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PORTSIDE  September 2012, Week 2

PORTSIDE September 2012, Week 2

Subject:

Best Care at Lower Cost

From:

Portside Moderator <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Sun, 9 Sep 2012 20:34:18 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (232 lines)

(1)
Best Care at Lower Cost:
The Path to Continuously Learning Health Care in America
Mark Smith, Robert Saunders, Leigh Stuckhardt, 
J. Michael McGinnis
Editors; Committee on the Learning Health Care 
System in America
Institute of Medicine 
September 2012
http://www.nap.edu/catalog.php?record_id=13444#toc

Description

America's health care system has become too complex and
costly to continue business as usual. Best Care at Lower
Cost explains that inefficiencies, an overwhelming
amount of data, and other economic and quality barriers
hinder progress in improving health and threaten the
nation's economic stability and global competitiveness.
According to this report, the knowledge and tools exist
to put the health system on the right course to achieve
continuous improvement and better quality care at a
lower cost.

The costs of the system's current inefficiency
underscore the urgent need for a systemwide
transformation. About 30 percent of health spending in
2009--roughly $750 billion--was wasted on unnecessary
services, excessive administrative costs, fraud, and
other problems. Moreover, inefficiencies cause needless
suffering. By one estimate, roughly 75,000 deaths might
have been averted in 2005 if every state had delivered
care at the quality level of the best performing state.

This report states that the way health care providers
currently train, practice, and learn new information
cannot keep pace with the flood of research discoveries
and technological advances. About 75 million Americans
have more than one chronic condition, requiring
coordination among multiple specialists and therapies,
which can increase the potential for miscommunication,
misdiagnosis, potentially conflicting interventions, and
dangerous drug interactions.

Best Care at Lower Cost emphasizes that a better use of
data is a critical element of a continuously improving
health system, such as mobile technologies and
electronic health records that offer significant
potential to capture and share health data better. In
order for this to occur, the National Coordinator for
Health Information Technology, IT developers, and
standard-setting organizations should ensure that these
systems are robust and interoperable. Clinicians and
care organizations should fully adopt these
technologies, and patients should be encouraged to use
tools, such as personal health information portals, to
actively engage in their care.

This book is a call to action that will guide health
care providers; administrators; caregivers; policy
makers; health professionals; federal, state, and local
government agencies; private and public health
organizations; and educational institutions.

(2)
Healthcare System Wasted $750 Billion in 2009, IOM Says
Robert Lowes
Medscape Today
September 6, 2012
http://www.medscape.com/viewarticle/770451

[moderator: the IOM report may be found here -


An inefficient, extraordinarily complex, and slow-to-
change US healthcare system wasted more than $750
billion in 2009, according to a new study from the
Institute of Medicine (IOM) that calls for a drastic
overhaul.

Excessive administrative costs on the part of insurers
explain some of those squandered dollars, but
unnecessary and inefficiently delivered services on the
part of physicians, hospitals, and other providers
account for the lion's share of the $750 billion, said
the report, which was released online today.

This attention-grabbing statistic is reminiscent of the
oft-quoted figure for deaths attributable to medical
error - up to 98,000 each year - found in a 1999 IOM
report titled To Err Is Human: Building a Safer Health
System. That report helped spark an ongoing campaign for
patient safety. The new IOM report, titled Best Care at
Lower Cost: The Path to Continuously Learning Health
Care in America, aims to build on the 1999 study and
other blueprints for progress from the IOM.

For all the dramatic advances in biomedical knowledge,
drugs, and procedures, the healthcare industry lags
behind other industries in terms of operating smarts,
the new IOM report says. "If banking were like
healthcare, automated teller machine (ATM) transactions
would not take seconds but perhaps days or longer as a
result of unavailable or misplaced records." In the same
vein, airline pilots would be free to dispense with
preflight safety checks and retail stores would not
display product prices in the aisles. Hospitals,
physicians, and insurers, the report said, have much to
learn from the best practices in other fields.

The healthcare system also suffers from informational
logjams. "The sheer volume of new discoveries stresses
the capabilities of the system to effectively generate
and manage knowledge and apply it to regular care," the
report states. Case in point: It took 13 years for most
experts to recommend the use of thrombolytic drugs to
treat heart attacks after the therapy proved itself to
be effective.

In the healthcare system envisioned by the IOM,
electronic health records (EHRs) would bring the
research contained in more than 750,000 journal articles
published each year to the point of care, and quickly.
In addition, researchers would mine EHRs for useful data
generated in everyday patient care.

A continuously learning healthcare system has other
characteristics:

    Patients and clinicians are partners.
    
    Healthcare providers are rewarded for reducing
    waste, rendering high-value care, and improving
    their performance.
    
    Transparency reigns. System vital signs for safety,
    clinical outcomes, costs, and the like are available
    to both clinicians and patients.
    
    The system is committed to a culture of teamwork,
    collaboration, and adaptability.
    
    The system strives for continual improvement through
    methods such as Six Sigma, Lean, and Total Quality
    Management.

The IOM report warns, however, that implementing this
brave new healthcare system will not be easy, especially
in the exam room. Clinicians are already stressed out by
patient care and administrative burdens and swamped by
piecemeal healthcare reform initiatives.

"Given such real-world impediments, initiatives that
focus merely on incremental improvements and add to a
clinician's daily workload are unlikely to succeed," the
report says. Instead, the entire infrastructure and
culture of healthcare must be reconfigured for
significant change to occur.

Wasted Healthcare Dollars in 2009

* Unnecessary Services: $210 billion

* Inefficiently delivered services: $130 billion
(Includes mistakes and unnecessary use of higher-cost
providers

* Excess administrative costs: $190 billion
Includes inefficiencies resulting from care-
documentation requirements

* Too-high prices: $105 billion

* Missed prevention opportunities: $55 billion

* Fraud: $75 billion
(Committed by patients, providers, and payers)


Source: Best Care at Lower Cost: The Path to
Continuously Learning Health Care in America, Institute
of Medicine.

Editorial: Do Not Assume More Care Is Better Care

An editorial published online September 7 in the
Archives of Internal Medicine called the IOM report an
"invaluable resource" for healthcare reform. The author,
journal editor Rita Redberg, MD, said that the report
and its tally of wasted healthcare spending are "well-
timed" during a presidential campaign preoccupied with
controlling healthcare costs for the sake of preserving
and expanding insurance coverage.

Dr. Redberg said the IOM findings are a reminder that
clinicians have been quick to order therapies and
diagnostic technologies - for example, prostate-specific
antigen screening, - that lack "an adequate evidence
base."

"The report details the challenges and highlights the
opportunities to advance our healthcare system by
promoting a culture that uses rigorous evidence-based
standards to help patients feel better and live longer,"
she said.

Dr. Redberg added that the "Choosing Wisely" campaign,
in which medical societies have identified questionable
procedures and therapies, is one cure for the problem of
overtreatment cited by the IOM. This campaign and others
like it, she said, teach physicians to "not always
assume that 'more care is better care,' which has been
the healthcare mantra for many years."

___________________________________________

Portside aims to provide material of interest to people
on the left that will help them to interpret the world
and to change it.

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