Is it Rationing or is it Better Health Care?

“Tell me,” said the gentleman visiting my office, “when Medicare cuts costs won’t that result in rationing? Isn’t it logical if Medicare pays less, we will get less and someone will have to do without?”

I told him, depending on the studies you read, anywhere from 30 to 40% of all the health care dollars are spent on over-use, under-use, misuse, duplication, inefficiency, unnecessary repetition and poor communication. And some of the easiest ways to save money are the simplest and the most cost effective.

What if you are a newly diagnosed diabetic? You look in your refrigerator and realize you have to go grocery shopping for the first time since you found out you are diabetic. You have a habit of heading for the candy aisle. But today, you call a diabetic educator, a registered dietitian, and she helps you prepare a shopping list. She reminds you not to go shopping on an empty stomach. She provides you the confidence to change your eating habits and the knowledge to stay with your new diet.

Following up with patients and coordinating with health professionals are some things for which insurance companies and Medicare seldom pays. But for several years, Medicare has been investigating ways to change this practice.

Marshfield Clinic in central Wisconsin is one of ten sites in the United States chosen to demonstrate how changing the way Medicare pays for health care can keep people healthy and save money. Last week the Centers for Medicare and Medicaid (CMS) released results that demonstrated for three years in row Marshfield Clinic improved the quality of medical care and saved taxpayers more than $48 million dollars.

The project taught Marshfield Clinic professionals how to “more quickly advance the value of care” to patients according to Dr. Theodore Paxel, the physician in charge of quality improvement. In a recent press release, he was quoted. “Our goal is to help them [patients] receive the right care at the right time in the right place.”

More than three out of every four dollars our nation spends on health care is spent on chronic diseases. Just five conditions – diabetes, asthma, depression, coronary artery disease and congestive heart failure – account for almost half of our medical bill in the U.S.

Marshfield Clinic uses computer technology to monitor care of patients with diabetes, coronary artery disease, high blood pressure and congestive heart failure. But the computers are only as smart as those who use them. The system must be set up to give doctors the information they need when a patient is in the clinic. When a patient is at home, a 24 hour nurse hotline helps the patient make good decisions about medical care. Telemedicine hook-ups help doctors advise doctors in other parts of the state.

Changing the way doctors do business, investing in electronic medical records and prescriptions, using computers to show gaps in care, alerting doctors to those gaps during the patient’s visit, providing feedback are not new ideas. But they are being combined to help doctors be better doctors and help patients live longer, healthier lives.

The Marshfield Clinic project and others showed spending money on little things saved big. Studies show people suffering from chronic diseases who participated in a training program to improve their health had less deterioration and used fewer health services over two years, when compared to the two years prior to the training. Patient education saves money and keeps patients healthier.  This is something nurses have long known. But far too often insurance and Medicare didn’t pay for patient education.

Could it be that doing right thing at the right time really means doing better?

It so reminds me of farming. A little bit of maintenance goes along way to making that machine run better and run longer.