Healthcare is a strange business. I recall a few years ago when one of our hospital presidents announced that we didn’t have a very good month financially, because we “didn’t have a good flu season.” What she meant was this: Not enough people in the community got sick so we could profit from treating them. As a doctor as well as a health system CEO, I was appalled. But from a financial standpoint, she was right: though our mission was to provide exceptional care to help our patients get well, we made money when they were sick.
We face the same issue when we try to improve the system. My organization is proud of our cancer care program, which includes cancer care coordinators who help those rocked by a new cancer diagnosis. We introduced the program to provide support, education, and guidance for cancer patients who too often are shuttled from lab to doctor’s office to hospital. We studied the results of the program and found that over six months, we avoided 95 hospitalizations for those supported by the care coordinators. Beyond the profound benefits of patients spending more nights at home in their own beds surrounded by loved ones, we saved our community $1.2 million in hospital costs. The only problem was that we lost $600,000, because our revenue source was the very admissions that we helped our patients avoid!
I firmly believe that the best way to make health care more affordable is to provide early access to good care and avoid unnecessary acute care and preventable complications. The Affordable Care Act was more than just an insurance bill. It included quality improvement programs and care model reform initiatives, including the Accountable Care Organizations, all designed to improve value in healthcare. These should be continued in order to improve care and lower per capita costs. Repealing the ACA with a TBD replacement plan does nothing to further support reforms intended to eliminate waste in the system.
We also must protect our poorest citizens. Medicaid block grants, from my perspective, will disadvantage more effective and efficient markets with lower payment levels. As with our cancer care coordination program, good deeds may well be punished financially. I believe that those in most need—the poor and those impacted by health disparities—will be impacted adversely with what likely will be a “block then chop” reality.
I would implore those in the incoming administration to both clarify ACA replacement/refinement components and look at the implications of block grants to our fellow citizens before acting. As we say in my profession, “First, do no harm.”