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In healthcare, we get what we pay for.


Many quality/safety experts, public policy wonks and those who pay most of the costs would beg to disagree  – in the strongest possible terms.  That chorus includes the families of the hundreds of thousands of patients who died in hospitals last year, the victims of preventable medical mistakes and hospital-acquired infections.

Everyone knows we pay too much for healthcare and that our quality and outcomes trail many other industrialized nations.  So how can my opening statement be justified?

Easy.  The implication is that because our healthcare costs are the highest in the world, and with our reputation for having the best technology available, we pay more but we get more.

Actually, we really are paying for the results we are getting because of the horrendous way our healthcare reimbursement “system” is structured.  There currently is preci0us little that rewards success and penalizes failure.  The more we do, the more we get paid, and accountability for the outcomes is almost non-existent.

Our reluctance to be accountable is our dirty little secret.  We know it but do not like to acknowledge it, and the public senses it but has yet to demand more of us.

A friend, a respected physician who studies quality of care and patient safety, is the author of my opening statement.  He is currently a candidate in a senior level search (I am not involved) so I am not using his name.  He is among the many in healthcare who believe that the Patient Protection and Affordable Care Act is more about payment reform with an emphasis on increasing the number of covered lives, versus the dramatically more difficult, realigning incentives.  Sure, ACA contains some measures but there are not many in healthcare who will risk their reputations in predicting when healthcare organizations will be paid for performance.  Until that shift occurs not a lot will change in terms of quality of care and patient safety.

The Republicans want to repeal and replace ACA but when pressed for specifics on the replacement part, the best you can hope for is the Congressional/political equivalent of mumbo jumbo.  The Democrats are guilty as well because they are loathe to reopen the bill to changes for fear that the GOP and some Democrats might gut their hard-won, albeit poorly crafted, legislative accomplishment.

Then there are the court challenges.  There are several cases that question the constitutionality of insurance premium subsidies in state’s that do not operate their own exchanges.   If the Plaintiffs prevail, that will essentially gut the law.  Some constitutional scholars with no dog in the hunt believe that this could very easily happen, especially if one of the challenges on the insurance premium subsidies lands at One First Street, NE (Supreme Court).

So much for clarity and the demise of uncertainty.

We continue to get what we pay for.