affability, and affordability.

Timothy Johnson trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor.  He blogs at Timothy Johnson, MD: On Health.

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  • doc99

    Auto repairs are too expensive. We need to abandon “fee for service,” and move to a new payment model.

  • karen3

    how about the #1 item for patients????? Reduction of errors. With preventable medical error being the third leading cause of death. it is hardly appropriate to draft a list without addressing this issue.

  • Docbart

    Just what we need, another burnt-out ex-physician oversimplifying solutions to our problems. Why not propose just curing all diseases? That will save lots of money and lives?

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    Forget about a new payment model. Why don’t we move onto a whole new healthcare model? Health is first a state of mind. It’s not your disease labels, it’s what you believe you are. Health is life. Every aspect of our lives affects our health. When we are financially squandering our health today, to pay for disease today, we will on every count, lose our health now and in the future. And health is determined by you, the individual. You have the power to choose your health network, not some cheap disease-infested crap network that’s dished out by an oh-so-expensive health plan. So what’s the answer to a new healthcare model? http://www.youtube.com/watch?feature=player_detailpage&v=6-IOsBOLG0I

  • buzzkillersmith

    There’s no evidence that EHRs do a damn thing but irritate doctors and nurses. And yet this hammerhead lauds them. Groupthink pure and simple, in a data-free zone.
    Get back to the media, mediadoc. We don’t buy crazy at this blog.

  • MarcGarfield_DPM

    How about this:

    First, every patient has their claims adjudicated through the claims processor of their choice (for a fee). Rules for claims adjudication are universal reducing time spent on claim resolution and input for adjudication is agreed upon by representatives from the AMA, APMA and AOA. Even if you do not have coverage, you only get charged what insurance companies get charged. This is then matched to a few tiers of fee structuring. Doctors could choose which tiers they would belong to opening up their access to patients or limiting themselves to better paying plans that allow for more time with patients.

    ~Patients could choose to utilize government or private fee processors, though no payment would be made on their behalf unless they pay into an attached HSA or qualify for such coverage.

    2. No elective services rendered without all charges itemized so that consumers could begin comparing services between providers and hospitals in comprehensiveness of services and PRICE,

    3. Government yes, I said Government run patient advocate centers. This will really enrage my colleagues. But I strongly believe every patient needs a medical professional advocate before getting care. This would be a PCP that would be responsible for evaluating their need for referrals, surgeries or other tests and treatments. NO care would be delivered at the centers, just discussion and information. Specialists would volunteer periodic specialty consultation services in exchange for referrals of business. Patients would provide feedback about their results to their advocate and feed back would be dispensed back to the community specialists. Better care= more referrals. No capitation needed.

    4. Replace the legal lotto malpractice system with a system of disability coverage for patients with legitimate needs, reducing physician defensive practices and ensuring that patient’s that need help actually get it, not gamble on it in the courts. This would involve a system of the patient advocate, and three unrelated MD/DO/DPMs to evaluate the patients probable worthiness.

    5. Primary payers pay doctors for all qualifying services in full and collect from patients and secondary payers themselves. However, it would remain physician responsibility to check the payer sites to determine if the patient is eligible for such services. ie: ensure their HSA can cover such services or they have insurance coverage for services. This ends the collision of fee parsing and rule changes that cause doctors to loose thousands of dollars as the fee remnants cost more to collect than to write off.

    6. Let doctors chart to the extent they need to deliver care and relay information to colleagues. NO EMR Bonuses or Penalties. So we can get back to treating patients rather than computer charts. Patient advocacy centers would track and organize appropriate screenings, exams, test and other PQRI measures and relay them to the appropriate doctors to prevent duplication of effort.

    6. Get Rid of the provisions in the affordable care act that block alternate plans such as the above.

  • southerndoc1

    “I believe it will be impossible to intelligently cut costs and improve safety without them. (electronic records)”

    I believe in puppy dogs, rainbows, and beautiful sunsets.

    Thank you for that wonderful share.

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