The Cost of Improvement
Previous articles in this column have detailed the efforts of the Leapfrog Group, a coalition of more than 100 Fortune 500 companies, to come together and use their considerable health care purchasing power to influence the quality and the cost of medicine. We welcome the effort of major health care purchasers to work with medicine to improve care received by our patients.
A recent news release has come to our attention upon which we would like to comment. A member of the Leapfrog Group’s steering committee, Francois de Brantes, said, “The employer group recognizes that the cost of implementing Leapfrog recommendations can exceed what hospitals get from payers as a result of making those changes…Leapfrog is developing a procedure to examine the cost of fulfilling these recommendations, forecast their fiscal impact, and help cover the difference, usually through direct payments by Leapfrog members themselves or by telling their insurers to redirect premium payments to the hospitals.”
The Institute of Medicine report, “Crossing the Quality Chasm,” among its many laudable recommendations for improving the quality of health care, makes the following statement: “The Committee views public support as important for catalyzing the needed changes…public support can provide partial funding for the up-front costs that health care organizations face in undertaking the changes recommended—public funding for some portion of the up-front costs can be a valuable resource for organizations—to redesign the delivery of health care.”
In another publication, Leadership by Example, the same group states: “Congress should consider potential options to encourage and facilitate the development of the information technology infrastructure including tax credits, subsidized loans, and grants.”
One of the real barriers preventing health care from proceeding with the necessary changes related to the storage and transmission of information, as well as other processes to improve the quality and safety of care, are financial. The economic constraints currently impacting the health care industry related to Medicare and Medicaid cutbacks, private insurance discounts, and the growing numbers of uninsured frequently unable to pay for the cost of their care—compounded by the increasing costs of labor, technical equipment, and pharmaceuticals—results in little margin to maintain and improve facilities, let alone to invest in costly information systems and process redesign.
In response to the statements noted above regarding the needed aid in financing the costs of essential changes, to quote a television commercial, we ask, “Where’s the beef?”
No one wants to implement changes in health care to improve patient care more than we who provide that care. Securing the necessary amounts of funding to accomplish these recommendations will continue to be one of the major challenges and struggles we in health care need to continue to actively address. IBI