You’ve heard the phrase “We should pay the health care providers not for “volume of care” but for “quality of care”. You’ve heard it from politicians on the left, right and center. You’ve heard about the transition to “evidence based” care that will save us tons of money. But do you really know what “quality of care” means and what “evidence based medicine” means.
Quality means different thing to different people. Quality may refer to the perception of the degree to which the product or service meets the customer’s expectations. Your grandma’s apple pie may be the standard for quality for you. However for a Continuing Improvement Specialist quality is lowering the standard deviation in outcomes. The McDonald’s apple turnover is closer to quality for such scientist – it tastes the same in NYC, California and Arizona.
So when President Obama promises you quality health care you think you will get care that meets your expectations, however the ObamaCare means quality in more ‘scientific’ terms as: everybody will get about the same care. How much care you get is not designed according to you and your doctor’s expectations, but according to the government expectations of less deviation in outcomes.
These are two very different definitions of quality – both are considered ‘quality’.
Let’s look at the science in the heart of the ObamaCare new bureaucracies and scientific projects – the Accountable Care Organizations that will measure “quality of care” and reimburse providers accordingly.
The main ideology is best described with Milton Roemer’s phrase: “A built hospital bed is a filled hospital bed.” The idea is that if you go to health care provider with lots of capacity (beds, physicians, and equipment) the provider will utilize all available recourses. More care however does not translate into better quality care.
Two researchers spent their lifetime proving this theory. Dr. John Wennberg and Dr. Elliott S. Fisher from The Dartmouth Institute for Health Policy and Clinical Practice give the scientific basis for moving from volume based to quality based care. You can read a sample of their work here. In Layman’s terms it goes like this:
The Wennberg/Fisher research shows that people with the same illness will get different care in different parts of the country and the amount of care they get is always in correlation with the capacity available.
The more beds available in intensive care the better is your chance to die in ICU despite your own wishes. The more physicians and specialists available the more visits and procedures the patients will get whether they need it or not.
The researchers also found that patients are happier with the care in regions of the country where the capacities of the providers are less.
Wennberg/Fisher also prove that hospitals that are top-rated in providing quality care vary dramatically in the volume of care they give to the patients suffering from the same illness. Yet – they all are perceived as top-quality hospitals despite the fact that they have unique patterns of care. In the views of the researchers this proves that the medical care in America is unscientific.
I repeat – according to these folks the medical care in the USA is not based on science and basically everybody is doing whatever they want.
Here comes the term “evidence based health care”. That means care that is based on scientific standards. Unfortunately for Wennberg/Fisher and friends such standards have not been created in America. There is no standard how much care is enough care and how much care is too much care.
But have no fear ObamaCare is here.
The first step in “bending the curve” (cutting Medicare costs) is research how to measure the quality of care. Billions of dollars are allocated for this gigantic project. The research will be done by contractors – independent experts. Here is why:
If Wennberg and Fisher come up with a number (let say 53% of the Americans want to die at home and not in Intensive Care) the public will say: interesting. If the Government HHS comes up with the same number the public will say: death panels. So to set a national standard about what percentage of the American people want to die at home – the government calls and pays independent expert and then proclaims the results as a scientific standard of the land.
The standards will be imposed on the number of visits to the doctor, number of days at the hospital etc for every aspect of the health care.
Then according to the new “evidence based”, scientific standards the government will move to step two: providers will be paid based on the new standards. Let’s say, if 60% of the hospital’s chronically ill patients die in Intensive Care – the provider will not be rewarded for all because if the provider is doing “quality care” the number should be 47% not 60% (I am making up the numbers).
The strategy to sell this to the people is to remind them that with the “unnecessary” care come “unnecessary” co-payments and out-of-pocket expenses.
The hospitals will be deemed unscientific, greedy and with less quality rating if they provide more “volume of care” then necessary according the government “quality measurements” and the cost of Medical Care will go down.
May be Wennberg and Fisher are correct, but there is still a creepy feeling when the government decides what is science and what is not and what is quality and what is not.
The same trick goes for education. When politicians promise you quality education you think the public schools will finally meet your expectations. Wrong. It only means there will be less diversity in the ideas, curriculum and the way the things are done in schools, because for the government bureaucrats ‘quality’ means less deviations in the outcome. The easier way to get the same outcome is to ensure the same input.
So the patients and the students become just another brick in the wall and just another statistic.