Innovation and the Affordable Care Act

By on August 27, 2012

Chief Justice Roberts’s rescue of the Affordable Care Act has big implications for innovation in medicine. Those who crafted the law felt the most successful way to bring down future costs of health care was to promote efficiency and oblige adoption of best practices. That means if some hospital in Sheboygan can get a patient after gall bladder surgery out of the hospital in less days than anyone else, and run fewer tests and have the same or improved outcomes, everyone else should try to copy them. In fact, the government plans do everything in its power to see that other hospitals and doctors see what Sheboygan is doing and feel obliged to adopt their practices.

Ignoring the all-patients-are-not-created-equal argument for the moment, the Health and Human Services Department sees this as a way of cutting costs, eliminating waste and raising quality. Many of these best practices already exist. We used to keep open-heart surgery patients in the hospitals at rest for six weeks or more. Now we know that they do just as well, if not better, if we encourage them to become active as soon as they are out of danger of post-operative complication. Some are home in less than a week with fewer complications than previously.

Best practices are not written in stone. What was a best practice ten years ago may have been greatly improved on in the years between. That’s where the innovation comes in. Continuous quality improvement has been a goal of health care organizations for years. The trouble was the quality was always in the eye of the beholder. “That’s not what they taught us at Yale” or “I prefer the technique my professor Dr. Flurkey favored” or “The Home Office insists we do it their way.” frequently prevailed. Now outcomes will be measured closely to see that they actually work and do help bring down costs — the number one problem in US Health Care.

HHS Secretary Kathleen Sebelius

Under the Affordable Care Act, the Secretary of Health and Human Services will oversee a sub-unit of the Centers for Medicare and Medicaid Services designed just to promote improvements through innovation. It is called the Center for Medicare and Medicaid Innovation. It will have money available to reward those who demonstrate new best practices, and encourage future innovation. It is designed to pay for itself.

 

Dr. Emmanuel who built Innovation into the health care delivery systems of America

Ezekiel Emmanuel  MD, one of the gurus of innovation in health acre reform has publicly stated, “Reform incentivizes innovation that lowers costs, increases quality, reduces infections, permits closer out-patient monitoring and increasing compliance with medication— anything new that increases quality of care, decreases side effects or decreases costs.”

On June 15 of this year, CMMS awarded $772 million dollars of a possible $1 billion allotment to projects using innovative techniques to lower costs and improve quality. Regardless of whether you think this solves the entire cost problem in America, it is not a bad approach to future challenges facing us in medicine.

 

Tom Godfrey

 

 

 

 

 

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