By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.
Health care reform is difficult, in large part because it’s so hard to achieve consensus on many issues related to it. Repeal Obamacare, or amend it? Keep the private option, or replace it?
So maybe more attention should be paid to reforms where agreement is possible. For starters, here are two.
One would be for hospitals to make fewer people sick. According to the federal Centers for Disease Control and Prevention, 648,000 Americans contracted infections while in an acute care hospital in 2011, and 75,000 of them died while a patient, though not necessarily from the infection. One in 25 hospital patients is infected during their stay.
Not all of those infections were the hospitals’ fault, of course. Many patients have weakened immune systems. But many infections are preventable if hospitals follow simple procedures. Sometimes it’s as simple as making sure physicians and nurses wash their hands.
That’s one of the practices at Unity Health in Searcy, one of nine hospitals in the country and the only one in Arkansas given a top rating for infection control by Consumer Reports.
The magazine recently rated 3,000 hospitals based on five infections: clostridium difficile, or C. diff, which develops in 290,000 patients each year and contributes to the death of at least 27,000; methicillin-resistant staphylococcus aureus, or MRSA, which contributes to more than 8,000 deaths annually; catheter-associated urinary tract infections; central-line associated bloodstream infections; and surgical-site infections.
Unity Health staff members told me there’s no magic bullet. Instead, they just follow nationally recognized guidelines, such as using a bleach-based cleaning procedure to combat C. diff infections. They avoid unnecessary catheterization. The housecleaning staff keeps the rooms clean.
How can more hospitals be encouraged to follow Unity Health’s lead? One way is to continue changing the perverse incentives surrounding health care. Medical providers traditionally have been paid by insurance companies and government payers under a “fee for service” model. They bill for each service they provide, so if a patient is infected while in the hospital, the hospital gets paid for treating that infection. That doesn’t mean hospitals are purposely careless, but it does give them less reason to be extremely careful.
Arkansas is a national leader in creating an “episodes of care” payment model based on appropriate costs for select procedures, such as knee and hip replacements, from the beginning to the end of treatment. If average costs for all such patients fall below a certain threshold, medical providers are paid a bonus, and they face a penalty if costs are too high. So if enough patients contract an infection, the hospital’s bottom line will suffer.
The model was created with input from government agencies, insurance companies and medical providers. In other words, consensus was created. The state started with five episodes and has been increasing the number. The federal Medicare program is experimenting with the model as well.
Makes sense, doesn’t it? If health care is to remain a free market entity, then providers should face the same expectations as other businesses: If I hire you to fix something, you don’t get paid more if you break something else.
Another health care reform where consensus should be possible is increasing the number of medical professionals.
Recently, 214 physicians completed their residency training at UAMS and are ready to practice medicine. Unfortunately, that’s only a drop in a bucket with a hole in it. According to a 2015 study sponsored by the Association of American Medical Colleges (AAMC), the United States faces a shortage of between 46,000 and 90,000 physicians by 2025.
A medical education is costly. According to the AAMC, 84 percent of 2014 medical school graduates had education debt, with a median debt of $180,000 – and that comes after many years of school, long after law school graduates are making money suing doctors.
Gov. Asa Hutchinson has made increasing the number of high school students with computer coding skills a top priority. How about an effort to produce future doctors? Could we agree on that? If Arkansas can award more than 168,000 lottery scholarships, many to students who aren’t particularly focused or directed, can it reallocate resources to qualified medical school students?
More doctors are needed, and hospitals shouldn’t make people sick. Solving those problems won’t be easy, but coming to a consensus will be easier than it’s been with Obamacare and the private option. So can we talk about the easy stuff more often, and fight about the hard stuff a little less?