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DIY HEALTHCARE SYSTEM: Why Now is The Time for Clinicians to Take Action

Posted on Wed, Dec 03, 2014
DIY HEALTHCARE SYSTEM: Why Now is The Time for Clinicians to Take Action

BY: TOM PECK

“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

PART 1

How Did We Get into this Jam?
Dr. Nash cited the gap between perception and reality as a major contributing factor to the current state of the U.S. healthcare system. The concept of accountability in healthcare can be traced to a statement made by the American College of Surgeons in 1918, “…all hospitals are accountable to the public for their degree of success…if the initiative is not taken by the medical profession, it will be taken by the lay public.” Considering that the U.S., the world’s largest economic engine, spends 19 percent of GDP on healthcare, significantly more than any other industrialized country, you would expect stellar outcomes. However, many other countries spend far less and achieve better outcomes resulting in longer average life spans for their citizens. In fact, the U.S. health system ranks 17th in the world. Dr. Nash cited a 2013 Institute of Medicine report that predicted children today living in the U.S. may have shorter lives and worse health outcomes due to our broken health system. He also cited the lead article in the New England Journal of Medicine, An Uneven Adherence to the Evidence, in which the author pointed out that even when we have solid medical evidence upon which to base treatment decisions, practitioners don’t do an equally good job.

“Eighteen percent of what we do is based on solid, grade A randomized clinical trial evidence,” Dr. Nash pointed out. “So, 80 percent of the time we are practicing the art of medicine, not the science.

Dr. Nash is optimistic, citing the Institute for Health Improvement’s Triple Aim as a road map to improve care and dramatically lower costs. In fact, much of the Accountable Care Act is designed to achieve those very things.

“How we achieve the Triple Aim goals, measure our progress and get paid for it is the whole reason for this conference,” Dr. Nash told attendees. “The end goal is value-based payment focused on managing the health of a population. That’s where we are headed. Our only three choices are to adapt, migrate or perish.”

Dr. Nash reviewed the Institute of Medicine’s (IOM) strategies for healing the nation’s healthcare system:

Reduce care related costs by:
  • Preventing medical errors
  • Preventing avoidable hospital admissions
  • Preventing avoidable hospital readmissions
  • Improving hospital efficiency
  • Decreasing costs of episodes of care
  • Improving targeting of costly services
  • Increasing shared decision-making

Reduce administrative costs by:
  • Using common billing and claims forms

Institute related reforms:
  • Medical liability reform
  • Prevent fraud and abuse

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