THCB

Bringing Clinicians, Patients, and Financial Administrators into a Common Conversation About Affordable Care

Neel Shah ERAS 2 x 3 cropIt all started a few years ago with an out-of-the-blue e-mail:

Neel – I saw the work you are doing via the article in the journal ‘Leadership’.  Congratulations as this is a great area of focus to pursue – the need to take down the complexity as it relates to cost/charge/reimbursement is a tough and an important issue.  There may be some interesting ways we can collaborate.  Best, Dan”

That e-mail would lead to a major initiative, a National Story Contest called The Best Care, The Lowest Cost: One Idea at a Time that we are launching this week.  More on that below, but first a little more background. 

At the time, Neel was finishing his clinical training as a physician and about to join the faculty at Harvard Medical School. Despite all that training, there was something that no one taught him: how his decisions were impacting what patients had to pay. Dan, who was leading Strata which is a company that helps hundreds of healthcare delivery systems with financial analytics, realized that most of these organizations didn’t have any access to cost data – they were flying blind.

Our conversation started the way most conversations about healthcare costs start, talking about a gargantuan, $3 trillion problem that requires serious muscle to wrangle. The interesting twist was that while we both agreed that muscle needed to come from policymakers in the halls of Congress, we felt there was a much bigger opportunity in the halls of hospitals and physicians practices, especially when you consider 80% of treatment decisions (translation: spend) come from clinicians.

Those of us who spend time on the frontlines of healthcare delivery see routine opportunities to deliver better care at lower cost every day: the 5AM lab draw that happens on almost every medical/surgical ward in every hospital in the country even though it is often unnecessary, the 5PM turf that lands a patient in the emergency room because the community practice is oversubscribed.

Ultimately, Neel started a non-profit called Costs of Care to help clinicians and patients share their stories.  Yet while hundreds of stories have been submitted over the past few years outlining the problems, together we felt that now was to the time to broaden this conversation to a wider audience and focus on solutions and ideas that can make a difference.

With that as a background, today we are excited to launch a National Story Contest called The Best Care, The Lowest Cost: One Idea at a Time. In partnership with the Healthcare Financial Management Association, the top association for financial managers, and Yale New Haven Health System, one of the top academic medical centers in the county, as well as Cost of Care and Strata, the objective is to collect and “open source” ideas to start a national conversation on creating a healthcare system that truly delivers value. 

While sky-rocketing healthcare costs have many drivers, we believe bringing together shared insights from both clinical and financial leaders is a critical element of making care affordable. We are calling upon clinicians, administrators, and patients to submit essays and videos about experiences and ideas that reduce unnecessary cost while providing better care for individuals and families. (If you have a good idea, send it our way by September 28 –www.costsofcare.org/story)

Neel Shah, MD, is the Founder of Cost of Care and an Assistant Professor at Harvard Medical School

Dan Michelson, MBA is the Chief Executive Officer of Strata Decision Technologies

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  1. There’s a bumpersticker that says:

    “if you think healthcare is expensive NOW, just wait until it’s FREE”

    This is about the most well-reasoned and sage bit of advice I’ve seen in a long time. I don’t know about Harvard and Yale, but the people that seem to cost the most money where I live are people who pay absolutely ZERO for any of their care. They are called Medicaid recipients and they use the ER as their 24 a day, 7 day a week, personal, free, walk-in convenience clinic, and there is NOTHING that anyone can do to stop them.

    In fact, it seems like no-one really wants this to stop, or even slow down. Like hungry dogs under the table, the rural hospitals yearn for the scraps of sharply-discounted payments for Medicaid services. The large ER contracting groups don’t want it to stop, they are happy with billing $875 for the physician’s component of a level III (99283), the more the merrier!!! The patients don’t want it to stop, they have prompt access to state of the art care at any of 5,000 emergency departments across the country, any time, day or night, and it’s all free free free!! hooray!! Obama doesn’t want it to stop, he just added about 9 million more people to the free care scheme. Alas, it’s only the poor taxpayer who wants this abuse to stop, and certainly no one cares about him.

    Today I saw a patient in the ER for chest pain. Workup was well over $2000, with EKG’s, stat labs, portable CXR, Iv medications, swarming nurses, respiratory therapy responding as required to “possible ACS” patient in the ED. Then, I saw the patient’s name. It was the same patient I had seen last week, twice the week before, and 17 TIMES in just our ER alone since having her CABG 3 months ago. Why? because she did not go to her primary care provider. It was just easier to come to the ER for any ache, pain, post-op concern, wound check, cough, BP check, fingerstick glucose, etc. She has spent more of the taxpayer’s $ on ER visits than her actual bypass surgery.

    Solution? pretty simple. just make sure people have some “skin in the game.” Even if you are indigent, you can pay a small copayment. Just skip that extra pack of smokes. Allow ER’s to defer your care to next-day clinics, or FQHC’s. Permit the hospital emergency rooms to actually treat emergencies, as opposed to being operated as the medical equivalent of a 7/11. It’s amazing what having some small responsibility for costs will engender.

    Oh, and one other suggestion: don’t allow any mid-level provider to order any test that costs more than $25, and don’t permit any home health or school nurse to call an ambulance, give any type of medical advice, or send a patient to the ER. These alone will likely save the healthcare system about $500 Billion. Just a drop in the bucket, I know, but as Senator Dirkson used to say . . .

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