Conventional wisdom got turned on its head in many ways lately in the world of managed healthcare.

Two studies published in Health Affairs cast doubts on practices many of us thought made sense: using electronic records makes physicians more efficient, and public reporting on hospital performance improves patient outcomes. A third report, this from the Congressional Budget Office a few weeks back, concluded that 34 disease and care management programs, plus four value-based purchasing programs, failed to reduce Medicare spending.

Together, they paint a grim portrait of the hard slog ahead in controlling healthcare costs and improving medical outcomes.

The first study by Harvard Medical School found that giving office-based physicians access to their patients imaging and lab results did not decrease test orders it actually produced a 40 percent to 70 percent greater likelihood that imaging tests would be ordered. Experts concluded that it's not enough to outfit physicians with IT resources they actually have to be trained on them.

The second study concluded that Medicare's seven-year reporting effort for hospitals, called Hospital Compare, had no impact on reducing death rates for heart attacks and pneumonia and a marginal effect on heart failure. The study's authors showed that Health Compare produced no improvement beyond what was already occurring with innovations in clinical care. Researchers also questioned whether consumers even take advantage of report card-type information.

Finally, the third report details the joint failure of various care coordination programs to produce material savings to Medicare over time. There are many reasons this was not the case; among them were the intense investment the additional care required in staff and IT at physicians offices. While the overall results are disappointing, several of the groups involved in the pilot program say they believe longer-term savings and improved results are on the way.

What does all of this mean in the lead-up to healthcare reform Clearly, the millions of dollars being spent on healthcare IT are not enough if we don't change processes around IT to be more efficient. Second, transparency may not be all it's cracked up to be. Most of us remain uninterested or uncomfortable in vetting our physician, drug and hospital choices.

As for care coordination, it's possible that it will take a long time to see the return on investment, especially for the very sick, the old and the poor. On that cheery note, it's quite likely our grandchildren may be solving this one.

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