Donald Berwick, a Boston pediatrician and former administrator of the Centers for Medicare and Medicaid Services, said the country must move from its low-value, high-cost, fee-for-service system to one that emphasizes good health outcomes.
“We have to change the way we think; we don't get more when we pay more,” said Berwick, who referenced the website choosingwisely.org and a health care project in Alaska, where team-based care has resulted in 50 percent fewer hospital bed days, 53 percent fewer emergency department admissions and 65 percent fewer specialty visits.
Meanwhile, Gov. Patrick, making similar arguments, vows “Massachusetts will be the place that cracks the code on cost containment.” The governor in August signed a cost-containment bill estimated to save $200 billion in health care costs over the next 15 years. The state's goal this year and next is to hold increases in health care spending to 3.6 percent, or no more than the growth in the state's economy.
Ultimately, it may come down to individuals to collectively make the difference. Depending on whether we choose the latest technology or lean toward natural healing, are doubters or believers, minimalists or maximalists, each of us has a highly individual approach to weighing the risks and benefits of treatment, I learned from spouses Jerome Groopman and Pamela Hartzband, doctors with Harvard Medical School and authors of “Your Medical Mind: How to Decide What is Right for You.”
For example, though best-practice guidelines may call for cholesterol-lowering medication in patients with levels 200 or more, individuals may opt for no meds and doctors, under health reform, consequently may be publicly rated as not meeting outcomes.
Moreover, when it comes to end-of-life issues, individuals can't effectively forecast what they'll choose until they've experienced it, the author-researchers found. Prostate cancer sufferers, for example, might predict they'd rather die than live so many years with incontinence and/or impotence but, if and when they're diagnosed, choose treatment and the associated risks.
Plagued with a backache my entire week at the conference, I, for one, am a maximalist — when it comes to treating pain anyway. I pounced on the meds my twin sister, who lives in a Boston suburb, generously shared with me.
Back home, I promptly paid a visit to my internist to, among other things, request a prescription for muscle relaxers so I — hopefully — can head off any future back spasms. I have yet to meet my annual out-of-pocket deductible, but didn‘t give much thought, if any, to the costs I personally am helping run up.