Wednesday, June 10, 2009

Did Obama Read the Piece?


In the New Yorker Dr. Atul Gawande wrote "The Cost Conundrum," a piece on variation in health care costs and quality in South Texas. He interviewed physicians and administrators in South Texas, trying to find reasons for high medical usage under the Medicare program.

The piece made clear, Medicare utilization and quality data isn't on provider radar. Why not? Did Medicare share the data? Did it gather teams of providers to work on improvement?

The article showed how little attention doctors and health executives pay to quality measures, of the specific kind. They focus on revenues, billing and take home pay. So how will layering pay for performance change anything? The focus will still be on what the doctor or hospital has to do to maximize the money. There is another way. The piece stated:


…decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income.
This is clearly not the Obama plan. Gawande continued the Mayo way:

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.
It’s not happenstance, according to Dr. W. Edwards Deming, once the world’s foremost quality guru. Higher quality means lower costs. Dr. Deming would excoriate the Obama plan, rankings, pay for performance, etc.

Dr. Atul Gawande should study Dr. Deming’s work. There is a multi-decade track record and many books chronicling his accomplishments. Profound knowledge is sorely needed and President Obama hasn’t a clue.

“We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.
Texas has no Certificate of Need. That means anyone can build and operate any health care facility anywhere, anytime. If it’s someone with the power of the ordering pen, watch out.

Mayo isn't alone in delivering high quality, lower utilization Medicare services:

All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.
The Obama health reform team is led by a for-profit insider. White House Health Czar Nancy-Ann DeParle has a very profitable history with for-profit hospital companies. Beware, foxes are in the hen house.

President Obama was so taken by the article he gathered advisers and key legislators. Did they miss the solutions embedded in the low utilization institutions? The piece refutes key elements of Obama's reform plan.

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