Improving the Quality of Health Care: The Kennedy Bill

It's one day after the dropping of the draft of the Senate Health, Education, Labor and Pensions Committee bill in advance of hearings and mark-up of the language.  Most news stories have focused on the "placeholders" put into the bill for the contentious public health insurance option and the employer mandate (or "pay or play" - I guess we'll find out which it is soon).  Far too many have focused on the Frank Luntz bingo of Republican talking points in reaction to the bill.  These fall along the lines of an outraged, "I am shocked--shocked!-that Sen. Kennedy's bill contains what he said it would two weeks ago!"  The 600 pages or so that aren't rhetoric and don't involve the public plan or the employer mandate have gone somewhat underrepresented.

So I want to dive in on two parts that aren't as flashy as how you expand access or how you control costs, but are just as important to the success of the bill:  how do you improve the delivery of care, and how do you make health care better?

As you'll remember, I was particularly taken by Sen. Mikulski's quote from the press release:  "Emphasizing quality improves lives, saves lives and helps pay for reform by saving money."  That's not part of our conversation often enough.  It's not enough to cut costs to a more politically manageable level if the quality of our health care suffers.  And it's not enough to do what we've done so far, which is push every new treatment in the hopes of seeing a payoff in quality, if we're only going to come up with expensive treatments that drive up the cost past the point where most people can afford it.  That creates the situation we're in now, where you can have heart surgery done using the latest high tech surgical arm to no better value if you can afford it.  If you can't afford it, you can't even get reasonably-priced primary care or cholesterol-managing pills to prevent you from getting heart disease in the first place.

So what tools would the HELP Committee bill provide?  (Those of you who want to follow along, start on page 245, section 211.):

• A new agency within HHS, the Patient Safety Research Center, devoted entirely to new research on best practices, specifically focusing on high quality providers who regularly exceed their peers in terms of efficiency and health outcomes (one of the obvious examples being the Mayo Clinic), and then blasting out the results of that research so more doctors can learn from the superstars in their field.  You may think it's weird we don't have this already.  You'd be right.
• More grant programs to establish medical homes, a model of care that yields better outcome, lower costs and, most important of all, better patient education
• Better reporting working towards the lowering of preventable hospital readmissions.  There have been many reports of patients on Medicare who are released without proper training on how to care for their condition and without sufficient follow-up, either from their hospital or their primary care provider.  This is one of the huge wastes of money in our system in that most cases are easily and cheaply preventable, but it's not a priority for the hospital releasing them.  Guess what?  It'd be a priority now.
• Funds to create more "patient decision aids" and ways for patients to be more active participants and make better decisions in conjunctions with their doctor.  These are particularly important where we don't actually have good information on which treatment is better - how else are patients supposed to figure out what works best for them, and not just what their doctor really, really, really strongly recommends for them?
• Analysis of how we're packaging drug information, and whether there's a better way to get that information across to Jane Schmoe, who hasn't had 4 years of medical school plus X years of private practice as a doctor.
• And trial programs to make sure our provider workforce of tomorrow is learning about patient safety and how to improve quality and teamwork from day one of medical or nursing school.

Notice a common trend?  It's about education.  This point can't be stressed enough - we talk way too much about the sacrosanct nature of the decisions made by a doctor and a patient, and not enough about what we can do to learn to make better decisions.  For something that's already been dubbed "the most liberal approach" to health reform, we're not talking about command and control, fiats and mandates here.  We're talking about learning what works from people who are really, really good at what they do - and then giving us the tools to do more of that.

The only surprise is that we're not doing it already.

(Photo credit:  KB35 on Flickr.)