All Americans will benefit from care delivery reforms

The Billings Gazette

A year ago, back when health care reform drew a significant measure of bipartisan support despite differing ideas of how to accomplish it, Sen. Max Baucus, D-Mont., and Sen. Chuck Grassley, R-Iowa, issued a series of detailed reform proposals, including one titled “Proposals to Improve Patient Care and Reduce Health Care Costs.”

“A reformed health care delivery system will re-orient payment incentives toward services and activities that improve patient care in an effective and efficient manner and bend the curve of growth in national health care spending,” they wrote.

The senators noted that the United States in 2008 spent 17 percent of gross domestic product on health care, which translates to higher per-capita spending than any other nation.

However, the Congressional Budget Office has estimated that up to a third of U.S. health care spending – $800 billion a year – doesn’t make us any healthier. That includes fraud, waste, overcharges, expenditures on ineffective or incorrect treatments and duplicative services.

Health costs have been rising at more than double the rate of general inflation for many years. What reformers are trying to do is slow down that runaway growth while getting better value for our health care dollars.

Amid the heated partisan rhetoric about health reform, organizations that have long advocated consumer-oriented changes are praising the new law. AARP is pleased that it will cover preventive health services for Medicare folks at no out-of-pocket cost. The Medicare Rights Center says it “will strengthen Medicare financially and improve the health care people with Medicare receive.”

Consumers Union, the independent testing organization that evaluates products and services, heralds the law’s provisions for improving patient safety.

“Millions of American are harmed every year by medical errors and health care acquired infections that are preventable,” said Lisa McGiffert, director of Consumer Union’s Safe Patient Project. “The new health care reform law will save lives and dollars by arming consumers with information about each hospital’s patient safety record and leveraging federal health care dollars to give hospitals a stronger incentive to prevent needless suffering and deaths.”

Long before this Congress took up health reform, Consumers Union started a campaign calling for changes to cut the number of medical errors in hospitals. The project focused on reducing hospital-acquired infections, which kill about 100,000 Americans a year, according to an estimate from the Centers for Disease Control and Prevention.
Surgical site infections account for 20 percent of those infections, even though there are proven medical protocols to reduce the risk of surgical infections.

The benefits of prevention are enormous because patients who acquire infections from surgery stay an average of 6.5 days longer in the hospital, are five times more likely to be readmitted after discharge and twice as likely to die, according to research published in Infection Control and Hospital Epidemiology.

To help ensure that all hospitals use the best practices for every patient, the new health law will:
Pay hospitals for improving Medicare patients’ care, including reducing infections.
Withhold Medicaid payments to hospitals for extra care that was necessitated by poor care, as Medicare already does.
Beginning in October 2014, disclose hospitals’ records on medical errors and infections on the Health and Human Services Web site, so patients can compare hospitals.
Require private insurers to include quality improvement efforts in their contracts with providers.

Most of the health care debate has focused on the millions of Americans who have no insurance and efforts to cover at least 32 million of them. These steps toward consistently high quality care will benefit everyone — those who have insurance now and those who are expected to be covered under the new law.

Ultimately, the best care costs less because patients have fewer preventable complications, get well faster and are less likely to relapse. Last year, Baucus and Grassley warned that by 2017, total U.S. health spending is expected to equal 20 percent of GDP, or $4.3 trillion. To bend that cost curve, the system must refocus on universally good care.