“V” Is For The "Victory" of “Value” over “Volume” – An Interview with a Venturesome Visionary

Whether is fled the visionary gleam?

Where is it now, the glory and the dream?

William Wordworth (1770-1850), Intimations of Immortality

July 30, 2012

Q: I understand you have future dream, a visionary gleam in your eye.

A:  That’s absolutely, irrevocably true.  My dream is based on fact, not fiction.

Q: What is your dream?

A:  My dream  is that  it will be clinical  “value,” not clinical“volume,” that will be paid for. It will not be the number of patients passing througgh the health care tollgates but what happens to them - how much their health improves and their death rates drop.

 I call my dream  “Value-Based Purchasing,” or "VBP, " “Evidence-Based Purchasing ,” or “EVP,” or “moving from volume to value.”  Everything in medicine, I dream, will  be “evidence-based.”  Reason, not personal relationships,  will be in season. That’s my dream.

Q: You must be frustrated.  It must be a nightmare out there for you now.  After all, hospitals and medical groups still recruit physicians looking for “productivity,” the volume of patients seen or services provided, not the value of those services or the outcomes.- to pad their bottom lines.   

Fee-for-service remains the lay of the land.  Volume of specific  current clinical actions is what payers pay for, not the bang for the buck or  ultimate outcomes down the road.  An alternative payment model has yet to be developed.  It’s hard to code a dream. It's easy to code a visit, a procedure, or a visit.

A:  I know.  But in the end, data will be our salvation.  It will trump frustration.   Fellow reformers share my vision and my dream.  We know it will be prevention, not treatment,   processes and outcomes, not what patients and doctors want and are currently paid for, that will  count.

Q:  Do you tolerate any variance from your dream of the scheme of things?

A: No, none.

Q:   Why not?

A: Because human-based “Fee-For-Service” drove us into this mess. VBP and EVP is the way out of the FFS morass.  “Fee-For-Service” ought to be called “Fee-for-Nervous.”  It is nothing but nervous people looking for emotional rather than factual care.

Q:  But people want human “service” not  impersonal  “data,” do they not?

A:   Exactly. That’s the problem.  We can’t yet put a number on data-based  services. So providers provide a greater and greater number of “services.” That is a vapid, vacuous view of the world.  It is not scientific, and it is not value- based.

Q:  But  it is very human, is it not?

A:   Not really.  It is based on the past, the Art of Medicine,  not the Science of Medicine.  It doesn't compute. In humanity patients and physicians may trust, we scientific reformers  trust only Data.

Q:  What is your message?

A: Verily, verily, I say unto you. “V” is for “Victory”of “Value over Volume, the vanquishing of subjectivity by the forces of objectivity.   Ours will be the final dictum. Fee-for-service will be the victim.   Hard data, not human errata, will be the rule.

Source:  Jordan M. VanLare and Patrick H. Conway, "Value-Based Purchasing - National Programs to Move from Volume to Value," New England Journal of Medicine, July 26, 2012

Tweet: In the future,  payers will pay for value, evidence-based services and outcomes,  rather than fee-for-service, so say value-evidence-based visionaries.