Paradox and imperatives in health care

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Intrigued by Dr. Bauer's words earlier today? So was I. That's why I decided to drop in on his afternoon session, "Paradox and Imperatives in Health Care: Effectiveness, Efficiency and e-Transformation."

Bauer dropped more than a couple of jaws in this morning's general session when he forecasted a slim 30% chance that some form of health care reform legislation will pass. Those jaws were dragging on the floor when he suggested that radiology, already a beleaguered sector of medicine by anyone's standards, needs to take the initiative in enacting measures that will improve efficiency and quality of care.

So: how does he imagine the grassroots revolution playing out? What can we do?

Health care, Bauer pointed out this afternoon, has become highly inefficient. According to a meta-analysis of several studies, in health care, which currently represents 17% of the GDP, anywhere from a fifth to a third of costs are attributable to waste of one form or another:

* Additional services necessitated by incorrect or unsafe practices
* Widespread use of unproductive or counterproductive clinical interventions
* Failure to use the least expensive resources to achieve desired outputs
* Poor utilization of personnel and facilities
* Redundant reimbursement procedures with "perverse" economic incentives
* Imbalance between acute care, disease management and prevention

Bauer says the mission statement of every health care organization should be "doing it right all the time, as inexpensively as possible" -- i.e. making quality the number-one priority, with cost-effectiveness playing second fiddle but still very important. "It's imperative that we do new things, not the old things in new ways," he noted. "We have to recognize the rising cost of human error, both clinical and operational." According to what Bauer has observed in other industries, the way to solve this puzzle is a continued commitment to both performance improvement and embracing the power of new IT.

So what are some common characteristics of successful health care provider organizations -- those that have trimmed waste, reduced costs and maintained or even improved quality? According to Bauer, they are standardization, flexibility, integration, alignment of strategic goals, leadership (in all but two of the successful health care systems he's studied, the leadership consisted of physicians), accountability, and creativity.

Bauer concluded that health care will continue to develop unevenly over the next few years. "There will be winners, there will be losers," he said. Reform will continue to evolve, and if anything does make it through, it'll cause new problems. Consumerism will shift the focus even further onto affordability. Reimbursement's deficiencies will get increasing attention. Policy focus will shift from cutting costs to maximizing use of existing resources.

But Bauer also believes that private-sector developments will achieve desired systemic improvements. "The really neat changes will occur because of you all," he said. "We need to be proactive and bring a sense of urgency to this, but at the same time, you have the opportunity to do something with other stakeholders."