Sunday, January 30, 2011

The Hot Spotters Lower Medical Costs

Author physician, Atul Gawande has done it again with his well written article in The New Yorker magazine called, The Hot Spotters.  It deals with the fact that 5% of people with chronic illness make up over 50% of all health costs.  If we can zero in on providing better preventive care for those people, we can finally get our arms around runaway health costs.   How great that you don't even have to have a New Yorker  subscription to read it.  Here are a few cliff notes until you get to it:

  • In Camden, New Jersey, one % of patients account for 1/3 of the city's medical costs.  By just focusing attention on the social and medical out-patient needs of those people, they not only get healthier but costs were cut in half.
  • Our current system is unable to reign in costs.  We need to completely re-design and fund how we do primary care.
  • Charging high co-payments to people with health problems just backfires.  They avoid preventive care and end up hospitalized with expensive and life-threatening illnesses that are much worse and more costly.  
  • Our current system is not designed for patients with complex medical problems who incur high costs.  The patient with heart failure, obesity, gout and on 11 different medicines needs a different kind of care than the traditional emergency room, hospital and multiple specialists handling one specific organ.  That  patient needs care-coordination.
  • Doctors are financially penalized for providing care-coordination.
  • The health system is designed to say "no".  We need to shift into a mind-set that says "yes" and really understands the patient's need at that moment.
  • To bring the cost of care down, we need less hospital beds.  The more health services in an area, the higher the cost.  Preventive and comprehensive care means less expensive (hospital) care.
  • Medical companies, hospitals  and specialists profiting from the excess of scans and procedures will get squeezed.  This will provoke retaliation, counter-campaigns, and intense lobbying for Washington to obstruct reform.  It is already happening.
  • For every dollar spent in school districts to finance smaller class sizes and better teachers' pay, that money was diverted instead to covering rising health care costs.  For every dollar, the cost of maintaining teacher health benefits took a dollar and forty cents!
  • High-touch health care will face the obstruction of lobbies that want to keep the status quo. 
These bullets don't do the article justice.  Take some time and read it and learn how we can do things differently.

17 comments:

Anonymous said...

"The health system is designed to say "no". We need to shift into a mind-set that says "yes" and really understands the patient's need at that moment."

This would be a big improvement that would be meaningful on an individual basis, starting with a patients physician and provide better care.

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Pet Carriers said...

This would be a big improvement that would be meaningful on an individual basis, starting with a patients physician and provide better care.

tracy said...

Thanks so much, Dr. Brayer!

Dr. Gawande rocks! (Yes, i'm a groupie!)

gradydoctor said...

yes, that full gawande article is wonderful. and yes, your ability to break things down continues to astound me.

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Anonymous said...

"Medical companies, hospitals and specialists profiting from the excess of scans and procedures will get squeezed. This will provoke retaliation, counter-campaigns, and intense lobbying for Washington to obstruct reform. It is already happening."

The institution where Dr. Gawande practices is one of the worst offenders in this regard, and has been identified by the Massachusetts Attorney General as a major contributor to skyrocketing health care costs in the state. Rather than putting McAllen, Texas, under the microscope, he would do well to turn his attention to the administrative suite down the hall.

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