The Quality Cure

Attached is an article that Larry Benz sent me outlining David Cutler's viewpoint on how to reign in skyrocketing healthcare costs. To give some perspective, Mr. Cutler was instrumentally involved in drafting the 1993 healthcare reform policies in the first Clinton administration, which was a dismal failure.

Regardless of your political leanings, he offers great insight on how best to get our healthcare system under control. For those who identify with evidence-based practice, these ideas will not be all that surprising, however they are radically different from the current model focused on restraining costs. The gist of this approach is that we should forget about costs and direct all of our attention toward improving quality. The notion is that the healthcare system should pay for performance (defined as improved health), rather than focusing on consuming less healthcare. I won't steal his thunder, but here is a key summary.

"Cutler's approach is radically different. He says that most health-care spending is actually good. Spending has been rising, he says, because it delivers positive, and measurable, economic value, and because it can do more things that Americans want. Therefore, Cutler says, we should focus on improving the quality of care rather than on reducing our consumption of it. Rather than pay less, he wants to pay more wisely -- to encourage health-care providers to do more of what they should and less of what is wasteful."

We have a long way to go toward this end, but the ideas are compelling for any healthcare practitioner who identifies with evidence-based practice. Enjoy the read.

John

Download the_quality_cure.pdf

Comments

[Ryan Girrbach]

Several thoughts come to mind after perusing the article:

We need more:
1. Prevention, prevention, prevention.

2. Patient education.

Outcome-based bonuses for doctors who provide the highest tier of "quality care"? Sounds like the need for outcome measures just became greater.....

Eliminating waste: Indeed. When is the last time any of us military PTs interviewed a client NOT on an NSAID? It's truly amazing.

Thanks for the article, John. It was a welcome light read following yet another day of hectic patient care.

--Ryan Girrbach

[Selena Horner]

What if the same philosophy were extended to the physical therapy world?

What would the model look like? How would our services be measured? How would "quality" be defined?

Are we individually ready and as a whole profession ready for this type of philosophy?

Do we as individuals and as a profession have a mindset of improving, improving, improving ourselves and our methods and not being complacent?

Will there be different strategies with marketing continuing education? And will therapists then demand only proven methods/theories of practice that definitely have a known impact on provided care?

Do we have in place a communication system that will disseminate information to a large population of practicing physical therapists so the most can stay current?

And... are we ready as individuals to change our practice patterns in light of new research that indicates a better method for specific patient populations, even if each individual believes his/her method is the best (although unproven)?

[Cliff Hall]

Quality care, prevention, outcomes…what a concept. I believe PTs probably are more amiable to this approach than many other health care providers because these values lie at the heart of what we are all really wanting to accomplish with our patients every day. I’m not saying that other medical providers don’t value these things, but I’m not sure that they are at the forefront of their practice.
What kind of outcomes are we talking about? Less pain, more function, better compliance, less visits for medical care (what a concept!). I think we will need to develop some better long-term outcome measures to really know if we are making a difference in PT. There could be a problem if PTs are compensated for measured positive short term outcomes when our patients may only be experiencing short term changes, rather than long term benefits from our services. Potentially we could have an inflated impression of our true effectiveness/impact on many conditions that we typically classify as chronic.
I would also like to see us rewarded for demonstrating that we have successfully educated patients to self-manage some chronic conditions that typically put a drain on our system. The article makes a good point in that health care provider behavior can be influenced by the almighty $. We might not seem “ready” for a change such as this, but if Medicare embraced it, I’d bet we would see a radical paradigm shift towards EBM and outcome based medicine in our profession…not a bad thing at all.
Cliff