QUALITY/POLICY: Sicko, Deloitte and the reason for EBM

The Deloitte Center for Health Care is best known for being headed by Paul Keckley, recently of the Center for Evidence Based Medicine at Vanderbilt, and a minor actor in Michael Moore’s recent spat with CNN. (CNN didn’t come clean that Keckley has consulted for lots of health plans and, horror of horrors, is a Republican).  I personally thought that Moore won that spat pretty convincingly, in that CNN couldn’t spend 12 seconds googling Paul.

The joke is that some of what Paul said was exactly what Moore said. Health care that is free at the point of care is not without cost, as it’s paid for out of general taxation (or some variant of it). Of course, it’s pretty shallow to say Americans don’t like paying tax, but then ignore the fact that they are otherwise (via reduced wages) forced to pay a "private tax" in health costs which massively exceeds that paid in tax to governments in other countries (after all there it adds up to 10% of GDP, here 17%). And I thought Moore was pretty clear in the movie twice (once with Tony Benn in the UK, and once when he went to visit the well-off French couple) that Europeans accepted higher taxes so that they can take care of the poor. Of course they probably don’t realize that in paying higher private taxes they save money overall.

However, the good folks at Deloitte are moving on, led by Paul, to talk more about the problems within the US system, and I suspect that Paul has learned his lesson about letting CNN tape his words without being clear about what their going to do with them and how they’ll represent him.

Instead, Deloitte’s gone to Kansas. Topeka, KS to be precise. Overall Topeka is a mirror of the national average in healthcare delivery data. Their analysis done using Healthgrades’ and other data is that if hospitals in Topeka could just do a little bit better than average they could save over 150 lives a year by just performing a little better–and that in a metro of just under 230,000.

The point is not that the two big hospitals in Topeka are bad. It’s
just that they’re average. If they could move themselves up the
performance curve they’d improve their outcomes and save lives and
presumably money too. The Deloitte Center has studied Topeka to prove that point. There’s nothing new or earth-shattering in their analysis–they’re just saying that we can improve the average.

And of course that points us to the real issue. Keckley and Moore ought to be on the same side. In fact everyone should be.

We know that a combination of universal care and some type of
pay-for-performance can improve care quality. Moore himself ranted
about HMOs in Sicko, yet had no problem with British GPs being
paid extra to keep their patients healthier–the biggest pay for
performance program in the world. And who (if anyone) does P4P here?
Well HMOs of course

Uninsurance, and the costs it inflicts on the sick, is a real
scandal. But the next biggest scandal is what we accept as "average" in
health care delivery. And if we cure that we’ll not only improve
quality but we’ll save money into the bargain. And if we pay
consultants and film-makers to help us get there, I can live with that!

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