The Commonwealth Fund contends that: reforms physicians could champion to eliminate waste and duplication (inefficiency) include, but are not limited to: "integrated systems of care,""shared savings, bundled payments, or global fees" and "performance measures that promote care coordination." I say that docs aren't happy about any of that. I can hear them now....
Take on risk? Why should I? Worry about the 'downstream costs'? I can't control what the specialist does? I cannot be responsible for what the patient doesn't do (for themselves). This is merely cost-shifting and a squeeze.
As a former medical director, on the other hand, I'd say it doesn't go nearly far enough.
I've defined "the value equation" in such a way that these opposing views are brought together, re-aligning the incentives, as it were. Clearly, that's the most preferred outcome for healthcare reform. The process is simply measuring and managing; managing and measuring." Easier said than done and harder to do it fairly, however. Neverthless, the information one needs is:
- "Who" does "what," "where" and "when" and "how well."
- 'Apples must be compared with apples.' In other words, we need to know how sick the patients are; this is called "acuity" or "case mix" adjustment.
- The best construct with which to view care is a comparable, longitudinal picture of all care over time, regardless of setting and that is called an "episode of care."
(Note: for those shrugging their shoulders, saying an electronic medical record (EMR) is the answer to all of this, it's only a baby step.) There's a huge danger in making invidious comparisons, so let's demand acuity adjusted, comparative data that reflects an entire episode of care. That way if a doc is too costly, at least it won't be because his or her patients are sicker.