Saturday, April 30, 2011

CAP talk by Atul Gawande - 42911. Reducing Health Care Costs Without Rationing: A Clinician's View

Went to Center for American Progress talk by Atul Gawande yesterday.  He has many excellent ideas for improving care while lowering costs.

Reducing Health Care Costs Without Rationing: A Clinician's View
Atul Gawande, M.D.
Here is link to video of talk

Health care, there are too many profit centers.  Patients are treated as profit centers.
5% of population counts for 60% of the costs
Many receive inappropriate care
Best quality care frequently has lower costs
Key steps
1.      1.  Recognize community failures and successes
2.       2. Devise group solutions
For hospital surgery, procedures, infections, death rates, complex patients, etc. , develop checklists

Need to develop productivity revolution in health care
One project reduced complications by 35% and deaths by 47%

Use of checklists adopted universally in England, Ireland, Spain and VA hospitals, but by only 25% of U.S. hospitals.

Need to move from individuals to organizations. Kaiser, and Mayo Clinic are two excellent examples that focus on group strategies and not cowboy approach

3.       3. Need to move from project thinking to portfolio thinking.

See hot spots article

The Hot Spotters

Can we lower medical costs by giving the neediest patients better care. 

In Camden, New Jersey, one per cent of patients account for a third of the city’s medical costs. Dr. Jeffrey Brenner has taken a comprehensive social approach to these issues and is lowering medical costs.  This is where we need to be. 

150,000 deaths per year post –op, half are avoidable.

End of Life care is inadequate, too many folks die in Emergency rooms
Too many catastrophic procedures
Need checklists for these.

Need policy levers to move these

IPAB is essential.  Independent Payment Advisory Board.  The Republicans want to do away with this.  Detect some inconsistency here with their desire to reduce the deficit.

Need more data and information at community level.  More funding for NCHS. National Center for Health Statistics

Denmark was very successful using medical homes

Need to reduce smoking, obesity, air pollution

Need to reward systems and individuals. 

“We are in a battle for the soul of our medical care.  We are fostering a learning system, there will be mistakes but inertia equals failure.”

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