If it Ain’t Broke, Break it
Ever have the kind of day where you wish you could just go back and start over? Press reset and start fresh so you could avoid the horrible, soul-crushing errors you made the first time around? That of course, would be awesome. Unfortunately, that is impossible. It is fun to think about, however, and can provide some clues about how to move forward in the real world.
Take the healthcare industry for example. What would a do-over look like if we had the opportunity to go back in time and make different choices? If one could wipe the current slate clean, what kinds of choices could we make to build a better, more effective and efficient healthcare system?
Looking through the literature there are several developments which, intentional or otherwise, stand out as moments in time that merit a do-over.
- Fee-for-Service Reimbursement – The granddaddy of do-over opportunities. Build a system based on quality, outcomes and shared risk.
- “Sickcare” Rather than Healthcare – A result of incentives associated with fee-for-service reimbursement, is that our system ignored people until they were “patients.” No symptoms, no illness, no service. Gain 50 pounds, develop high blood pressure, we’ll treat that. The culture focused on treatment to the near exclusion of prevention.
- To Each His/Her Own – Another artifact of fee-for-service, healthcare delivery fractured into specialized components between which there was little, if any, communication. Higher reimbursements for specialty services meant each patient engagement generated revenue. Each specialist treated their patient in a silo. The problem is that patients aren’t silos.
- The Art of Medicine – A phrase that should never have been coined. Bedside manner is an art. Treating disease, or proactively preventing it, is more of a science. For years the concept of evidence-based medicine was eschewed by many providers. The problem is… there’s this thing called “evidence.” The data proving benefit of treatment fidelity and lack of variation is there. However, the advent of outcomes-based reimbursement has started to shift that dynamic.
- Can You Hear Me Now? -- The development and proliferation of IT systems that can’t communicate with each other.
- Can’t We All Just Get Along – The advent of an adversarial culture between providers and payers rather than one based on cooperation and collaboration.
- May Experience Dizziness or Nausea – National drug policy. ‘Nuff said.
- Behind Curtain Number One! – The creation of a system that makes it all but impossible for consumers to identify and compare the cost and/or quality of services provided.
- Return Customers – More fee-for-service fallout. Zero incentive for providers to proactively engage with patients around chronic disease treatment and/or management.
- Another Year Older and Deeper in Debt -- The cost of medical education drives physicians to pursue high paying specialty medicine and avoid primary care roles.
Sometimes it seems going back in time is the only way to fix a problem that’s been generations in the making. People took each step thinking it was the right thing to do. Interventions designed to solve one problem layered on top of other interventions designed to solve other problems, without consideration for how each would impact the other, and the system as a whole.
Come to think of it, sounds like the patient might be a victim of medical error.
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Payers, providers, the U.S. government, and other entities have made initial investments in value-based reimbursement. And while these initial investments have, in some cases, made great strides in the march toward quality-based care, costs are still increasing, payers and providers are no closer to a trust-based relationship, and fee-for-service is still a large part of reimbursement.