Bringing it back to health care

In a break from my feminist rantings, I found this post from the Health Affairs blog (in an effort to to read other health care blogs). Frank Opelka, a professor of surgery and vice chancellor for clinical affairs at the Louisiana State University Health Science Center, discusses the problems with the way the sustainable growth rate is currently calculated, a better way that it could be calculated and the problems that would be encountered (and overcome!) in implementing his suggested system.

I'm not going to go into the problems with the SGR (see my previous post on Leavitt's blog post of the subject), but I think Opelka's endorsement of a MedPAC suggestion has merit. MedPAC suggested, as part of a Deficit Reduction Act mandate, that the government create "unique Service Category Growth Rate (SCGR) targets as well as payments based on participation in a system of care," noting, "In each proposal, the goal is to avoid the blunt, lofty economic drivers and provide physician incentives to moderate growth in volume and intensity within a geographic setting, specialty base, or system of care," i.e. regional, rather than a national, targets.

In general, when it comes to measures based on economic indicators (like eligibility guidelines for public programs), I think that regional is always better. It does not cost the same to practice medicine in middle-of-nowhere Nebraska as it does in New York City. Regional just makes more sense.

He adds a bit about incorporating quality measures into the SCGR:

These quality tools could serve as a valuable resource for regions and systems of care to promote evidence-based, efficient care. Physicians, medical groups, and hospitals will need to use the current measurements available for comparison against their peers and national benchmarks. Through payment incentives and a clinically focused approach, regional efforts and systems of care will have a greater opportunity to reach individual providers.

Concluding

The best model for modifying the SGR likely includes both regional targets and assessment of spending by specialty. The true answer lies in changing the reward system so that physicians are rewarded for collaborating and making decisions in the best interest of the patient and the overall health care system. The payment system can no longer pay blindly on volume, but must instead financially encourage providers to remove waste and promote efficient, high-quality care. The SGR is too far removed to change behavior at the individual provider level. Regional and service category proposals will bring the requirements closer to the individual, but it is important that unintended consequences be modeled in advance and offset by mandatory quality targets.

I think Congress is supposed to tackle this sometime this session, although I seriously doubt that they will (seems a bit too complicated for lawmakers to handle). But maybe next session, if Democrats can manage to win control of both houses and the presidency. Even if they don't, someone needs to tackle the SGR revision, and soon.