Friday, September 21, 2012

The Scale Of The Mess That Is The US Health System Is Barely Believable. Sadly It Is Real However.

The following report appeared a few days ago:

IOM report: Informatics, transparency and data to fix healthcare crisis

By Erin McCann, Associate Editor
Created 09/06/2012
WASHINGTON – The U.S. healthcare system has long been laden with growing inefficiencies, heightened costs and increasing complexities, all of which have stymied industry progress, according to a new Institute of Medicine (IOM) report.  
However, report officials also noted existing knowledge, transparency, and new informatics tools wield the potential to mend the  –  some say broken  – healthcare system to achieve continuous improvement and better quality care at lower costs. 
In a Thursday morning live webcast of the IOM report release, Mark Smith, MD, president and CEO of California HealthCare Foundation and committee chair said two fundamental issues are currently facing the U.S. healthcare system: cost and complexity. Thus the mission of the report was “to find the foundational characteristics of a system that is efficient,” said Smith. 
According to the report, the costs of the system's current inefficiencies underscore the urgent need for a system-wide transformation. The committee calculated that approximately 30 percent of health spending in 2009 – roughly $750 billion – was wasted on unnecessary services, excessive administrative costs, fraud and other problems.  
The U.S. pays some of the highest costs for healthcare, but “at the same time, we do not attain the results in health outcomes and performances that others are able to achieve,"  said IOM President Harvey Feinburg, MD, in the live webcast. “How do we face up to that reality?”
Smith added that a “30 percent increase in income has been effectively eliminated by a 76 percent increase in healthcare costs,” leaving the U.S. healthcare system full of “wasted opportunity.”
Moreover, inefficiencies can potentially lead to patient 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.
Incremental upgrades and changes by individual hospitals or providers will not suffice, the committee said. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health system into a "learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery.  
The report was sponsored by the Blue Shield of California Foundation, Charina Endowment Fund, and Robert Wood Johnson Foundation.  
Read the full awful story here:
Wasting $750 Billion is really quite something!
Here is another report with a link to the free pre-publication draft:

New IOM Report Seeks a New Path for Health Care

SEP 6, 2012 4:40pm ET
The American health care system is in deep trouble and needs a “systemwide transformation,” of which better use of data is a major component toward improvement, according to a new report from the Institute of Medicine.
The report concludes that the health care system is too complex and costly to continue business as usual. Authors contend 30 percent of health care spending in 2009 was wasted, and cite a rough estimate that 75,000 deaths could have been averted in 2005 if every state delivered care at the quality level of the best performing state.
The ways that providers train, practice and learn new information cannot keep pace with new discoveries and technological advancements. And care delivery and payment practices lead to inefficiencies and may hinder improvement. “The threats to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck,” says Mark Smith, president and CEO at the California HealthCare Foundation.
Better use of data would facilitate better treatment of 75 million patients with more than one chronic condition by improving care coordination and having quick access to best practices, according to the report. “For example, it took 13 years for the use of beta blockers to become standard practice after they were shown to improve survival rates for heart attack victims.”
The report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, “demonstrates how a health care system that delivers the best care at lower cost is not only necessary, but also possible,” says Harvey Fineberg, M.D., president of IOM, in a foreword. The report is available here in a free pre-publication version.
 The full article is found here:
Lastly this article summarises the recommendations:

IOM Urges 10 Major Healthcare Fixes

Cheryl Clark, for HealthLeaders Media , September 7, 2012

The U.S. healthcare system operates like an ATM machine that takes days to release cash. It functions like a home construction project whose carpenters and plumbers use different blueprints. And it does business like a store that prices items depending on who is making the purchase.
It fails to contain wasteful spending, estimated at about $765 billion in 2009 alone, largely from unnecessary and inefficiently delivered services, excess administrative costs and overpricing, and in fraud and missed prevention opportunities.
Those are some of the findings from a 382-page report the Institute of Medicine released Thursday calling for a major overhaul to remove inefficiencies and other barriers to quality care.
The report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," was prepared by a 17-person committee chaired by Mark Smith, President and CEO of the California HealthCare Foundation.
"We tried to address a big-deal problem in a way that is very comprehensive, because we feel much of what has been said to this point has been in bits and fragments," says Gary Kaplan, MD, a member of the authoring committee as well as Chairman and CEO of Virginia Mason Health System in Seattle. Providers, payers, patients, funders, the government—everyone—has to see quality, outcomes, technology, fraud and waste in a holistic fashion.
Kaplan adds that the committee hopes "that the first thing to come from this is awareness. Too many providers are saying to themselves, 'We're alive and well; we know change is coming, but we're banking that change will be glacial, so we don't have to do much right now. We're profitable.' "
A case in point is the transition to electronic health records and the attainment of meaningful use attestation. While some providers may see these moves largely as big expenditures, for which they may recoup some federal incentive payments, they may overlook the enormous potential of using EHRs to gather real-time data on inappropriate, unnecessary or incorrect use of expensive hospital resources.
"We can know for the last 100 patients who had X procedure, we have this percent of complication. We know that in real time, not through 18-month-old data. This is not an abstraction, and can provide us with early warning signs and places where we may intervene."
The report issues 10 recommendations to improve quality of care, and use healthcare resources better.
Read the 10 recommendation here:
All you can say reading this is that they have a very hungry tiger by the tail and that is looks like sensible use of Health IT will be a major contributor to fixing it over the next 20 or so years!
One really has to wonder how it got as bad as it now seems. A ‘boiling frog’ issue I suspect.

1 comment:

InformaticsMD said...

Re: "transform the U.S. health system into a "learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

The problem with thinking of IT as a tool to help this "transformation", is that the health IT sector is itself the antithesis of a "learning" system.

An IOM "discussion paper" on that problem was recently released:

Comparative User Experiences of Health IT Products: How User Experiences Would Be Reported and Used