In response to a recently posted blog note (see: Risk for Consumers as Healthcare Systems Rapidly Expand), Dr. Doug Mitchell submitted the following comment:
Data suggest the "common wisdom" that preventive care saves tons of money is wrong. If one assumes the consolidation of systems is unstoppable, how might the above study be good news? The feds could more easily -- and with less push-back --heavily incentivize preventive care from these systems. Why? Fewer entities are easier to monitor. And if the study is right, the systems could make as much $$$ preventing disease as treating it. Costs being equal, is it better for a woman to die at age 80 because years earlier she was (a) repeatedly stented, or (b) put on statins? Of course, this scenario wouldn't decrease total expenses (the 800 lb problem). But might at least *value per healthcare dollar* be increased? Or am I in an overly optimistic mood today?
The question under discussion is a simple one. Will health systems invest some of their capital and expertise in the development of wellness and preventive medicine programs? This would seem to be logical direction to many observers including myself. The federal government is ratcheting down payments for various types of services including surgery, chemotherapy (see: The Oncology Concession Under Attack by Health Insurance Companies), and medical imaging (see: Medicare Imaging Cuts Restrict Access to Care and Discourage New Technologies Which Would Benefit Patients). Doug also suggests above that the development of preventive medicine could be accelerated if the feds were to heavily "incentivise" such care.
I personally think that the answer to this question is no for the majority of health systems in the U.S. with the rare exception of some like the Cleveland Clinic that have publicly declared, and acted as if, they are in the wellness business (see: Cleveland Clinic Wellness Institute). You may disagree but, off the top of my head, here are the reasons underlying my opinion:
- Most physicians and hospital executives see themselves as treating disease rather than preventing it; they do not view wellness and preventive medicine as a logical corollary and flip-side of the treatment of disease. In previous notes, I have tried to demonstrate the seamless continuum between wellness, predisease, and disease (see: Wellness, Preventive Medicine, and the Classic Disease Model; Predisposition to Disease and Pre-Disease on the Health Continuum).
- Hospital executives have grown accustomed to the high profit margins associated with surgery, outpatient diagnostic procedures like endoscopy, and labs/radiology and will continue to "ride this horse" as long as they can balance their budgets by doing so. In this regard, they are similar to most executives in other industries.
- Most hospital executives best understand the following strategies: revenue management from various payers, new facility construction, and mergers with other systems. They will be wary of investing in a business that they don't understand (e.g., preventive/predictive health services), even with the long-range view of offsetting the decreased revenue associated with disease management.
- If all of our healthcare expenditures were calibrated in terms of value per dollar as suggested by Doug above, our world would look vastly different. Unfortunately, the vast majority of healthcare consumers only pay attention of their health when something goes wrong. Our politicians, physicians, and healthcare executive are thus responding to the perceived needs and desires of these consumers.
"Hospital executives have grown accustomed to the high profit margins"
This says it all for me. Health care is big business with profits before patients.
Posted by: David | November 28, 2010 at 12:35 PM