Power to the Physicians, Not the Hospitals
President Obama has explained his approach to health reform on numerous occasions. “Let’s find out what works, and then go do it,” the president says. In other words, let’s find something we like and then go copy it. Yet after spending millions of dollars on pilot programs and demonstration projects, there is little to show on behalf of this concept.
The Congressional Budget Office has studied the demonstration projects on three separate occasions (here, here and here) and each time has concluded that their performance has been lackluster and disappointing. They are producing no serious savings and are unlikely to do so in the future.
What about grading hospitals based on the quality of care? One recent study finds that Medicare’s reporting has had almost no impact on mortality. Another survey finds that quality report cards not only don’t work, they may do more harm than good. What about paying for results? The latest study of pay-for-performance finds that doesn’t work either. Accountable Care Organizations? The latest results show no reason to be hopeful. Electronic medical records? The latest survey of all the academic literature shows they don’t improve quality or reduce costs. Indeed, a new study in Health Affairs found that when doctors can easily order diagnostic tests online, they tend to order more tests — increasing costs.
Yet, even as all the demonstration projects are failing, there are numerous highly successful examples of success prior to and outside of the periphery of the Patient Protection and Affordable Care Act (PPACA).
