Monday, February 06, 2012

The Politics of Measuring Outcomes

It's February, and with February comes Valentine's Day, and with Valentine's Day, comes Heart Month, and with Heart Month, comes the department of Health and Human Services press release promising a million lives saved if we just eat right, stop smoking, and have our free blood pressure and cholesterol checks. We are told this bold new initiative will be working to save a million lives. After all, "$1 of every $6 in health care" is spent on heart disease.

But how, exactly, are we going to measure our outcomes with any of these initiatives? Will our feel-good press releases make it so? Do we really have a good system of determining the cause of death now versus several years from now to measure the impact of these programs? Are we really measuring how much it costs to screen all these people versus how much money we save?

Of course not. That would be a scientific approach.

Today we are seeing medicine increasingly managed through politics and empty promises. As doctors interested in saving lives, we would LOVE to see the impact of these simple measures first hand, but we rarely do. Only after ten or twenty years can we see the sudden lengthening of mortality curves from smoking cessation, for instance. Yet smoking, even with it's well-publicized detrimental health effects, is still widely practiced by our teenagers and young adults. More importantly from a cost standpoint (our real problem, right?), even if these prevention programs are effective, longer lives mean more costs spent per person on health care over people's lifetime, not less.

So while I appreciate the government's call for preventative measures in heart disease as a way to save a million lives and save money, we should ask ourselves as money is stripped from government health care in the future, on whom will the health care axe be falling? Sadly, it's likely to be the very people who need the most health care services in the first place: the elderly.

Hospitals and doctors are working hard to cut the fat from our health care spending. Never before has there been such scrutiny on the health care system to save money. Large systems of care provision are being developed to economize and streamline care delivery in an effort to do more with less. But the inevitable cuts to spending on health care promised by the government in the next several years is lost on none of us tasked with the day-to-day responsibility of caring for people in such a setting. As staff are continually pruned and work-hours extended, rest assured there be a flipside to the rosy prevention promises made by our government as cuts to health care funding take effect.

Yet somehow, no one seems interested in measuring the impact these long-term changes will have on our older, sicker patients or on those who care for them.

You see, that wouldn't be good for politics.



Lisa said...

Sometimes the problem is people not realizing that the risk of death in humans is 100%

Anonymous said...

I agree. A major drugstore chain has this promo newly out that you can go in and get a "free" BP check and consultation from a pharmacist.

Really? That's just gonna have disclaimers all over it, LOL, and still somebody is gonna say, "My pharmacist checked me out and said I was OK just this morning, Dr. Wes, you must be wrong"


Anonymous said...

1) Rather than the politicians having a transparent, frank discussion with the American people about limits of care, our physician and political leaders will sell the concept of ACOs where the doctor will be the covert rationers.

2) Further cuts will be enacted in reimbursement; however, the new way to circumvent congress is to pay the money then have the DOJ/OIG/(insert regulatory agency here) claim fraud, threaten jail time to the executives then request penalties. The good news is the regulatory burdens in prision will be less while you practice there.

3) If anyone can convincingly achieve the outcomes demanded, new outcomes will be measured and cuts to reimbursement will be based upon this failure.