Healthcare Cost Relief is Hiding in Plain Sight

In the overheated rhetoric surrounding the state of healthcare in America, there is one concept nearly everyone can agree on: Costs are too high. The trouble, of course, comes in finding a way to get those costs to come down.

I'm convinced we've been looking in the wrong places. Real relief from the pain of high healthcare costs won't come from financial juggling. Rather, it will come from improving health, reducing hospital-based harm, and delivering better quality care.

Department of Health and Human Services Secretary Kathleen Sebelius announced Tuesday a $1 billion patient safety initiative aimed at doing just that. The Partnership for Patients program aims to save lives and reduce hospital readmissions by 20% over the next three years. It also has a goal of reducing hospital-based harm by 40%. Along the way the program could save as much as $35 billion in healthcare costs.

During the rollout of PFP, Donald Berwick, MD, who heads the Centers for Medicare & Medicaid Services, talked about the systemic change in hospital processes that will be necessary to achieve these goals. He noted that the effort will require the clinicians, physicians, nurses, and hospital leadership to work together to reduce medical errors.

What struck me about PFP is how program announcements often exist in a parallel universe in Washington, D.C. While Berwick and Sebelius were touting PFP as a program made possible by the Accountable Care Act, congressional staffers were back in their offices reviewing yet another proposal to defund the ACA.

Paul Ryan, (R- WI) who chairs the House budget committee, has presented a budget proposal to reduce the federal deficit by trillions of dollars. His plan would privatize Medicare, convert Medicaid to a community block grant program, and eliminate any funding for the implementation of healthcare reform.

I'm not going to dissect his proposal here because that has already been done by others, but I will make this suggestion to Rep. Ryan: Stop focusing on the money and think about the care.

Improving health, lowering cost, and saving lives is Donald Berwick's mantra. He contends that we won't improve medical care by cutting costs, but we will get there by improving the process of delivering care.

That message seems lost in all of the political posturing that regularly takes place around the federal budget debates.

Among the suggestions bandied about to reduce Medicare costs is to increase the beneficiary share of the Medicare Part B premium, which covers doctor visits and other outpatient services. Some think it might be a good idea to add copayments for home health services or for the first 20 days of a stay in a skilled nursing facility.

I'm sure the people who support these ideas can throw around some impressive numbers about how much this or that change will save taxpayers. But are these "savings" a Bandaid or a cure? How does increasing the cost of seeing a doctor help make someone healthier? And what is accomplished by adding copays to home healthcare or stays at an SNF?

I am beginning to agree with Berwick that we are looking in all the wrong places for healthcare cost relief. Our politicians seem to focus on a quick fix that can be touted in a media sound bite along the lines of "implementing these changes will save the American taxpayer money without affecting the delivery of healthcare services."

Wouldn't it be better to take a longer view and resolve the problems that send a patient to a doctor or a SNF in the first place? If reducing surgical site infections or central line-associated bloodstream infections or ventilator-associated pneumonia will mean fewer trips to a doctor or lower readmission rates at a hospital then those are probably the areas where we should be focusing our collective medical expertise and political clout.

Resolving these medical concerns will take time. The Partnership for Patients is looking at a three-year window to implement process changes that will reduce costs and save lives. That's a long-time in the world of politics, but it's a short time for hospitals to put in place policies that will have such a far reaching effect on healthcare costs.