Friday, December 04, 2009

Evidenced-based care

On Thanksgiving day, while walking down a very uneven sidewalk toward the park with the grandchildren, Brenda tripped and fell.  She broke her fall by stiff-arming the sidewalk.  She bumped and scratched her face and badly bruised her hand.  She shook off her injury and went on to the park! 

The next day, after a short visit with her doctor, she went to a local hospital emergency room to have her hand checked out.  After a lengthy wait and a couple of rounds of X-rays, she learned that no bones were broken.  During the exam, the examining nurse practitioner (she never saw a physician) questioned her about the scratch on her face, finally suggesting an MRI to make sure there were no broken bones in her face.  Brenda assured her that such a procedure was not necessary and that another X-ray would suffice, if even was really necessary. 

She left glad to know that there were no broken bones and with her hand and arm wrapped up to the elbow.  She also wondered if the attending staff was guilty of over prescribing treatment. 

In a "fee for service" health care system like we now experience, her suspicions make a lot of sense. 

Then, on Sunday morning, The Dallas Morning News carried a front page story on evidence-based medicine and cost sharing and the move of the Baylor Health Care System to such a strategy for providing care to its patients (by the way, the ER Brenda visited was not a Baylor hospital!). 

No one wants to talk rationally about health care realities these days.  But, in view of rising costs and our return in health and wellness benefits for what we pay, the time has come for serious discussions.  From the report it sounds as if Baylor will lead the way in that much-needed conversation.  Good for them! 

Be sure and read the story, "Baylor will try new Rx," by clicking here.


Anonymous said...

There was an excellent article in the Atlantic recently. The author's father had died a year earlier after extensive medical treatment for which Medicare had been billed over $500,000. A significant part of the bill was for treatment necessitated by faulty medical care. But, in health care, doctors and hospitals actually profit from their mistakes, because they still get paid to fix them. All in all, it's an excellent assessment of just how broken our current system is.

His conclusion is that any system in which the user bears little or no direct cost will inevitably result in massive amounts of unneeded care. The doctor says "let's run this test," and the patient has no incentive to ask how much it costs or whether it's really worth it. Nothing else - no other service we get - works this way.

I fear if we don't fix this part of the system - that is, control costs - anything Washington does right now will only pile more and more 'last straws' on a badly broken system that is already an astonishing 17% of our GDP. And the most rational way to control costs may be to recreate the system in such a way that patients pay more for the treatment they receive, not a popular idea with those who have good health insurance.

BTW: Bravo, Brenda, for questioning whether you needed that extra test!

Dallas, TX

Baylor said...
This comment has been removed by the author.
Baylor said...

Larry, thank you so much for your enthusiasm about Baylor Health Care System’s new Accountable Care program. We appreciate you posting a link to the Dallas Morning News article as well. It’s nice to hear real stories from people like you to remind us of how impactful this program could be. We are looking forward to making progress. Again, thank you for your support. Take care!

Ashley Howland
Baylor Health Care System