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By Ruth Benton, New West Physicians

As Colorado and this nation examine plans to improve our health and health-care system, it’s important to remember that no effort to address these concerns will be effective unless we also lower costs.

Changing how we pay medical providers and speeding up the adoption of information technology in the health-care industry will create savings to help support a sustainable system that ensures every citizen has access to quality health care.

Currently, medical providers are paid on a fee-for-service basis, meaning more care equals more pay. This payment structure, coupled with reduced reimbursement rates from insurance and government payers, has resulted in the inefficient use of our health-care system. On the other hand, providers are not paid adequately for some key preventive care services such as smoking cessation counseling and diabetes education.

Rather than pay providers and facilities to treat maladies, government and private health-care insurers should pay providers to keep certain patient populations healthy. When a person chooses a physician, hospital or other provider, the insurer would pay a set amount for that patient’s annual or monthly care, creating an incentive to provide efficient, effective and preventive care.

This payment mechanism also must reward quality care (providing bonuses, for instance, for helping patients manage chronic and potentially costly diseases such as heart disease and diabetes).

Health care is the largest U.S. industry that remains predominantly dependent upon paper-based systems. According to a 2005 study by the Medical Group Management Association (MGMA), only 14 percent of physician practices across the country have converted to electronic health records. However, an MGMA survey of osteopathic physicians showed that a whopping 90 percent of those who had converted to electronic health records wouldn’t want to go back to paper records.

There are many reasons why people change doctors or seek care from someone other than their regular provider, including moving, changing insurance plans or emergencies. Electronic health records would ultimately allow each of us to carry an ID card linked to our personal health record. This would allow all providers to maintain and update the record, avoiding costly duplication of testing and treatment when medical records don’t keep up with patient mobility.

One of the barriers to using this technology is expense, and it’s important that the state — or country — adopt a “carrot and stick” approach, with incentives and supports to make the technology more affordable for providers, as well as consequences for those who do not comply with mandates to adopt it.

In the long run, many providers realize significant savings after implementing electronic health records technology. According to a recent HealthLeaders article, some practices have recouped their costs within the first year, in part due to increased operational efficiency.

Health care is truly a life-and-death issue, and we all are affected. As we strive to increase access to care and improve health-care goals, we also must take measures to contain health-care costs. As health-care consumers, we need to urge our providers to begin the process of implementing electronic health records. As providers, we must begin using this technology to support a more streamlined health-care system and create efficiencies within our practices.

And all of us — consumers, providers and business leaders — must urge policy-makers to rework our provider pay system and support the adoption of technology to create the savings necessary to support a sustainable, long-term solution for our health-care system.

Ruth Benton is the CEO of New West Physicians, a primary-care practice group serving more than 250,000 patients and 13 Denver-area locations.

READER COMMENTS

Allowing people to select, and pay for, their own services is the only way to fix the health care mess government has created. It is also the only way to separate issues such as illegal aliens from the health care issue. Everytime I see the "800,000 uninsured Coloradans" quote, I cringe because that very fact ensures single-payer healthcare will never happen, if for no other reason than it is completely dishonest!

I challenge Hank's assertion that we will ultimately get better deals when we shop in a competitive system. How is one individual going to negotiate a better price for an MRI when MRI units are booked up weeks in advance? Also, as an individual, will I be able to negotiate lower prescription prices with drug companies? I don't have the economic clout/power to persuade such corporations to lower prices. Thus I need to have the system help me.

One last thing, what's wrong with the post office? We have some of the cheapest, reliable and efficient postal services in the industrialized world. What's wrong with that?

Right on, Ruth!
In addition to keeping people as healthy as possible (and paying providers more when they use proven methods for doing that) and making the systems function as efficiently (electronically) as possible, we must realize that we can't provide every possible treatment, proven and unproven, to anyone who wants it. What one buys with one's own money is one thing; what one demands that others pay for (especially in a "community rated" system) is another. Provide basic, proven care to everyone as a "social good". Allow access to unproven or less cost effective care to those who choose to buy it themselves.

And what better way to lower costs than to provide each healthcare consumer with the ability shop and make choices in a competitive system, acting in his/her own best interest and using his/her own (not somebody else's) money.

Monopolies are hostile to consumers, competition and choice is friendly. And there is nothing like spending you own money (no MRIs for hangnails) to keep costs down.

Otherwise its the same guys who run the post office for your liver transplant!

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