STF na Mídia - MyClipp

The New York Times/ ­- Politics, Sáb, 14 de Abril de 2012
CLIPPING INTERNACIONAL (Supreme Court)
Why Medical Bills Are a Mystery
RISING health care costs are busting the federal
budget as well as those of states, counties and
municipalities. Policy makers and health care leaders
have spent decades trying to figure out what to do
about this.
Yet their solutions are failing because of a fundamental
and largely unrecognized problem: We don’t know
what it costs to deliver health care to individual
patients, much less how those costs compare to the
outcomes achieved.
When insurance companies or government bodies try
to control costs, they usually make across­-the­-board
reimbursement cuts that ultimately are unsustainable
because they have no connection to the true costs of
delivering care. Providers themselves do not measure
their costs correctly. They assign costs to patients
based on what they charge, not on the actual costs of
the resources, like personnel and equipment, used to
care for the patient. The result is that attempts to cut
costs fail, and total health care costs just keep rising.
Regardless of what decision the Supreme Court
reaches on the legality of the Affordable Care Act,
measuring outcomes and costs is indispensable to
driving improvements.
Because health care charges and reimbursements
have become disconnected from actual costs, some
procedures are reimbursed very generously, while
others are priced below their actual cost or not
reimbursed at all. This leads many providers to expand
into well­-reimbursed procedures, like knee and hip
replacements or high­-end imaging, producing huge
excess capacity for these at the same time that
shortages persist in poorly reimbursed but critical
services like primary and preventive care.
The lack of cost and outcome information also
prevents the forces of competition from working:
Hospitals and doctors are reimbursed for performing
lots of procedures and tests regardless of whether they
are necessary to make their patients get better.
Providers who excel and achieve better outcomes with
fewer visits, procedures and complications are
penalized by being paid less.
Our research and executive workshops show that
many sites are already improving their measurements
of patient outcomes. But they have done little to
measure the actual costs of achieving those outcomes.
We are currently working with several health care
organizations, including MD Anderson Cancer Center
in Houston, Children’s Hospital Boston, Partners
Healthcare in Boston and Schön Klinik in Germany,
that are beginning to figure out how to measure costs.
They use teams of clinicians and administrators to
identify all the processes involved in care, from a
patient’s first contact with a health care provider
through his or her inpatient stay and outpatient
follow­-up care. The teams then identify the quantity
and unit cost of each resource — clinical staff,
equipment, supplies, devices and administrative
support — used in each process and add these
together to learn the total cost of a patient’s care.
The information helps them discover immediate and
significant opportunities for improvements in care and
reduced spending. MD Anderson, for example, has
studied its evaluation process for new head and neck
cancer patients. By substituting trained staff members
for physicians, standardizing processes and improving
information technology, it has been able to make care
more efficient without any adverse effect on patient
outcomes. It has made changes that reduced total
costs by 36 percent, and freed employees to serve
more patients without adding to costs.
A surgeon repairing cleft palates at Children’s Hospital
Boston discovered that 40 percent of the total cost of
an 18­-month­-care process was due to the time a child
spent in the intensive care unit before and after
surgery. By using a far less intensively staffed and
equipped observation room, the hospital could achieve
equivalent quality and safety at much lower costs.
Most health care providers have hundreds of these
opportunities to use time, equipment and facilities
more intelligently. These opportunities have been
obscured by existing costing systems that have little
connection to the processes actually performed.
With accurate information on outcomes and costs,
providers can improve care and save money by
eliminating things that don’t help the patient, like
multiple check­-ins and medical histories, tests that
provide little new information and long waiting times.
Many routine tasks are performed today by highly
trained doctors and nurses. These tasks can be shifted
to others, freeing the most skilled clinicians for far
more productive work.
Health care providers with expensive and poorly
utilized equipment, space and staff can see the
benefits of consolidating services to improve utilization
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