Recipe for U.S. Healthcare Reform

Dead end.  Turn around.  Try again.

Many policymakers have pitched ideas on how to reign in healthcare spending as well as reform the U.S. healthcare industry as a whole.  Healthcare reform is difficult because everyone has a stake in it; consequently, many proposals are going nowhere.  Donald Berwick, a former Administrator of the Centers for Medicare and Medicaid Services (CMS), recently published an article in JAMA where he outlined his views on transforming healthcare in the United States.  In nine principles, he outlined what he refers to as a new “moral era” for healthcare:

  1.  Reduce Mandatory Measurement. “Intemperate measurement is as unwise and irresponsible as is intemperate health care.”  He argues that much of what the government currently mandates providers to measure is useless and wastes valuable time and money for providers.  He would like to see a reduction in all metrics by 50% within 3 years and by 75% within 6 years.
  2. Stop Complex Incentives. He calls for a moratorium on complex incentives that are placed on individual physicians because they are “confusing, unstable, and invite gaming.”  He would like to see CMS “confine value-based payment models for clinicians to large groups.”
  3. Shift Strategies from Revenue to Quality. Aside from the obvious regarding quality-based healthcare, he also jabs at payers, calling on them to stop linking reimbursements to current input metrics which “are not associated with quality and drive volume constantly upward.”
  4. Give Up Professional Prerogatives. He calls for a reform in medical training, stating “physician guilds should reconsider their self-protective rhetoric and policies.”  He argues that physicians and nurses alike should focus more on working as a team rather than exposing their individual competencies.
  5. Use Improvement Science. In short, he advocates for the study and usage of Edward Deming’s PDSA (plan-do-study-act) cycles.
  6. Ensure Complete Transparency. He calls on Congress, insurers, and regulators to ease data sharing and encourages states to adapt all-payer claims databases.
  7. Protect Civility. This one is pretty much self-explanatory.  Although, he does go on to say that “jokes about herding cats . . . or the demanding patient . . . are not funny.”
  8. Listen to the People Served. “Clinicians, and those who train them, should learn how to ask less, ‘What is the matter with you?’ and more, ‘What matters to you?’
  9. Reject Greed. He demands for “a new set of forceful principles for ‘fair profit and fair pricing,’ with severe consequences for violators.”  He continues by stating that medical training institutions and healthcare professional associations must “articulate, model, and fiercely protect moral values intolerant of individual or institutional greed in health care.”

Indeed, if healthcare reform were simple, we would have done it already.  Are we at a dead end?  Should we turn around and try again?


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