Wednesday, May 19, 2010

Political Nostrums About Controlling Health Care Costs: A Case Study

Oh, those wacky politicians. Blessed with a charismatic ability to spin half-truths into yummy sound-bites, the more successful ones float into our field of view like oversized blimps and mesmerize us mere mortals with astonishing chutzpah and plausible fibbery.

Look no further than the Health Affairs blog for an example of this kind of spectacle, courtesy of none other than the Keystone State's Governor Edward Rendell. His approval ratings are lower than Obama low, budget crisis impasses are routine, taxes and spending are out of control and he still has time to share his half-baked health policy opinions. They make for an, ahem, interesting read.

It's easy, says the Disease Management Care Blog's Governor, to reduce health care costs. It's just a matter of....

"...not paying for medical errors (1); decreasing the number of hospital-acquired infections by requiring hospitals to report the rate of such infections and penalizing hospitals that do not make progress in limiting them (2); fostering the development of “medical homes” in practices across the state (3); and expanding the scope of practice of nonphysician medical providers (4), thus promoting the growth of after-hours clinics staffed by nurse practitioners and other providers and thereby cutting the number of unnecessary emergency department visits by people unable to access their physicians on nights and weekends (5)."

1. What Mr. Rendell is probably referring to is the adoption of Medicare's 'no pay' policy for hospital acquired conditions (HACs). While many HACs are avoidable, their overall frequency is much lower than the salacious media would have us believe. In this Health Affairs study, the future economic impact of the policy is estimated to be negligible.

2. Check out this study report looking at the statistics behind dreaded "Staph" infections among patients discharged nationwide: 0.8% of patients.

3. Oh? Other than a few studies in Medicaid or integrated delivery system settings, the DMCB can find no conclusive evidence that the medical home reduces costs in community care settings. Isn't the fact that this is all still rather experimental why they're calling them "pilots?"

4. Mr. Rendell may have special biases about the role of non-physicians as primary care providers thanks to his spouse, but this isn't a slam dunk solution thanks to a similar shortage of nurse practitioners as well as lingering economic dysfunctions.

5. That's a commonly held perception, but this review of the literature fails to support the contention that uninsured persons using the ER do so for lack of primary care access or for the sake of convenience. While primary care access undoubtedly plays a role in patients' willingness to use an ER, that's still less than 3% of the nation's health care bill.

It'll take more than these overused platitudes to control health care costs. The DMCB ultimately admires Mr. Rendell and knows he's a lot smarter than this. Pennsylvanians and readers of the Health Affairs blog deserve better.

Image from Wikipedia


Anonymous said...

I'm not a doctor and I don't believe much of what politicians say, but I can't let your criticism of half-truths stand while propagating one yourself.

The report from the Archives of Internal Medicine does state that the S. aureus infection occurs in only .08% of inpatients studied. However, it also indicates that each patient represents about $34,000 in extra hospital charges and has 5times the chance of death in the hospital. The report's conclusion states that if hospital reduce infection rates, the potential benefits to hospitals in terms of reduced costs are significant.

If you total the cost numbers it comes to an extra $10 billion per year and since this type of infection seems to account for only about 1/6 of all hospital based infections the number are even more striking.
Here's my point, politicians lie and exagerate but that doesn't mean that we can't reduce costs in the American medical system dramatically.

Jaan Sidorov said...

Thank you for your feedback JL. You're right: it's how the numbers get framed. When presented in absolute terms ($10 B, $34K) the numbers are shocking; when presented in relative terms (percents), the numbers are less impressive. And you're on spot with the observation that hospital infections are a part of the problem that can be fixed.

That being said, politician-speak has not served our Republic well because - in the Governor's case - he skipped over the relative and absolute numbers and presented a list of taste great/less filling solutions, portraying them as THE solution.

When it comes to fixing the system, we can both agree that infections are part of the solution, but disagree on just how much.....

Thanks again!