With implementation of the Affordable Care Act, and insurers and hospitals focused relentlessly on decreasing health care costs, we risk losing the excellence that distinguishes America’s health care from others worldwide.
Over the next several years, we will insure more Americans, expand primary and home care, improve patient safety and outcomes, and better utilize technology — all substantial advances. We must also reduce overlapping services and testing, medical errors, and the burden of administrative and legal costs.
We fear however, massive health system consolidation and homogenization; a zeal to decrease the testing and number of procedures performed; and the further commoditization of the physician/patient relationship (with providers having such a brief time with patients and families to actually listen to their needs), which will progressively worsen health care delivery and outcomes. Limiting or eliminating access to specialists or second opinions may reverse the astonishing gains we have made in treating some of the most deadly and chronic diseases, and raise health care costs.
For example, at National Jewish Health, an academic health center here in Denver focused on respiratory and related diseases, 25 percent of children and adults referred with a diagnosis of asthma find they do not have asthma. Something else is causing their symptoms. Another 70 percent of those referred patients are diagnosed with asthma complicated by additional diagnoses. Making the correct diagnosis not only is requisite for patients to attain better outcomes, but also substantially lowers costs by reducing hospitalizations, emergency room visits, and other excess use of health care resources.
After the diagnosis, ongoing collaboration between specialists and primary care physicians in caring for the 150 million Americans who suffer chronic diseases is another important but under-recognized approach to reducing costs and bringing value to patients and the system.
In addition, as research has increased our medical knowledge exponentially, coordinated specialty care and the integration of research and clinical care has led to astounding advances and decreases in death rates from cancer, cardiovascular, infectious and respiratory diseases. Similarly, basic and translational research studies and clinical research trials when applied to patients make specialty care critical to further advances and potential cures.
Unfortunately, what Clayton Christenson describes in his recent book, “The Innovator’s Prescription,” as the “disruptive innovations” in medicine that will radically lower health care costs, have not yet been realized. In the interim, as we work to improve care and limit the rate of cost increases, we risk what we do exceptionally well for patients, which has differentiated the leadership of American medicine and science.
Michael Salem is president and CEO of National Jewish Health, Denver.
