The Cost Conundrum

The New Yorker prints and excellent article by Atul Gawande on health care costs. He focuses on McAllen, Texas, in Hidalgo County, which happens to be one of the most expensive health care markets in the U.S. The problem?

Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—surgery, imaging, home-nursing referrals—they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. A doctor sees a patient in clinic, and has her check into a McAllen hospital for a CT scan, an ultrasound, three rounds of blood tests, another ultrasound, and then surgery to have her gallbladder removed. How is Lawrence Gelman or Gilda Romero [both hospital administrators] to know whether all that is essential, let alone the best possible treatment for the patient? It isn’t what they are responsible or accountable for.

After reading the article it may not surprise you that Hidalgo County also ranks third on our Community Need Index's highest need counties in the U.S. (right after Kings and Bronx counties in New York).

Are Urgent Care Centers the Future of Primary Care?

This week the Chicago Tribune examined the growing trend of urgent care centers and concluded that, for many, they are preferred over primary care physicians. According to the Tribune:

Urgent care centers have been gaining ground in Illinois and across the country recently as an attractive medical option for time-pressed families trying to avoid spending hours in a hospital ER or days waiting for a doctor's appointment.

Sometimes known as “docs in a box,” the centers offer walk-in medical services and extended hours to customers with sore throats, ear infections, sprained or fractured limbs, simple wounds and other non-life-threatening medical problems. Doctors provide the care, assisted by nurses, and generally X-ray and laboratory services are available. Most centers are open 365 days a year, and insurance policies cover most services.

This convenience-oriented format, started more than 20 years ago, is getting a boost as hospitals and private firms build new centers, responding in part to new competition from retail clinics in Walgreens, CVS and Wal-Mart stores.

For patients, the centers offer easy access and affordable care, charging a fraction of what services would cost in an emergency room. Many insurers, keen to keep costs down, have begun encouraging people to use urgent care as an alternative to ERs in the evenings or weekends when their doctors' offices are closed.

That puts the onus on patients to evaluate their symptoms and recognize what level of care they need, said Dr. Sandra Schneider, an emergency-department physician at the University of Rochester Medical Center in New York and a vice president of the American College of Emergency Physicians.
…

For some consumers, urgent-care centers are usurping primary care physicians -- a trend some medical experts view with alarm. Pina Lobraco, a mother of two young girls who lives in Addison, said she finds it easier to pop into a nearby Alexian Brothers Hospital Network immediate-care center than to call her doctor and wait to get an appointment.

On Mother's Day, Lobraco was at the center with Daniella, 4, who had started crying and holding her ear earlier in the day. “I don't know why it is, but a lot of times it seems [the girls] get sick in the evening or early in the morning or on the weekends,” she said.

“My regular doctor doesn't know who I am,” Lobraco said later in an interview. “But these people [at the center] know me -- they see me all the time.”

Granted, this anecdote from Ms. Lobraco and others in the Tribune article don’t constitute quantitative evidence, but they do represent the preferences of busy people who aren’t being adequately served by traditional care delivery models. Especially alarming is that Ms. Lobraco has a better relationship with the staff at the urgent care center than with her regular doctor.

With shortages of primary care physicians throughout the country and appointment wait times increasing, will urgent care centers and other walk-in clinics replace primary care physicians as consumers’ first choice for care? And how will this impact the continuum of care? Can primary care doctors tailor their services and hours to offer comparable convenience? In fact, several newspapers, including Minneapolis Star-Tribune and the Washington Post, have been reporting recently that there is a growing number of doctors performing house calls in cities across the nation.

Your Voice Matters in the Health Reform Debate

At Catholic Healthcare West, we believe that a health care system that guarantees access to medical care will make our country stronger. And a system founded on compassion will make our country better.

For those of you who are new here, this blog is intended to capture multiple viewpoints and insights. We believe that no one organization or individual alone has the answer to the current health care crisis, but together we can find the right solution. So we're asking for your opinions. How can America put the "care" back in health care?

What has your experience been moving through the health care system? What has worked well? What hasn't?

Take a look at some of the things we've heard, then share your story by adding a comment to our blog. Let us kow your ideas for improving health care in the U.S.

You Know It's Real When...

...protestors show up to disrupt your hearings. 

May 5th's Senate Finance Committee Roundtable Discussion on Expanding Health Care Coverage may have been more exciting than most, but we're no closer to consensus on how to pay for the reforms.

We are, however, coming closer to consensus on several key issues. Most of the representatives at the Roundtable were in favor of mandating that everyone have health insurance (so long as subsidies are in place for low-income families). There's also general agreement on health insurance portability, strengthening Medicare, and using health care IT to help drive efficiency and lower costs.

The elephant is still in the room, though: how are we going to pay for it?

Are We Ready for Health 3.0?

The realization of change in the U.S. health care system has, in many ways, been centralized in the Health 2.0 movement (see the always excellent The Health Care Blog for the full scoop on all Health 2.0 happenings).

Health 1.0 was characterized by disenfranchised patients and a "Dr. Knows Best" approach. This model has effectively given way to the Health 2.0 model, which is more interested in giving consumers the information they need to make more informed choices about their health care. The empowered consumer, the argument goes, will make the system more efficient and individuals healthier.

The individual responsibility prized in the Health 2.0 model may soon give way to Health 3.0. In this model, personal responsibility becomes part of the social contract we all have with one another. Not only will consumers be given the tools and information they need to make better choices -- they'll be expected to do so. And there will be consequences for not doing so.

Just as the government and some private insurers are moving to a "pay for performance" model with physicians and hospitals, so too are employers now beginning to require their employees maintain a certain level of physical health in order to receive the benefits of the company's health plan. This is Health 3.0. It is the completion of the movement from disempowerment to empowerment to expectation, and we anticipate that it will be an important part of the health care reform solution.