More money, better results? Not so fast…

November 3, 2014 at 8:00 am | Posted in Uncategorized | Leave a comment

Carrie Colla’s talk at NAHSL on the shift to value-based payment was interesting. Some of the data about variances in medical spending regionally was not entirely new, but the study she spoke of focusing specifically on Medicare spending was not familiar.1 The logic would seem to dictate that higher spending would result in better outcomes, but this was not borne out, and, in fact, the study revealed worse outcomes in areas where there was higher spending. The study compared content, quality, and outcomes in the highest and lowest spending areas. What influenced the outcomes?  One discovery was that a third of costs in the higher-spending areas were wasted/unnecessary tests. There was a higher use of low value tests in the areas that spent more money per patient. She mentioned the Choosing Wisely campaign. (Anecdotally, when she asked the audience if we knew of the campaign, and viewed the response, she told us more librarians were aware of it than MDs.)

Some ways to lower costs are to reduce the incentives that drive the ordering of tests, better clinical decision support, clinician feedback, and clinical education. She also spoke of accountable care organizations, 51% of which are led by physicians. Other strategies include performance management, care management and health IT.

As to how healthcare reform is evolving, she said that she anticipates a higher percentage of participation, increased quality, improved data sharing and opportunities to save more money. The talk was a step toward a better understanding of this topic.

1.Spending Differences Associated With the Medicare Physician Group Practice Demonstration
JAMA, Sept. 12, 2012;Vol. 308, no. 10: 1015-1023

Christine Fleuriel
VA Maine Healthcare System


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