A new season of MythBusters is about to start and will provide a valuable service to those of us who enjoy the quasi scientific approach to dispelling beliefs and commonly held truths that we have come to accept simply because “that’s the way it’s always been.” I think we need a healthcare myth buster program to help solve the dilemma of affordable care since there seems no difference between fact and fiction in what constitutes value in out delivery system. Currently the majority of all healthcare decisions, including those in rehabilitation, are made on the basis of belief rather than evidence. Most healthcare actions have not been researched. And even when there is some research available, it is not easy to translate research into a definitive factor determining a decision (Wade D, Clin Rehabil 2009; 23; 387).
Myth #1 The spiraling costs of healthcare is the direct result of the costs associated with delivering that care.
There is no relationship between what it costs a provider to deliver patient care and how much they are paid for that care. There is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved. The September 2011 issue of the Harvard Business Review by Robert Kaplan and Michael Porter make these points with arguments that care costs are calculated based upon how payment is calculated rather than costs to deliver.
Myth #2 The care delivery system is capable of providing the right care at the right time to the right patient.
Incorporating evidence-based medicine into standardized care minimizes waste because doing so creates consistency… at least that is the theory demonstrated by quality improvement science in other industries. The CMS approach in the pay for performance initiative has attempted to eliminate subjective decisions in favor of objective standards through requiring compliance with evidence based indicators of treatment for various diagnoses, such as pneumonia or heart failure. By eliminating variation, it is anticipated that waste is reduced. Clinicians can plan for care proactively and prospectively. The formulary for medications and equipment should be developed on the basis of population, rather than individual patients; staffing can be efficiently planned, and patients can move through the continuum more efficiently when processes are standardized and consistent.
Myth #3 The current quality initiatives of CMS provide adequate information about the effectiveness of healthcare (outcomes) to make informed choices about provider differences.
The Joint Commission requires that leaders be involved in quality, but the regulatory requirement is often perceived as a compliance issue rather than an impetus for improvement. Until and unless the senior leadership gets involved in improvements, things will remain the same. Quality defies measurement and unless expressed as value, (outcomes achieved per dollar spent) the majority of patient care consumers will not understand differences.
Myth #4 Provider profit exists whenever costs are less than charges for those services.
Providers have an almost complete lack of understanding how much it costs to deliver patient care. Charges for that care are routinely developed by a survey of like providers published charges and bear no relationship to the cost of providing that service or procedure. Profit or margins are an accounting justification of management decisions and attempt to communicate a favorable picture to the provider’s respective stakeholders.
MythBusters is a success because of their response to the public’s need to know methodology is based upon measurement and analysis using reliable numbers, specifically, valid and reliable data. Their conclusions often prove to be counter intuitive. The U.S. healthcare dilemma could benefit with one or two such episodes.