Bills should cut health care costs
11/18/08 | 5 comments
Dr. Erik Steele

Bills should cut health care costs


By Dr. Erik Steele

When Maine’s Legislature convenes in January, its members will face lots of bills about health care, but they should focus like lasers on those initiatives that will reduce health care costs in the short term. That’s because, to paraphrase former President Bill Clinton, “It’s the costs, stupid.”

In fact, they — and we — should consider little else when it comes to health care for the immediate future, because unless those costs are brought under control, little else is possible. Those costs and a tanking economy imperil virtually every other health care initiative, and any other legislative initiative for that matter, that costs anything.

Toward this end, the first order of business should be legislative initiatives to help rein in the estimated 25 percent to 35 percent of health care spending that is either wasteful or of marginal value. The Legislature should first convene experts from around the state and country to help identify a few key steps — such as formulating a list of procedures, tests, and treatments of marginal value that would not be paid for in Maine by Medicaid or private insurers — that would help reduce unnecessary use in the next few years.

Successful efforts to reduce costs by reducing care of marginal value will require that we all bring to the “table” of health policy and legislative debate some principle or practice we are now willing to sacrifice that we were never willing to sacrifice in the past. Anyone not willing to do that should be asked to leave the table (and in these kinds of cost-cutting discussions, if you are not at the table, you are probably on the menu) and should not get anything else they want from the Legislature on their health care agenda. If we are all unwilling to make such sacrifices we are doomed to failure.

If I were in the Legislature, this would be my approach to everyone who wanted my help on a health care issue. If you are another legislator, don’t even talk to me about your idea if you are unwilling to make tough choices like banning the use of cell phones while driving in Maine. You are not serious about costs if you are not willing to restrict frivolous freedoms that waste health care dollars. Ditto Maine voters; don’t waste my time complaining about your costs if you are unwilling to make difficult sacrifices of your own to reduce costs.

If you are a doctor, don’t complain to me that your fees are being cut unless you are willing to support aggressive and widespread use of medical protocols that help avoid unnecessary testing, procedures, and treatments. Don’t look to me for support in malpractice reform either, unless you are willing to tie it to more cost-effective care on your part. Ditto hospitals on both points.

If you are a trade union in Maine, your frustrations about higher health insurance premium shares for your members will be unheard by me unless you are willing to push your members to get healthier and support measures to reduce their use of wasteful medical care. If you are a representative of consumers in these debates, the same goes for you.

If you ride a motorcycle I wouldn’t give one varoom for your growing out-of-pocket medical expenses unless you are willing to support a mandatory helmet law. If you are a person who doesn’t get a little exercise every day or who smokes, don’t talk to me about how much your pills cost until you change those unhealthful ways. If you are a business in Maine, your complaints about your health care costs will whistle through the space between my ears until you are willing to take a few steps to improve the health of your employees, support a cell phone while driving ban, etc.

As the ad for Pepsi Max says, “Wake up, people!” Maine’s economy is dying, and we are all helping to kill it with our self-serving inertia on our own roles in rapidly rising health care costs, and the statewide inertia that results. This is the legislative session in which we all must focus on health care costs, especially those costs related to medical care that’s unnecessary or of marginal value. We are running out of time and economic rope, so be part of the solution to tough decisions and sacrifice some of your own sacred cows or get the heck out of the way.

Erik Steele D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.

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Comments
5 comments on this item
On 11/18/08 at 8:48 AM, franseamans3 wrote:         Repeated separate thumbs down will cause comment to be hidden

I don't pretend to know much about medical care costs, only that they are out of control. After working a few years at a local hospital, I wonder if it would be a feasible alterantive for some of these hopitals to form walk-in clinics for those without insurance and for receipients of MaineCare. Many of these people use the local E.R. in place of a primary care physician. This practice is very cost ineffective!!! There has to be a way to create a reasonable heathcare alternative for this segment of patients load.

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On 11/23/08 at 1:06 PM, RDaniel wrote:         Repeated separate thumbs down will cause comment to be hidden

Sorry Dr. Steele but you are treating the symptoms when you declare, “It’s the costs, stupid,” because “It’s the culture, stupid” that cultivates a health care delivery system that is operationally inefficient and quality challenged. The genesis of this “disease” is in Medicare’s cost reimbursement methodology that allowed operational inefficiencies to be factored into costs reports. This allowed hospital leadership to ignore the tough task of challenging the status quo by throwing FTE’s at process and knowledge problems allowing failed processes to rankle at higher costs driving Medicare annual hospital inflation rates to double digits.

In 1983, CMS responded with price controls hoping revenue pain would force leadership to pursue efficiencies. Unfortunately, hospitals stunted in operational efficiency skills cut nursing staffs to survive. With higher patient to nurse ratios, conditions were conducive to increasing preventable medical errors which CMS rewarded with higher DRG values. The savings gained from price controls in essence became rewards for preventable medical errors. When failure to be quality driven and efficient is rewarded by the federal government it creates a cultural environment where knowledge workers, which represent fifty percent of a hospital’s workforce, face insurmountable barriers in efforts to advocate for excellence in patient and financial outcomes.

Today, with few exceptions hospitals could cut their operations budgets a minimum of 30% while improving employee moral and patient outcomes. Unfortunately, hospital leadership numbed by government policies do not understand that operational efficiencies are the rails that quality travels to excellence in patient and financial outcomes, because government itself is clueless.

May I state Dr. Steele, do not waste Mainers time addressing the symptoms of health care inflation but make the difficult professional “sacrifice” of challenging your hospital’s status quo to pursue a culture of excellence to cure inefficiencies and substandard patient outcomes. Challenge government and insurers to pay for excellence and never preventable medical errors of any type. Challenge transparency in operational costs for all hospitals so boards of directors can hold senior leadership accountable, the same for preventable medical errors. It is a great opportunity for you to lead by example rather than directives to others to address “frivolous freedoms.”

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On 11/25/08 at 12:17 PM, HermonMom wrote:         Repeated separate thumbs down will cause comment to be hidden

There is no easy answer to fix this health care crisis that our country is faced with. Making the system simpler would be a great first start. Every Dr. should have a set price for each procedure. No matter what insurance or no insurance, that is the fee. You go to the Dr. and you pay $100. The next guy goes, and he pays $100. Legislature needs to stop playing with the numbers to make it work out for them. The Dirigo system can not continue this way. I am all for helping those that are sick and in need, but I don't agree to paying for them to run to the ER every time they have a hangnail. If I go to the ER and it is not an emergency, my insurance will not cover it. The State program should be the same. Also, if you are on the State system and you have children, you are restricted from having anymore. I'm sure the civil rights people will be all over that, but come on, if you can't pay to take care of yourself and your current childrens healthcare, don't have another one!

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On 11/28/08 at 11:34 PM, vichet wrote:         Repeated separate thumbs down will cause comment to be hidden

This may be a non-sequitor but as I pay for my own care (deductable) with cash I would like to know what each procedure will cost me before i have it. Couldnt doctors offices list their fees in the lobby? This might mean if i have a cold... ..and it costs a $100.00 it would motivate me to do the math and go to the pharmacy and get a $10.00 bottle of Nyquil.

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On 11/30/08 at 4:04 PM, kmorris wrote:         Repeated separate thumbs down will cause comment to be hidden

Dr. Steele makes excellent points about the steps needed to achieve real relief of health care costs. However when the Legislature reconvenes in January most all of the health care bills considered will focus on further regulation of health insurance rather than on reducing the underlying health care costs. To quote another politician in a memorable speech: "That's not change; it's more of the same!" Maine already has plenty of laws regulating the availability of affordable insurance. MedSave.com (http://medsave.com/low-cost-health-insurance-availibility.htm) reports that Maine's restrictive insurance laws already prevent residents from using four of the nation's most popular types of low cost insurance plans. The current reform proposals are lame. We need fresh bold initiatives as Dr. Steele suggests.

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