Reforms and Innovation Needed to Lower Costs and Improve Quality in Healthcare
By: Tomas Gregorio,
Senior Executive Director, Healthcare Delivery Systems iLab, New Jersey
Innovation Institute Healthcare in the United States is complicated,
inefficient and expensive.
Many individuals and families can no longer afford to see a doctor, fill
a prescription or get the most basic medical care without having to
sacrifice other essential items such as putting food on the table or
paying the mortgage. These
are choices that no American should be forced to make.
Unfortunately, after seemingly endless attempts at
reform, the costs of our healthcare system continue to move steadily
higher, impervious to all attempts from the government, private
companies or other stakeholders to hold back the ever-rising healthcare
tide. Healthcare, by its very nature, is resistant to
change. Concerns over
privacy and safety often delay the sharing of information or adoption of
new technologies that could reduce the costs of care. While these issues
are valid, they can and must be addressed as the status quo is no longer
acceptable. This point has not been lost on the U.S. Department
of Health and Human Services and the West Health Institute that in a
recent whitepaper noted that greater interoperability of healthcare
devices alone could help save more than $30 billion a year in wasteful
spending. While the Rand
Corporation in an earlier study estimated that full national
interoperability could save $77 billion annually. A national network in which all providers have
access to medical records is still many years away however, there are
steps being taken right now by the Centers for Medicare & Medicaid
Services (CMS) that promise
to have a positive impact on healthcare costs and quality.
The initiatives, “Patients
Over Paperwork” and “Meaningful
Measures” seek to reduce the regulatory and reporting burden on
providers. Reducing the amount of time physicians spend on
paperwork is goal that I am sure would garner 100 percent support in the
healthcare community.
Providers spend countless hours filling out forms or checking boxes that
in many cases have no obvious benefit for either the physician or the
patient. Seema Verma, CMS Administrator, noted this problem
during remarks on October 30, at a Healthcare Summit when she said, “We
publish nearly 11,000 pages of regulations every year. That is a lot of
paper, and it’s taking doctors away from what matter most – patients.” Further, the American Hospital Association recently
published a report showing that health systems, hospitals and post-acute
care providers spend nearly $39 billion a year (let that sink in for a
minute) solely on administrative activities. CMS is beginning to address this problem by taking
on a full scale review of current regulations by asking some very basic
and important questions:
What is the purpose of the regulation? Does this regulation help prevent
fraud and abuse? Does the regulation have a meaningful impact on patient
care, safety and improving outcomes?
This review alone, and a subsequent role back of regulations has
the potential to save untold billions of dollars, improve patient care
and restore the sanctity of the provider/patient relationship. CMS’ Measures Management effort is about examining
what quality measures should be reported to the government as part of
their overall goal of moving our healthcare system from fee-for-service
to value-based care. My organization, The New Jersey Innovation
Institute (NJII), fully supports this effort and is partnering with CMS
through their Transforming Clinical Practices Initiative (TCPI) that
seeks to save more than $1 billion in healthcare costs by the end of
2019 by helping physicians adopt value-based care payment models. NJII
has recruited a network of nearly 10,000 physicians to be part of the
initiative and we are on pace to save more than $135 million in costs
and improve the health of more than 500,000 Medicare patients over the
life of the program. Meaningful Measures will focus on having providers
report only on measures that are most vital to providing high quality
care and improving outcomes for patients.
In essence, CMS will focus more on results, less on process, and
promote a more market driven health care system. NJII applauds CMS in its efforts to bring
innovation to our healthcare system and examine opportunities for
advancement. We
encourage healthcare stakeholders at every level to bring their
expertise to the table and further the collective effort to lower costs
and improve healthcare quality. |
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