In a recent issue of the Journal of the American Medical Association, we learn that physicians generally blame other groups for the runaway train that is American health care costs: lawyers and patients, for instance. Ezekiel Emanuel, in an accompanying editorial, bemoans this buck-passing, and identifies several domains which must be changed to remake health care, with the physician in the lead. "There is no magic solution," he says - rather, a combined approach is needed to control health care costs.
He lists the following ways in which health care delivery must be transformed:
Do you notice what I notice about this list? It's centered on the provider, or the team, and not on the patient. Patients in general aren't cost conscious; it's not clear whether preventive health, rather than treating exacerbations, will actually lower costs; who knows how patients will react, in general, to the team-based care promised by medical homes; price and quality transparency doesn't improve outcomes, at least according to a review we published this year.
My favorite point, however, is the "process standardization with customization for selected patients." Which processes can be standardized with only "selected customization" - that's my question. Is cardiac catheterization *ever* done exactly the same way in two patients? What about treatment for pneumonia? Blood pressure control? Depression treatment?
I'm not being flip, or at least - I'm trying not to be. The article, in its population-based naivete, points up the gap between cost-saving measures and patient-centered care - while failing to recognize it at all. Selected customization, indeed!
He lists the following ways in which health care delivery must be transformed:
- More cost consciousness in decision making
- Increased emphasis on keeping patients healthy rather than treating exacerbations of chronic illness
- A move toward team-based care delivery and away from individual practitioners
- More organized and coordinated systems
- More process standardization with customization for selected patients
- Greater price and quality transparency
Do you notice what I notice about this list? It's centered on the provider, or the team, and not on the patient. Patients in general aren't cost conscious; it's not clear whether preventive health, rather than treating exacerbations, will actually lower costs; who knows how patients will react, in general, to the team-based care promised by medical homes; price and quality transparency doesn't improve outcomes, at least according to a review we published this year.
My favorite point, however, is the "process standardization with customization for selected patients." Which processes can be standardized with only "selected customization" - that's my question. Is cardiac catheterization *ever* done exactly the same way in two patients? What about treatment for pneumonia? Blood pressure control? Depression treatment?
I'm not being flip, or at least - I'm trying not to be. The article, in its population-based naivete, points up the gap between cost-saving measures and patient-centered care - while failing to recognize it at all. Selected customization, indeed!
RSS Feed
