Yes, I know you have heard...The 8000 lb. gorilla in the room concerning our fiscal woes over the long-term is the ever increasing cost of health care. This is not credibly disputed by anyone...no one!!!
Medicare is underfunded by approximately $38 Trillion over the next 75 years. The reality is that we are not necessarily deriving value as we spend ever more to obtain care. The strategic objective is to IMPROVE QUALITY, VALUE & RESULTS while simultaneously SLOWING THE INCREASE IN COST to provide the care. This is anything but easy to accomplish. Accomplishing this strategic objective will certainly require a complete and fundamental shift of the incentives within the system. If we "move the cheese" the results we desire ("the mouse") will follow!!! Try these possible solutions on for size.
01. Move away from the "Fee for Service" model we currently operate under. Rather than paying the physician "per procedure" we should pay the physician for actual results achieved in relationship to other like practitioners but aggregating their patients and creating metrics that reward results, relative to the results of other peer practitioners rewards the outcome, not the series of tests or procedures engaged with little emphasis on their actual outcome. Measuring aggregate metrics against other aggregate metrics (peer-to-peer) will ultimately weed-out (or seriously under compensate) the under-performing physicians and will increase the compensation by more effectively compensating physicians that can deliver results through the practice of intelligent medicine. Aligning compensation with actual outcomes and value provided per dollar will increase exponentially. That's good for each of us!!!
02. Medical Malpractice Reform: Get Rid of the Frivolous Law Suits in the System...Need I say more??? This has got to be almost painfully self-explanatory as a cost reduction technique!!!
03. End of Life Care: Let's agree from the get-go to quit the demagoguery..No one anywhere on the planet advocates "DEATH PANELS"...The reality is that a vast majority of the cost in the system surrounds "end of life" care. Everyone is literally "endowed by their Creator with certain unalienable rights" and one of those might be to have access to appropriate end of life care as determined by you- the patient, your doctor and your other advisers such as your attorney and your ecclesiastical leader- not to mention spouse or family.
Care should not be "rationed" but sensible, humane steps should be taken to encourage planning that includes care deemed appropriate to preserve and maintain life during these sensitive scenes of decline leading to the finality of the eventual demise. Notwithstanding the sensitivity of the issue, we can do a better job coordinating and defining what is really reasonable and necessary by again separating real "need" from the avid "want"...The key is to leave the decision making to the patient and the doctor, not in the hands of a bureaucrat.
To protect the integrity of the system a "sliding scale" per procedure can be developed to place greater economic benefit on "joint replacement surgery" (for example) making it more tenable economically when done during at an age range that statistically suggests both value and a real life return on the investment based upon current life expectancy. Those who wish to have the same surgery at ever advanced ages could be required to shoulder more cost as an incentive to encourage the tough conversation separating real "needs" from the avid "wants"...
The principle is to encourage reasonable care to be provided by using the economic realities of life and care to help motivate cost conscious decisions that are never prohibitive in relationship to getting care but that reward people for making decisions that are both in line with their best interest in terms of health but which minimize the expense of the care systematically when it is provided in less efficient and less viable circumstances.
Cause the recipient to shoulder more of the cost in acceptance of these economic and actuarial realities.
Complex, yes...Doable, yes...Easy, no...Effective, yes...Humane, yes...Efficient, yes...
What are your thoughts?
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