Consultant and self-proclaimed health care futurist Ian Morrison did not mince words for the opening bell of the annual HFMA conference, held this year in Las Vegas after flooding curtailed the originally planned Nashville venue.

The industry, he said, is hampered by the "fallacy of excellence," namely the idea that by spending large sums on modern hospitals and high-tech equipment, it is somehow fulfilling consumer need and delivering quality care.

In slide after slide, Morrison detailed how, while our spending exceeds that of other industrialized countries, our outcomes lag. The United States spends twice per capita compared with our peer group countries, such as Canada, but lags far behind in outcomes measures, such as morbidity rates among patients with chronic conditions.

Moreover, U.S. primary care physicians are far behind their peers in other countries in adopting clinical I.T. Primary care physicians in New Zealand, for example, have almost universally adopted EHRs. He did praise the Obama administration, however, for its appreciation of how the clinical I.T. lacking in this country is part of the evidence-based future of medicine.

Morrison cited several factors behind the lackluster performance, including overspending on futile, end-of-life care. He cited studies that estimated some 30 percent of Medicare dollars are spent on end-of-life care, largely invested in high-tech procedures that yield little in the way of either improved outcomes or quality of life for the recipients.

Morrison also blasted the recently enacted health reform legislation, questioning its long-term impact. Expanding the Medicaid insurance pool--a cornerstone of the reform measure--only sidesteps the issue of rising costs, since hospitals lose money on Medicaid patients. He labeled hospitals as among the losers of the new law, given that they face an increased volume of newly insured patients whose likely reimbursement rates will just push providers closer to the red.  "We're on an unsustainable path," he said. "You can't just give people an insurance card to a dysfunctional system."

--Gary Baldwin


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