Stories about: health care costs

Innovation opportunities from healthcare reform

President Obama signs the Patient Protection and Affordable Care Act, March 23, 2010 (Pete Souza/Wikimedia Commons)

National healthcare reform, including President Obama’s Affordable Care Act of 2010, is being driven by widespread dissatisfaction with the high cost and limited accessibility of care. Although we’ve yet to feel the full impact of these national reforms, the reform experience in Massachusetts indicates that mandated universal coverage, by itself, has failed to drive down costs.

So, in Massachusetts, we’re now in the next phase of healthcare reform, focusing on how to control and cut costs while still providing nearly universal access to high quality services and care. The need to bring down costs is stimulating healthcare innovation in three major areas – perhaps offering some lessons for the nation as it moves toward universal care.

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Reducing unnecessary care: The SCAMPs manifesto

Can we reduce health care costs without rationing? (Image: Fibonacci Blue via Flickr)

We all know the problem: The cost of health care needs to come down. About five years ago, pediatric cardiologists at Children’s Hospital Boston realized it was critical to practice more cost-effectively. “Most of the money that is going to be removed from the federal budget to reduce budgetary deficits is going to come from health care in one fashion or another,” cardiologist-in-chief James Lock told an audience of senior Children’s physicians last month. “There’s no question we were under a tremendous amount of pressure.”

Seeking to eliminate unnecessary care and testing, Lock’s team first turned to clinical practice guidelines, or CPGs, a tool meant to standardize “best practices.” But it soon became clear that CPGs were ineffective, giving no insight into how to improve care or how to deal with unexpected findings. Even worse, over time, many mandated CPGs have been shown to be wrong by subsequent data.

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The power of numbers: Rules for reining in the use of CT scans

When does a trauma patient need a CT scan? Clinical rules could help doctors decide, and in the process help reduce a child's lifetime radiation exposure. (Image: Andrew Ciscel/Flickr)

The use of computed tomography (CT) scans has dramatically changed the practice of medicine in the past two decades. Patients with abdominal pain are no longer routinely admitted for serial abdominal exams to evaluate for appendicitis, because now we can just get the CT. Children with head trauma may need less hospital observation time in the emergency department (ED), because we can just get the CT.

But “just getting the CT” comes with costs, not just medical healthcare dollars spent but the costs associated with lethal malignancies in the future caused by the radiation used in the course of CTs.

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Gauging the impact of pediatric “frequent flyers”

Jay Berry, MD, MPH, is a pediatrician and hospitalist in the Complex Care Service at Children’s Hospital Boston. He leads the multi-institutional Complex Care Quality Improvement Research Collaborative. This post is second of a three-part series.

Emerging evidence suggests that small groups of adult patients who are frequently readmitted to the hospital are responsible for a large proportion of health care costs. Is this also true in pediatrics? What impact do our young “frequent flyers” have on the inpatient health care system?

I’m fortunate to be part of a multi-state collaborative, supported by the Child Health Corporation of America, that is trying understand how to best deliver care to the neediest children. These patients have complex medical needs, who are fragile and predisposed to getting very, very sick. Often, they have multiple, chronic health conditions, neurodevelopmental/intellectual disabilities and impaired functional status, requiring feeding tubes, breathing tubes and other technology to maintain their health.

Many of them, like Jim, seem to be falling through the cracks.

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