Created: September 9, 2012 Last Updated: September 10, 2012
(L to R) Gail Cassell, Ph.D., Harvard Medical School; Craig Jones, M.D., Vermont Blueprint for Health; Mark Smith, M.D., California HealthCare Foundation; Rita Redberg, M.D., editor, Archives of Internal Medicine; and T. Berguson Jr., M.D., Department of Cardiovascular Sciences, East Carolina University, Greenville, N.C. The panel discussed Sept. 6 an Institute of Medicine report, ?Best Care at Lower Cost.? (Gary Feuerberg/ The Epoch Times)
WASHINGTON?Our health care delivery system needs to be fundamentally reformed, according to a new report from the Institute of Medicine, titled ?Best Care at Lower Cost.??
In the past 50 years, there has been an explosion in biomedical knowledge and impressive innovations in therapies and surgical procedures, as well as new capabilities in improving the survival of patients. Yet in terms of quality of care, cost, and meeting patient needs, American health care is falling short.
\>");?How is it possible that we spend much more on health care ? and at the same time we do not attain in health care outcomes and performance that [other countries] are able to achieve?? asked Dr. Harvey Fineberg, president of Institute of Medicine (IOM). Fineberg was speaking at a press conference, Sept. 6 on the release of the report.
The 331-page Institute of Medicine report was written by an 18-member committee, five of whom were present at the news conference.?
The findings are staggering. About $750 billion or 30 percent of health spending in 2009 was wasted, according to the report. Moreover, if the quality of care were raised to the level of the best performing state, an estimated 75,000 fewer deaths across the country would have occurred in 2005, according to one estimate cited in the report.?
Knowledge Complexity
One reason for inefficiencies is the ever-increasing complexity of the health care system. From diagnostic and treatment procedures, to the care management options available, and even administration?so many aspects of the system are more complicated than ever before.?
Today, a clinician cannot keep up with the expanding volume of new discoveries in treating disease. The number of research publications on health care topics per year has grown from slightly over 200,000 in 1970 to more than 750,000 in 2010, said Mark Smith, M.D., committee chair. The sheer volume of new discoveries stresses the system to manage the knowledge and effectively apply it to regular care.
Care delivery has increased in complexity. Clinicians in intensive care units, who care for the hospitals? sickest patients, must oversee about 180 activities per day ranging from replacing intravenous fluids to administering drugs.?
?Medicare patients now see an average of seven physicians, including five specialists. ? One study found that in a single year, a typical primary care physician coordinated with an average of 229 other physicians in 117 different practices just for Medicare patients. The involvement of multiple providers tends to blur accountability. One survey found that 75 percent of hospital patients were unable to identify the clinician in charge of their care,? says the report.
?About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions,? says the media release.
Quality
Health care can do a lot to improve quality and outcomes, according to the report. IOM reported in 1999 that between 44,000 to 98,000 patients died annually from preventable medical errors. Recent studies have found that ?as many as one-third of hospitalized patients may experience harm or an adverse event, often from preventable errors,? says the report.
The treatment of breast cancer provides a good example of the vast amount of information that is available but isn?t always being used for the best results. The report states, ?Five decades ago, breast cancer was detected from a physical exam, no biopsy was performed, and mastectomy was the recommended treatment for all detected breast cancers. Today, multiple imaging technologies exist for the detection and diagnosis of the disease ?? A variety of surgical, radiological, chemotherapy, and endocrine therapies are now practiced.
?How is it possible that we spend much more on health care ? and at the same time we do not attain in health care outcomes and performance that [other countries] are able to achieve??
?Dr. Harvey Fineberg, president of Institute of Medicine
The authors of the report say that doctors are embracing many innovations prematurely, writing, ?The comparative efficacy and safety of these diagnostic technologies and treatments have not been evaluated.?
Rita Redberg, M.D., editor of Archives of Internal Medicine, said that while it is a great thing that new technologies and treatments are available that didn?t exist when she went to medical school 30 years ago, the evaluation side hasn?t kept pace.?
?Before we start applying these [technologies and treatments] in a widespread way, it is important that we know that they are actually helping patients,? said Dr. Redberg. There are a fair number of treatments out that ?have no known benefit and do definite harm.? These are wasteful too, she said.
Cost
Health care costs have increased by 76 percent in the past decade, growing faster than the economy for 31 of the past 40 years. The growth in health care costs is unsustainable.?
Health care costs is an issue in the federal budget and is ?starting to crowd out education and public services in the budget of every state,? said Redberg.
Much of the money spent on health care is wasted and sometimes causes harm?estimated to be $750 billion in 2009. Unnecessary services?tests that aren?t necessary, unneeded higher cost services?are estimated to waste $210 billion annually. Many billions more are wasted with excessive administrative costs, inefficient service delivery, service and product prices not competitive, missed prevention opportunities, and fraud, according to the report.
The report calls for a new incentive system based on rewarding high-value care. Unfortunately, most payment systems have the wrong incentives, reimbursing providers for individual procedures and tests rather than paying a flat rate or reimbursing based on patient outcomes, the report says.
Solutions
The report advocates the establishment of a ?learning health care system,? whereby new research discoveries and everyday care experiences are systematically and broadly disseminated.?
The committee physicians want health professionals and their patients to have relevant information at the point where decisions are made. They lamented the fact that ?it took 13 years for the use of beta blockers to become standard practice after they were shown to improve survival rates for heart attack victims.?
With mobile technologies and electronic health records, the solution for real-time dissemination of real-time knowledge and patient health data is within reach for clinician and patient alike. Advances in computing and clinicians connectivity have the potential to expand the reach of knowledge and can assist patients and providers in managing chronic diseases, says the report.?
The use of electronic systems is likely to improve safety. The report cites several studies on using electronic systems that estimated that overall medication error rates dropped by 81 percent.
The panel also highlighted the benefits of patient-centered care. Patient and family involvement in decision making correlates with reduced pain, faster recovery, and better mental state, says the report.?
Craig Jones, M.D., director, Vermont Blueprint for Health, used an example of a child with a chronic condition like asthma. He explained that often the child is brought in for a quick office visit, his mother fills out a questionnaire, and the prescription is refilled.?
But in a patient-centered approach, the mother and the child are probed further about their personal goals. The child may have a wish to be on the track team. A solution might be to work with the school nurse and coaches in a developing health care plan. When teams of people are there to help the patient and families and the patient is a member of the team, that is a ?profound cultural change,? said Dr. Jones.
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