An EPIC Solution For Health Care Reform: Part 1

Health care reform has become a red hot topic that has inspired the wrath of Republicans and Democrats alike. Both groups, much like Nero, are playing the fiddle as Rome burns and health care costs skyrocket. Some have gone so far as to say that health care reform may even be unconstitutional. As the debate is waged, facts are lost in the vitriol and diatribe.

One fact that everyone agrees on is the cost of health care in this country. We are currently spending 17% of our GDP annually to pay for health care. Projections are close to 20% over the next decade. That is not something that can be maintained. Simple. Rome is burning and needs a fire extinguisher, and a big one at that.

As Einstein once said, we cannot solve problems using the same thinking that we used to develop them in the first place. And this becomes all the more apparent in health care.

This four part series is about exactly that – solutions to the health care woes in this country. It will require an EPIC solution for an epic problem.

The EPIC solution involves four key change elements:

E: Evidence – the use of evidence-based clinical guidelines (which does not equate to “death panels” and other silliness) as the accepted standard of care;

P: Payment – new payment and reimbursement strategies. It could also stand for Patient-Centered, something that a new health care system must focus on;

I: Incentive – changing the incentives that drive the system in the first place. It could also stand for Ideas, which would be a result of changing incentives; and

C: Choice – providing the consumer with an open market, removing the legalized monopolies that exist, and giving the consumer choices in their health care.

Before we even start with our EPIC solutions, we have to deal with another “E” in the mix, one that underlies the whole discussion in this country: Ethics.

First and foremost, citizens and residents of this country need to make one elemental decision:

Do we (or do we not) as a populace truly believe in universal health care (in any way, shape or form)?

Though many other countries have established that universal health care is good for the populace (and thus good for everyone in that society), I do not believe that this has been established within the US. That is truly an issue of personal ethics.

If we can’t answer this question first, then any further decisions beyond this are a moot point.

Strangely enough, discussions about health care reform have become laden with hypocrisy. The United States puts billions of dollars into “humanitarian efforts” worldwide – yet chooses not to improve the situation in our own backyard. You can go to church on Sunday and proclaim “love thy neighbor like thyself” – but then, under your breath, add in “as long as it doesn’t cost me anything”. Citizens can complain about the cost – yet spend a trillion dollars of unbudgeted taxpayers’ money to send troops to Iraq and Afghanistan. With multi-trillion dollar issues like that, the hypocrisy on health care reform gets a little ridiculous at times.

But if we could all come to agreement on this one ethical dilemma, we could then move towards the first pillar of an EPIC solution: Evidence.

Billions of dollars are being spent on medical research. From this, we have been able to produce sound and well-grounded clinical practice guidelines. “Evidence-based practice” has developed from comparative effectiveness research. As an example, look at the research on low back pain. Countless clinical guidelines have been developed worldwide, all of which are similar in their scope and content.

To many, comparative effectiveness research has come to mean “people not getting the care they need”. We’ve all heard of the talk of “death panels”. This is a fallacy. It isn’t about “not getting the best care” as much as it is about “getting what is right, given the context of the clinical condition and the evidence to support it”. Clinicians should be held to a higher degree of accountability when it comes to evidence-based practice. Regardless of the payer source, clinicians should not be paid just because they did a treatment or performed an intervention, regardless of what it entails. They should, however, be paid for an intervention that has evidence to support it’s use, given the condition and patient demographic. And should they provide a good outcome based on this evidence-based model, they should be reimbursed even more.

Evidence-based practice should be the standard of care in this country. It would not only have a direct effect on cost, but it would also improve outcomes as well. That unto itself would save the system billions of dollars.

Part 2 of this four part series will take a look at Payment – and developing new strategies of paying for this thing we call health care.

Photo credits: EpicFireworks