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Mon, Oct 12 2009 5:31 PM EST
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Picture this: Doctors spend more time with patients and sometimes even make house calls, prescriptions are delivered right to patients’ homes, medical office staff proactively telephone to make sure patients are following through on their treatment plans—in some cases, limousines are dispatched to pick up patients at home and bring them to their physician’s office.
Is that any way to control health care costs? Ezekiel Emanuel, M.D., thinks so. He noted real-life examples of organizations—both health care systems and employers—using some or a combination of those seemingly counterintuitive tactics to at least moderate the crippling rise in medical costs. Emanuel, who is on loan from NIH to President Obama’s reform team and is brother to White House Chief of Staff Rahm Emanuel, calls it “high touch medicine”; giving more personal attention to chronic care patients who use the vast majority of health care services, and shifting from a volume-driven payment system to one that rewards coordination and complete episodes of care. By providing adequate resources on patient care upfront, the nation’s health care system would realize huge cost savings in “potentially avoidable complications” that lead to unnecessary emergency department visits, hospitalizations and readmissions, Emanuel says.
During his keynote address at the MGMA conference, Emanuel cited studies showing that more than half of patients readmitted to hospitals did not visit a doctor’s office between their initial discharge and their readmission; that a startlingly large number of patients fail to get their prescriptions filled, some for cost reasons and many because they could not or would not get to a pharmacy; and that 65.2 percent of ED visits are preventable.
Among the steps to high-touch medicine: extended physician office hours and same-day appointments; more on-line communication between providers and patients; better data collection and analysis; and clinical guidelines that allow nurse practitioners and others to alleviate some work that physicians now do.
Patients also need to be empowered, he says: through education about their conditions, letting them share in decisionmaking about their care and by having them work with coaches to change—and maintain changes—in their lifestyles.
0in 0pt;">To achieve such high-touch medicine, Emanuel said we need to find a way to encourage physicians to go into primary care and to step back from a fee-for-service payment system to one that rewards quality of care by aligning incentives and bundling payments. The latter, he seems to think, is inevitable.
Bill Santamour is a staff writer with H&HN blogging live from MGMA 2009 Conference
