Health Care Reform - Highest Quality, Not Lowest Cost

Quality, not cost, should be our main focus when discussing health care.

There is much discussion about health care reform, with an alphabet soup of acronyms such as ACO, EMR, HIE, PPACA, etc. There is much room for error and success when it comes to reforming such a complex system. Two goals of health care reform are quality improvement and increased access to care.

I am an interventional radiologist. My training consisted of four years of medical school, one year of internship, four years of diagnostic radiology and one year of interventional radiology fellowship. I obtained my medical license by sitting for a three part medical licensure board examination. I obtained my Radiology board certification by sitting for written, oral and physics examinations which took place on three separate days over a one year time span. I was examined yet again to obtain my Interventional Radiology board “certificate of added qualification” (now known as a “subspecialty certificate”) while in my first year of private practice. In order to practice in my state, I met specific requirements and took an appropriate licensure examination to obtain my state medical license. It is necessary to fulfill such requirements in each state in which one wishes to practice.

Patients who meet with a board-certified doctor should therefore have a reasonable level of confidence in the quality of the physician seated before them. If a doctor has been board certified, s/he has attained the highest level of training documentation available to us in our respective professions. Board certification should therefore give patients a certain level of confidence in their doctors.

But quality health care is not just achieved through training and examinations. Quality care is delivered with integrity, through teamwork and collaborative cooperation. The health care system of yesterday was a much more individualistic enterprise, with doctors doing their best to care for patients, hospitals attempting to create a profitable environment for care delivery, and insurance companies focusing mainly on the income streams produced as a result.

The health care system of tomorrow must include a much more collaborative effort by patients and physicians. Currently, we are being marginalized by hospitals and insurance companies, who are vying for position as they anticipate bundled payments and shrinking reimbursements. Medicare is being altered with the aim of paying hospitals and ACOs (Affordable Care Organizations) a lump sum, to be disbursed to caregivers like Charlton Heston’s “Soylent Green.”

This method of payment for care delivery creates disincentives and has already demoralized thousands of physicians. The end result will likely not be high quality care. Instead we are on track to deliver the cheapest care possible. As we all know, you get what you pay for.

What we should be clamoring for is coordinated care, with a team-oriented approach to address the patient’s needs. Such an approach would result in the best quality of care delivered at a reasonable cost. A coordinated effort would reduce redundancy and maximize expertise. Whether this process can be accomplished remains to be seen. If caregivers realize that the only solution is to come together to care for the patient as a whole, health care reform may in fact end up well for our country.

Coordination of care delivery by caregivers, with the involvement of our patients, will result in the highest quality health care. It will result in decreased costs through fewer mistakes and improved outcomes. Time will tell which system wins. I hope we do.