Monday, October 4, 2010

Health Reform as the Mother of Health Improvement

In health care, experimentation is the mother of improvement.

Peter Orszag, Director of the White House Office of Management and Budget from 2009 to 2010, “Health Care’s Lost Weekend, New York Times, October 4, 2010

I see Peter Orszag, former Obama official, is lecturing doctors about working perpetually through weekends, running hospital equipment and operating suites constantly without stopping, and on adopting health reform measures to improve performance and to cut costs.

I do not know where Orszag has been, but doctors are already in short supply and are working overtime to serve patients. Many are working 60 to 80 hours a week, and most doubt they will be able to take on additional loads of 32 million newly insured patients and 36 million more new Medicare patients.

As far as being compared to their peers and improving care, that has been going on for decades. It is called peer review, something politicians might emulate.

Orszag seems oblivious to all of this.

Orszag patronizingly says,

“ Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.

“And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.”

“A second innovation is quality assessment and management. As the saying goes, if you can’t measure it, you can’t manage it — or improve it. That’s why the federal government is now making key investments to encourage hospitals, clinics and doctors to adopt health information technology and report statistics on quality of care. “

Orszag complains of the high costs and variability of care. If only hospitals and doctors worked constantly and had uniform standards and pricing, costs would plummet. And if only we had enough data and statistical evidence, presumably to separate the good doctors and hospitals from the bad, all would be well.

I would remind Orszag, an economist, that we do not call economics the “dismal science” for nothing, and that data has not separated the good economists from the bad.

I might be more sympathetic with Orszag’s argument if politicians would follow suit. If only we could make them work 24 hours a day, and cancel those frequent recesses, like the 45 day political recess they are now on, and if we could lock them in their offices over the weekends, and if we could measure each by their overspending habits and campaign contributions, maybe our political system would be better.

But maybe not. Politicians, like physicians, are not automatons, tireless, self-operating machines at work 24 hours a day, nor can hospitals keep their equipment working 24 hours a day without time off for maintenance and personnel to run them.

Fortunately, medicine is not like politics. In politics, elections are the mother of change.


Gary M. Levin said...

Peter Orszag is supposed to be running the OMB. Why doesn't he mind his own business and stay in his bookeeping suite. Why would anyone quote him? He is an idiot! And you may quote me on that one.

Richard L. Reece, MD said...

The New York Times would quote him. Orszag is, after all, one of their regular contributors. I do not know if I would use the word "idiot," but I wonder about his sanity. Does he honestly think you can cut costs by running a hospital full-tilt 24 hours a day?

Frank Hudson said...

Though it is interesting to note that the suggestion of distributing workflow evenly throughout the week not only improves resource utilization but also hits on the importance of accessibility, just like availability of service around the clock, reliability of a lifted tow truck ready to assist at all times harmonizes with consistent and reachable support.

Additionally, the stress on quality assessment and management highlights the role played by technology in health care improvement. Similarly, as federal government invests in health information technology for quality reporting purposes; technological advancements like lifted tow trucks equipped for diverse scenarios enhance efficiency and effectiveness of services.