Say that “healthcare costs too much” and you will see heads nodding in agreement. But getting a handle on just what to do to rein in costs is extremely difficult.
No one and no single body is in charge of healthcare. The incentives of doctors, hospitals, patients, insurers and employers are at odds. Added to that, there is minimal transparency and little to no accountability for healthcare’s “product”—patient outcomes. We get lots of healthcare, but it doesn’t add up to better health. An example helps illustrate the point.
Some Healthcare Doesn’t Help
In 1996, the U.S. Preventive Services Task Force officially recommended that women who have had a hysterectomy for reasons other than cancer do not need routine Pap tests. They don’t have a cervix and cannot get cervical cancer. One in five adult women (22 million) has had a hysterectomy. In 1992, 68.5 percent of women were getting regular Pap tests after hysterectomy. In 2002, that figure was 69.1 percent. Over ten years, there was no change!
More than 15 million women are getting regular Pap tests that are of no benefit. With conservative estimates at an annual cost of $200 per person, that means approximately $3 billion is spent every year on tests that do not benefit these patients at all. Many doctors ignore the recommendation and the science behind it because they can, and because it is in their economic best interest to do so. Patients are largely unaware of the recommendation.
Screening for prostate cancer could very well repeat this scenario. Dr. Otis Brawley, chief medical officer for the American Cancer Society, supports the “D” grade (“don’t do it”) for screening PSA tests. The PSA test can set off a cascade of diagnostic testing and treatment that carries significant risk of harm for an uncertain benefit. Dr. Brawley is quoted as saying, “Prostate cancer screening and aggressive treatment may save lives, but it definitely sells adult diapers.” And yet, other than the weight of science, there is nothing to dissuade doctors from ordering a screening PSA.
A New Community Asset
Quality Quest for Health is a new and unique community asset. Quest is your local not-for-profit collaborative focused on improving health outcomes and decreasing costs. We are the neutral place where healthcare stakeholders—patients and families, providers, employers and insurers—work together to make healthcare better. Because we are neutral, you can trust Quest to provide unbiased information and resources.
Quest’s innovative Preventive Care Calculator™ was developed to simplify screening recommendations and help people get the right preventive care—not more and not less. The calculator creates a personalized health checklist that adjusts based on age and sex. It is for people at average risk, which is most of us. Some people with certain personal or family histories or with a chronic condition like diabetes or heart, kidney or lung disease will require more services, or they may need the standard services more often. Your doctor can help you determine if the standard recommendations need to be changed for you.
Women who have had a hysterectomy for reasons other than cancer will learn they no longer need Pap tests. Men will not find prostate cancer screening on their checklist. The calculator makes it easier for local doctors and patients to get better results and save money.
Quest initiatives are strategically focused on improving results across the “Triple Aim” of the healthcare system—improving health, improving the patient experience and lowering the cost of care.
High technology diagnostic imaging (HTDI)—MRI, CT, PET and Nuclear studies—was selected by the Quality Quest Board of Directors for strategic focus in 2009. HTDI use has been increasing by double digits for years. It is estimated that the 75 million CT scans performed in 2007 will cause 29,000 future cancers. Many didn’t help the patient because they were not needed in the first place.
The project team, led by Dr. Carter Young of Central Illinois Radiology Associates, recommended clinics’ and hospitals’ emergency departments use decision-support software in their electronic health record. Quality Quest alerted doctors to the large radiation doses their patients were receiving. A pocket card converted radiation dose into chest X-ray equivalents and found that one chest CT scan is equal in radiation to 350 chest X-Rays. I am pleased to report that our region’s use of these tests flattened compared to the rest of Illinois, as the graph below demonstrates. Less radiation makes care safer, and fewer unneeded scans lower costs by approximately $80,000 per 1,000 people.
An early strategic initiative focused on the quality of screening colonoscopies. A local team led by Dr. Terry Baldwin gained agreement on quality parameters and began collecting data. It wasn’t easy. A pay-for-performance contract clause helped practices stay the course, and the work has paid off. When we began measuring, one in five colonoscopies was being done too soon, driving the cost up per person screened. Quality results have been reported publicly for more than two years, and over that time, the scores have improved dramatically. The per-person cost of colorectal cancer screening went down, and procedure slots became available for people who had not previously been screened. It’s another example of better quality costing less. The chart below shows the proportion of colonoscopies that received a perfect quality score, and the numbers are still on the rise.
Quest’s Current Focus
We are partnering with the March of Dimes, the Illinois Department of Health, the Midwest Business Group on Health and other organizations to eliminate the unhealthy practice of delivering babies for convenience before they are full-term, something that has become perniciously common. Babies can be harmed through the practice, and the average cost increases by $4,500 per elective early delivery, mostly due to extended stays in the neonatal intensive care unit. By eliminating this practice, we estimate Illinois’ cost savings at more than $147 million per year, with over $51 million in Medicaid savings. Be sure to check out our Healthy Babies, Healthy Moms Facebook group page for more on this initiative.
We Need Your Help
Get involved. We need your support to improve health, healthcare and the health of our economy. iBi