Thank you for inviting a doctor to talk to financial people. Thats how Atul Gawande, M.D. opened his June 23 keynote address at the HFMA Annual National Institute in Las Vegas, where he stressed that clinical and healthcare financial professionals dont talk to each other and need to.
Despite political battles, the Affordable Care Act is law and has settled the debate over whether people deserve healthcare, said Gawande, a surgeon at Brigham and Womens Hospital, physician IT champion and best-selling author. Fights continue over how to provide care, but the moral decision that people have a right to healthcare insurance coverage has been made, he asserted.
Gawande spoke about the underserved population before the ACA, such as an auto mechanic he treated who worked full-time for little money and without health coverage, and had huge medical bills. He was someone I had seen in third-world countries that I hadnt seen here--he was a healthcare refugee. He spoke of his son, born with a heart condition and now 18, who would be uninsurable without the reform law because of a pre-existing condition. The question of whether he deserves to be insured regardless of how much he contributes during his life is no longer at issue. His pre-existing condition is that he is alive.
In the new era of ACA and the accountable care that it has ushered in, it has become imperative that physicians and financial professionals work together to understand how to best handle the sickest people in the population, and data is a big part of the solution, according to Gawande. The sickest 5 percent of the population account for half of healthcare costs and the sickest 10 percent rack up two-thirds of costs, while one-half of the population consumes just 3 percent of costs. Doctors see the 5 percent, chief financial officers see the 50 percent, but we dont talk.
CFOs need to focus on the sick and data is the most important resource to improve care, Gawande said. Employers are learning that as they pass more healthcare costs onto employees, utilization drops sharply but costs continue to rise because consumers cut back on medications and other treatments. And those not cutting back on treatment arent getting the proper care because data isnt being used to analyze treatment.
Gawande spoke of a concerted effort in Camden, N.J., to identify where healthcare costs are coming from. An analysis found that 1,035 people in Camden accounted for 30 percent of care in the city and they were identifiable. He spoke of a 29-year-old woman who racked up $52,000 in costs. She had 29 emergency department visits, 51 physician visits and one hospitalization, all because of severe migraines and all emblematic of a person doctor-shopping for drugs. But data analysis found that she had a legitimate prescription for painkillers and was refilling it faithfully; the problem was that she wasnt on the right medication. No one saw the pattern of care, just each individual case, he said. She wasnt a drug seeker.
The work in Camden has found other ways to better serve the chronically ill that are far simpler than using analytics. Data analytics found that a single nursing home in the city routinely sent patients to the emergency department and rang up $100 million in charges with the patients not getting better. The solution was to put a nurse practitioner in the home.
Another simple way for clinicians and financial professionals to work together is to have clinicians teach patients with severe asthma how to properly use an inhaler to get the most benefit from the medication, and have finance pay for a free vacuum cleaner for patients.
Gawande also challenged healthcare CFOs to make a fundamental change in philosophy. The reality is that too often, hospitals make money when there are medical errors. CFOs need to say, We want to profit when things go right, he said. Nothing changes unless they do this.
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