“We need to fundamentally change the system to align what people are paid for…” — KELLY STANFORD, Group Health VP of Clinical Operations
KRISTEN BLACK PHOTO
for low back pain, and not prescribing sedative-hypnotics to treat insomnia, agitation or delirium in older adults. This is why it’s important for physicians to educate patients, says Olden, who adds that his patients understand that they may have to wait longer to see him because he spends more time discussing decisions with patients. He says physicians must talk to patients in a way that’s respectful and provides education, because it will ultimately lead to better outcomes in value and cost. Reducing unnecessary treatment, says Olden, will clearly reduce costs.
Yet there’s one sometimes overwhelming barrier in convincing patients to avoid a treatment they may not need. What if there’s even a 1 percent chance they do need it? What if, even though Choosing Wisely recommends against most CT scans for a headache, that CT scan ends up revealing something serious that otherwise would have been ignored? “That takes a long time to have that discussion. It’s easier to say, ‘Let’s go ahead and get it,’” Olden says. “We have to fight against that.” It’s tough for a physician. Patients have ideas about what they want, and the
system is designed around the idea that satisfied patients become repeat customers. If a patient doesn’t come back, doctors lose revenue. That’s why Olden says that health care reimbursement will need to change so doctors have incentives to value quality, evidence-based practices over quantity of visits. “That’s wishful thinking,” Olden says. “But that’s where we need to get if we want to bend cost curves and improve outcomes.”
MORE INCENTIVE
Physicians generally don’t object to Choosing Wisely recommendations, says Kelly Stanford, Group Health’s vice president of clinical operations and market integration. It supports the way they’d like to work every day anyway, she says. “The challenge is the gap between getting from one payment methodology to another,” she says. Right now, Stanford explains, physicians largely are compensated every time they do something — perform a procedure or order a test — a “fee-for-service” system. But for the amount of money we’re spend...continued on next page
Cross over to the bright side. Membership makes everything better.
Keep smilin’ at numericacu.com 800.433.1837
Federally insured by NCUA.
DECEMBER, 2016 - JANUARY, 2017 NEWS inhealth 11-28-2016.indd 17
Health 17 11/17/16 3:14 PM