No Direction Home

My apologies to Bob Dylan, but need to drive the point home.  I noticed this reporting on NPR:
 
NPR: doctors hesitate to ask heart patients about end of life plans

This flies in the face of everything I have encountered and learned over the course of personal and professional knowledge regarding Health Care Reform.  #hcr

Here is Ken's top 3 actions we need to take to get control of costs and efficiency for Health Care in the US:

1. Personal Responsibility
   Whatever happened to us as individuals that we no longer take responsibility for our actions and stand up to fix them?  I will expand on this topic in a future blog post, but here is something to think about.  We know that people who are obese over their lifetime will cost on average $13K/year more in health care costs than a non-obese person. 
   
   This is not very hard to understand.  Consider that likelihood of Diabetes, Health Disease, and increased need for hip and knee replacements.  These cost add up fast.  However, people who fall into this category do not pay more in premiums, that cost is distributed to all of us.  Therefore, all costs are driven higher unnecessarily.  So, a lot of talk these days, but we have not come to terms with the impact of this issue, why not? 
   
   Another example, we know in the state of MN, the cost the state pays dealing with smoking related illness comes to $554/year per person.  Not voter, or taxpayer, per person.  Yet, for all the progress made in this area, there was great opposition recently when the legislature wanted to raise the cigarette tax.  The reason, it would cost jobs at convenient stores and gas station?  How many jobs are being lost because living within our budgets, we can't invest appropriately in infrastructure and other items to create more jobs in the state because we give medical welfare to smokers? 
   
   Get my point?
   
2. Dealing with last 6 months of life.
   Bingo, this is why the NPR article hit home.  Unlike many other countries in the world, in the US we have to opt in to things rather than opt out.  If someone does not have a living will or other plans, then by default we go to extraordinary efforts to keep them alive.  We increase the quantity of life while throwing out the quality of life in many situations. 
   
   Remember during the ACA (ObamaCare) discussions the whole scar tactic of the government wants to kill Grandma?  Yep, keep fear alive, and by the way, we won't compensate via Medicare for Doctors to have the up front discussion for people to plan their end of life with dignity.  The costs here are staggering, for example: CNN Cutting the high cost of end of life care
   Therefore, time to us as a society to grow up and deal with death.  Hello, news flash we all are going to die, accept it and stand up how you want your final days to be.  Tubed up in a hospital, or, maybe at home with family?  If we don't opt in and put plans in place, prepare to tube up.  We can't tip toe around this anymore with the "Silver Tsunami" coming down the pike.  The important aspect here is for our politicians to step up on this topic before they just blindly go and pull back on benefits and cut these budgets.  Like many businesses out there, afraid to resolve the process issues to save money, just cut travel budgets, headcount etc.  Short term fixes because the core issue on whats wrong has not been addressed. 
   
3. Hospitals need to address their costs
   I have spent over two years working in the arena of Activity Based Costing for health care providers.  Wow, what a shock this was to me.  Go ahead and ask a hospital a simple question like, what is your cost for a CT of the abdomen?  They don't know.  They might know parts of it, but not the total cost.  Ask a car manufacturer in Detroit what was their cost for a car, you will get an answer to tenths of a cent. 
   
   Now, calm down, I'm not saying people are just a manufacturing line, but there is a corollary here.  Back to the CT, a simple workflow process would be Schedule-Checkin-Triage(maybe contrast or IV)-Scan-Interpret-Document.  It is a process ending up with a specific outcome of an interpretation of the scan.
   
   Now, for all these steps, consider the costs for labor, equipment, supplies, overhead items, the providers can't put their fingers on all of these components.  Bottom line, they don't know the actual cost.  All of that data is manged through a plethora of IT systems that don't talk to each other.  So, how do they know if they are making a profit or losing money?  That aside, the hospitals don't control reimbursement for these events, the government (Medicare) & Insurance companies do. 
   
   By the way, Medicare reimbursement will be declining at the same time patient numbers will be increasing.  Simple question, if we want to be more efficient to manage our resources better while not effecting outcome of procedures, why don't we understand this? 

Humbly submitted as food for thought ...