COST CONUNDRUM GAWANDE PDF

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How much has changed in the past 10 years? Gawande concluded that the high cost of health care in McAllen was the result of a culture of over-utilization in a fee-for-service system among healthcare providers. Compared to El Paso, Gawande discovered that Medicare patients in McAllen received 40 percent more surgeries and two to three times as many pacemakers, cardiac bypass operations, carotid endarterectomies and coronary stents. Per-capita spending on home-health services was five times higher than in El Paso.

Yet there was nothing to indicate that patients in McAllen were sicker or received more expensive services than Medicare recipients across the country—they just received more services. Gawande revisited McAllen six years later when he published Overkill in He discovered that McAllen had changed.

He acknowledged that changes in physician behavior had initially occurred due to increased scrutiny and the threat of more negative publicity and lawsuits. However, he credited primary care and the debut of the accountable care organization as the force that maintained this change.

Paying for quality and allowing physicians to share in the savings that are generated from better care makes sense. This is particularly true for the 30 percent of Medicare ACOs that are led by physicians.

Primary care physicians account for a small percentage of healthcare costs but have tremendous influence on specialist referrals that lead to elective procedures, screening tests, diagnostic imaging and lab tests.

Financial incentives are not the only way to reduce unnecessary care. In some cases, they are responding to pressure they receive from their own patients to provide a drug or medical procedure rather than rely on behavioral changes like diet, exercise or stress reduction. Gawande describes how one of his own patients insisted that he remove her thyroid when a 5-mm nodule was discovered, even though he felt the risks of surgery outweighed the benefit of watchful waiting.

The best way to reduce unnecessary care may be the promotion of a medical culture that is not only patient-focused, but also enables physicians and medical staff to work together as a team.

Not only do physicians spend more time with their patients at the Mayo Clinic compared to other health systems, but they collaborate more with each other and work as a team. Patients feel prioritized and supported by the system.

Patient-centricity and teamwork are basic tenets at Mayo. Physicians are salaried and do not receive incentive payments for providing more services. The aim is to raise quality and to help doctors and other staff members work as a team.

But, almost by happenstance, the result has been lower costs. As the awareness of unnecessary services has increased through such initiatives as Choosing Wisely and other published research , there has also been a greater focus on healthcare prices, which is the primary contributor to healthcare spending in the United States.

Recent movements such as Kaiser Health News Bill of the Month and renewed interest in public payment programs , such as Medicare-for-all, are positive signs.

Ultimately, however, change may not truly be achieved until physicians and patients can work together in an environment that prioritizes health over revenue, and teamwork over individualism. Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems. Your email address will not be published. Gordon Moore, MD. A 15 percent increase in value is a compelling reason for business and industry to consider investing in the health of communities.

How to reverse the trend of new […]. The realization that income, education and zip code have a significant impact on the health of a population has evolved over the past ten years and is now widely accepted.

The topic of burnout is all the rage lately. Whole conferences are designed to combat it and it is at the center of debates among healthcare delivery leaders nationwide.

Its […]. I took advantage of the quieter work environment over the holidays to catch up on my policy reading. He oversees the analysis and interpretation of healthcare data for 3M clients. View Profile. Want to receive Inside Angle content in your inbox? You can subscribe to any or all of our blog topic centers — and our podcast, too — and receive notifications whenever we publish new content. Search Site Home. Topic s : Population Health. Comments: 0.

Leave a Reply Cancel reply Your email address will not be published. You May Also Like. Gordon Moore, MD A 15 percent increase in value is a compelling reason for business and industry to consider investing in the health of communities. About Steve Delaronde. Physical vs. Name First Last. Yes, sign me up to receive notifications when we publish new blog content. We will send you notifications on topic centers of your choice.

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The Cost Conundrum

Atul Gawande. Whatever we select for our library has to excel in one or the other of these two core criteria:. We rate each piece of content on a scale of 1—10 with regard to these two core criteria. Our rating helps you sort the titles on your reading list from adequate 5 to brilliant Here's what the ratings mean:. Innovative — You can expect some truly fresh ideas and insights on brand-new products or trends. We look at every kind of content that may matter to our audience: books, but also articles, reports, videos and podcasts.

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Ten years after “The Cost Conundrum” – How much has changed?

Gawande's articles in The New Yorker lend some perspective to what he sees as the major drivers of high medical costs and how to address them. Atul Gawande had been selected to serve as CEO of their joint healthcare enterprise, focus is now shifting to his plans on containing high medical costs. Anyone looking for clues on how Gawande might approach his new job has plenty of material to pull from. His journalistic work has been impressing powerful business people and policymakers for years. The article caught the attention of the White House and was required reading for staffers during weeks of debate on the landmark legislation.

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This magazine article saved $500M in unnecessary Rx spending

How much has changed in the past 10 years? Gawande concluded that the high cost of health care in McAllen was the result of a culture of over-utilization in a fee-for-service system among healthcare providers. Compared to El Paso, Gawande discovered that Medicare patients in McAllen received 40 percent more surgeries and two to three times as many pacemakers, cardiac bypass operations, carotid endarterectomies and coronary stents. Per-capita spending on home-health services was five times higher than in El Paso.

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4 Insights from Atul Gawande's Influential 'Cost Conundrum' Article

This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology. Using that information we will explore various situations, showcasing coordinated care and payment strategies that can be implemented to improve patient health and the cost of delivery of healthcare services. By the end of this course, the learner should be able to: 1. Identify the drivers and trends of healthcare spending from the perspective of various stakeholders, including medical providers, insurers, government and private purchasers and payments 2. Critically assess the impact of strategic and financial approaches that have been put in place by the ACA and the various modifications.

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