Right Outcomes; Wrong Lessons

Geisinger Health System is the entity that gave us the first warranty on hospital surgeries. Patients and their employer/insurers are not charged for readmissions to correct mistakes on the initial surgery. However, other hospitals have not followed in Geisinger's footsteps. The reason: Hospitals typically make money on their mistakes, and since no payer is paying extra for the warranty, Geisinger loses money on the deal.

Geisinger is now experimenting with other innovations in the areas of chronic care, acute care and the creation of medical homes. In each case it is providing more evidence for one simple, plain, obvious, unavoidable, unquestionable, rock solid, self-evident lesson: providers need to be free to repackage and reprice their services (just like all other professionals), whenever doing so reduces costs and increases quality.

Yet this lesson is being completely ignored by our friends at the Commonwealth Fund.According to a Commonwealth report, Geisinger has created patient-centered medical homes, with round-the-clock access to primary and specialty care. Both patients and physicians have access to electronic medical records. In fact, the whole arrangement seems eerily similar to the ideal vision for care we described in the last chapter of the State Handbook on Health Care Reform. Preliminary evidence suggests a 20% drop in hospital admissions and a 7% drop in overall costs.

So what do we make of all this? For Commonwealth, the answer is: force everybody else to do what Geisinger is doing. But surely that is the wrong prescription. Although Geisinger has been able to improve on a dysfunctional payment system, there is every reason to believe that others could also be innovative in surprising and unforeseen ways.

In an ideal health care system, as in every other market, all the participants should be free to use their intelligence, creativity and innovative ability to solve problems. Let a thousand flowers bloom.

Doctors need to be liberated from a dysfunctional payment system rather than being subjected to more directives from bureaucrats who want to tell them how to practice medicine.

Comments (2)

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  1. Joe S. says:

    I think the Commonwealth Fund doesn’t understand what a competitive market is.

    They cannot imagine a health care system built on market principles.

  2. Hristina says:

    Add a carrot, some poiretn powder, a small beet or part of a large beet. (don’t worry you cant taste it ) now you have an almost perfect food, Fruit , veggies, and your poiretn. You could a a stalk of celery for more fiber if needed. Some people swear by wheat grass but it taste terrible and turns the smoothie a awful green color.