To corrupt an old quote, there is nothing like a new payment system to focus the mind of a hospital administrator. The U.S. healthcare system is witnessing an explosion of delivery system experimentation, fueled by numerous payment initiatives such as CMS’s hospital readmissions reduction program (established through the Affordable Care Act). New care models, such as the Presbyterian Healthcare Service’s “Hospital at Home” in Albuquerque, New Mexico and the Mercy Health “Care Transitions Program” in Cincinnati, Ohio are moving patient care out of the confines of hospital and clinic walls to the patient’s homes. There, patient education and care coordination may be more effective, thus preventing additional expensive hospital stays.
Preliminary data suggest that these programs work. Yet the history of the U.S. healthcare system tells us that these exciting initiatives can give way to perverse behaviors. The implementation of inpatient prospective payment in 1983 stimulated the home health care industry. However, along with increased care in homes came concerns about sky-rocketing costs, overuse, inappropriate use, and fraud.
To find the ‘special sauce’ that will truly move our health care system from one focused on treating sickness to one focused on heath, we need to rigorously evaluate these exciting new initiatives, in particular, looking at their effect on the ultimate endpoint, population health. The problem of paying for health rather than sickness has been a long standing conundrum. As George Bernard Shaw noted in 1906, “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.” If GBS were alive today he might be cautiously buoyed up by the current efforts to address this centuries old dilemma.
Tami Mark, Phd