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Making Care More Efficient: Promising Innovations and
Options for Reinvesting Savings
Christine K. Cassel, M.D., MACP
The Commonwealth Fund Bipartisan Congressional Health Care Conference
January 13, 2007
• Physician Services• Physician-Generated Services:
─ Referrals/technology─ Hospital use
• Generating Patient Demand─ Who rewards the physician to reduce
costs?
• Organization of Care Delivery─ Solo practice (20%)─ Multispecialty groups (20%)
Rewarding Efficiency, Reducing Waste: The Physician's Role
Went to ER for Condition That Could Have Been Treated by Regular Doctor (2005)
SOURCE: Schoen et al., “Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,” Health Affairs Web Exclusive November 3, 2005 W5-509–W5-525; Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
6
9
12
15
21
26
0
10
20
30
GER NZ UK AUS CAN US
Percent of adults who went to ER in past two years for condition that could have been treated by regular doctor if available
Physicians’ Use of Electronic Medical Records, U.S. Compared to Other Countries, 2000/2001
90 88
6258 56 55 52
4842
3730 29 28
25
17 1714
9 6 5
0
50
100
Sweden
Netherl
ands
Denmark
United K
ingdom
Finland
Austria
New Zealand*
Germany
Belgium
Italy
Luxembourg
EU Average
Ireland
Australia
*
Greec
e
United States*
Canada*
Spain
France
Portugal
Percent of physicians
*2000SOURCE: 2001 European Union EuroBarometer and 2000 Commonwealth Fund International Health Policy Survey of Physicians (Harris Interactive 2002)
Percent reporting test results/records not available at time of appointment in past 2 years
11 12
16 1619
23
0
10
20
30
40
50
GER AUS NZ UK CAN US
Test Results or Medical Record Not Available at Time of Appointment, Sicker Adults in Six Countries, 2005
SOURCE: Schoen et al., “Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,” Health Affairs Web Exclusive November 3, 2005; DATA: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Ways to Improve Care AND Reduce Costs
• Primary Care/Prevention
• Patient Engagement
• Redesign of Practice with Emphasis on Care Coordination
COMPARECOMPARE
• Interventional Cardiologist
─ hospital pays staff, technology
─ pay for procedure
─ 4-8 x annual incomes
• General Internist
─ pay for visits
─ no source of revenue for nurses, office staff, information systems
─ no reward for avoiding visits and hospital use(email, phone, presentation)
Primary Care - A Vanishing Species?GENERALIST SHORTAGEGENERALIST SHORTAGE
• Physicians pursue specialties more than primary care
• Clinical demands
• Inadequate reimbursement
• No support for teams and systems
How can the best medical care in the world cost twice as much as the best medical care in the world?
Uwe Reinhardt
Physician Training, Knowledge and Clinical Judgment
ABIM Exam: "Conservative Management Score"
High-intensity training areas correlated with worse performance on these questions EXCEPT for the top tier (20%) who did well on all questions
• Care Management / Incentive Fees
• High-Need Population: multiple, complex chronic illnesses
• 8 states / 3 years
• Board certified physicians─ Interdisciplinary teams─ Patient empowerment─ Health Information Technology─ Demonstration inspired by ACP:
http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/fed/jointprinciplesforpatientcenteredmedicalhome.Par.0001.File.tmp/patient-centered-medical-home.pdf
Medicare Medical Home Demonstration Project
H.R. 611Tax Relief and Health Care Act of 2006 (Sec. 204)
H.R. 611Tax Relief and Health Care Act of 2006 (Sec. 204)
1. Accountability─ Standards for professionals and how they
organize care─ Reform financing to reduce perverse
incentives
2. Rewards for reducing costs can be reinvested ─ More time with patients─ Information systems─ Interdisciplinary team
Innovation, Reward and Reinvestment