Three Value-Based Strategies for Physician Practices

Value is the life-giving power of anything: cost, the quantity of labor required to produce it; price, the quantity of labor which its producer will take in exchange for it.

John Ruskin (1819-1900), Munera Pulveris (1862)

“Value-based purchasing,” whether cost or quality; are integral parts of the equation now widely seen as a replacement  for traditional fee-for-service  in health care.”

Kaisa Movena,”Value-Based Health Care: Fad or Future,” Forbes, June 11, 2012

January 6, 2013-  The January 3, 2012 New England Journal of Medicine contains three articles pointing to what policy wonks have in mind for future physician reimbursement.

·         The first, “Code Red and Blue – Safely Limiting Health Care’s GDP Footprint,” is by Arnold Milstein, MD, from  the Clinical Excellence Research Center at Stanford.  He writes knowingly of creating “robust learning systems to strengthen incentives for improving value.”  He gives as examples Medicare’s bundled payments, pay-for-performance programs, medical homes, hospital value-based purchasing, and purchasers moving market-share to higher-value providers. He bemoans the fact that physicians resist policies that threaten their incomes and “powerfully influence the use of health care resources and public opinion about health policies.”  If only physicians  would play value-ball, he believes, we could decrease per capita health spending by 15% to 30% and clinical efficiency by 2% to 3%.

     And that's the health care news from the left coast.

·         The second, “Shared Decision Making to Improve Care and Reduce Costs," is by Emily Oshima Lee, MA,  and Ekeila Emanuel, MD. Emanuel is formerly Obama’s chief medical advisor. The authors  claim that if only doctors shared decision making with patients,  costs would plunge 20% or more.  This could be done by using patient decision aids – written materials , videos, or interactive electronic presentations informing patients about risks, benefits, and options. Lee and Emanuel believe CMS should certify, distribute, and make mandatory these aids to improve quality and reduce costs. CMS could begin, they assert, with the 20 most often performed procedures. If clinicians did not play ball, CMS could reduce Medicare payments by 10% the first year, gradually increasing reductions to 20% over ten years.

      Sounds like Obama hard ball to me. 
 

·         The third, “The Bystander Effect in Medical Care,"  is by Robert Stavert, MD, and Jason Lott, MD, of the Department of Dermatology at Yale.  They recite the case of a 32 year old male with a skin rash. He developed renal, hepatic, and pulmonary failure.  During his 11 day stay in the ICU, 40 doctors saw him.  They performed an average of 25 diagnostic lab tests and two imaging procedures  daily.   Result?  “Efficacious  patient care gave way to diagnostic chaos and incremental delay… The involvement of multiple covering providers only made things worse  since, each covering clinician  were understandably reluctant to initiate  changes absent a blessing from the primary team.” None of the doctors were paid FFS.  The lesson to the authors was that we must improve communication, coordination, and team-based skills among health care professionals, by federal actions if necessary.   What we need, they claim,  is “transcendent teamwork in modern medicine. ”


      And, I might add,  "transcendent teamwork"  between the Obama adminsitration and Congress.


P.S. When government proclaims  it will decrease health costs by executive or legislative decrees restructuring doctor pay, hold onto your wallet. To illustrate, I note in today's New York Times this front page headline,  "Health Insurers  Raises Rates by Double Digits; Loophole in New Law; Small Businesses and Individual Buyers Are Hardest Hit." 

     I thought these were the folks the law as supposed to protect.

Tweet:  Policy makers say U.S. should replace fee-for-service payment  with team-based “value-based” reimbursement to improve care and cut costs.