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Efficient or Effective? – Hospitals Embrace Pay For Performance


Life after Scott Brown has yet to be determined.

But one thing is for sure: no one in the Republican or Democratic parties would publicly deny after record deficits is that efficient health care comes down to a simple equation; doing more with less is a sure fire way to cut costs. Whether or not Obama gets his spending freeze next year, health insurance companies and medical practitioners will be looking for ways to infuse their efficiencies. Electronic medical records and patient management systems are quickly becoming the new-now-next frontier in the quest for industry reform. Chances are, it won’t take a federal mandate to make the flow of medical records abandon the paper highway and take an electronic route. Health care companies had been looking at the issue five years before health care reform became a top priority in Congress.

Consider the findings of The Commonwealth Foundation, an independent research think tank in New York who conducted a thorough survey of attitudes amongst medical care providers about how to make health care “click” in an era of reform. The survey of 1,256 “opinion leaders” in health policy and “innovators in the health care industry,” developed by Harris Interactive revealed that a majority of respondents (57 percent) believe that pay-for-performance is the only business model out there that makes sense. They also indicate that patients with chronic illnesses who require ongoing disease management (those with heart disease, diabetes, etc.) require the most intensive overhaul for health care delivery. Evidence based medicine (EBM), another buzz phrase in medical care today, is the second-most accepted approach for reigning in costs.

With doctors now forced to manage their time against an insurance company clock — where patient counts are the benchmark for payments by health insurance plans — EBM should emerge as a less attractive option since the practice involves much more one-on-one time with individual patients to determine the most appropriate course of treatment. Moving toward an EBM-based practice would likely slow down movement in the waiting room and thus, less billable visits. But more and more of our most respected health care institutions are proving that doctors and hospitals can have their EBM cake and eat it too. Insurance companies, who have been notoriously gun shy about the proof that EBM leads to better care, are starting to come around now that some of the nation’s most respected pioneers in the EBM movement have proven that using it more in everyday practice will save insurance plans in the long-run.

“The irony is that while it comes up all the time among providers, no one talks specifically about what evidence-based medicine is,” says Paul Keckley, executive director of the Vanderbilt Center for Evidence-Based Medicine, Nashville, Tenn. “Many people believe that somehow it is a new idea or that it’s a tradition-based practice. There’s a direct correlation between evidence-based medicine and the need to take out unnecessary costs and there’s now considerable avoidable cost in the health care system, such as the inappropriate use or overuse of antibiotics, lab tests and imaging, which are done more often out of [physician] preference than based on the evidence.”

Sound familiar? If not, it will very soon as the battle over affordable health insurance and health care reform transforms into health insurance reform on Capitol Hill.

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