Saturday, February 18, 2012

Why Can't Colorado Follow The Grand Junction Health Delivery Model?

At the top of the news lately in Colorado is the divergent cost of health care, as exemplified by the recent case of uninsured Justin Swanstrom (Denver Post, p. 1A, 6A) who went into more than $60,000 in debt after having a heart attack. Meanwhile, those on any kind of insurance, whether private or Medicare, are charged significantly less....WHY?

According to Serena Woods of the Colorado Consumer Health Inititiative (ibid.):

"The uninsured are charged considerably more than the insured in Colorado."

She went on to point out that a proposed new bill would "give people more chances to take responsiblity"

It would do this by peeling away the cost cloaking of most hospital bills and provide transparency. It would even go further by providing the basis for a standard set of costs-prices for all procedures, whether appendectomies, gall bladder removal, or open heart surgery. Thus, according to a standard cost set, each procedure will have its assigned, designated prices- say $11,000 for an appy, $35,000 for open heart surgery...whatever. No more charging one guy $60 grand and another $30 grand for the same surgery.

Backers of the bill cite a 2009 American Journal of Medicine study that found medical debt to the the driver for 62% of all personal bankruptcies, up from 8% in 1981. This is totally ridiculous!

And yet industry groups, like the Colorado Hospital Association, are claiming it will "increase the cost of health care and impede access".

They also add (Denver Post, Feb. 17, p. 1B):

that this amounts to "price fixing that will ruin many facilities"

Horse manure!


Maybe these hospital hotshots ought to take a good hard look at T.R. Reid's latest PBS effort, screened two nights ago - U.S. Health Care: The Good News . Reid traveled to three distinct U.S. municipalities - not Communist Cuba or anywhere "socialist" - where every person including the uninsured received medical care, and no one was turned away....not even Medicaid patients! The places included Seattle, and Evergreen, Washington, and Grand Junction, Colorado.

That's right, Colorado Hospital Association, Grand Junction, Colorado! Reid found an eminently rational model in which all patients are pooled together in one risk pool to lower the cost for all. All physicians in Grand Junction sign on to take any and all comers, no one indiscriminately turned away for whatever reason....whether Medicaid (low rates of pay, paperwork) or the uninsured. Any physician who doesn't agree is excluded from the Main physician network. He can go it alone and catch as catch can.

Each "in house" physician treats not only the patient's physical well being but also with an eye to his or her fiscal well being. This mission and network includes FIXED pricing for each procedure irrespective of what insurance vehicle one has....or doesn't. In this way, the delivery of care is rendered uniform without wild variations in costs, and in addition, costs can be controlled - especially as unnecessary procedures (say undertaken just to stir up cash flow) are frowned upon.

The implementation as portrayed on PBS:

was a model of simplicity, belying Cole White's claim (D.Post, ibid.) that "it is complicated".

No it isn't! It's eminently simple...IF you're out to serve people and not merely rake in profits!

The Grand Junction model was brought to Reid's attention by Dr. Elliott Fisher, of the Dartmouth Institute for Health Policy, noting " that about 30 percent of what we spend on health care is unnecessary".

Grand Junction's success at cost-saving was highlighted in The Dartmouth Atlas of Health Care . The accumulated data - extracted from billing records compiled from hospitals across the nation, discovered variations from one town to the next in the treatment of the same ailment. This leads to massive variation in the cost of treating the same ailment. As a result, some U.S. localities (like Miami) spend $17,000 per year on the average Medicare patient, while others (in Grand Junction) spend less than $7,000 per year with results that are just as good.

This led Reid to investigate what made Grand Junction different. For this reason I commend the video link to all readers to watch, at least for the introductory Grand Junction segment - lasting maybe 15 mins.

Unlike the hospitals that gouge the uninsured patients like Justin Swanstrom, the ones Reid encountered featured communities that have several important things in common, including a clear commitment by doctors and hospitals to lower the cost of health care.

I would strongly advise the Colorado Hospital Association defenders of the status quo to watch that PBS program....then try to come up with more excuses for not doing what Grand Junction is to deliver high quality medical care at lower cost.

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