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No doubt a key goal of the health care overhaul is slowing the growth of spending. Left unchecked, spending on health care could consume a quarter of the nation's entire economic output by the year 2025. Some policy experts think there might be a way to slow spending without hurting the quality of care and without slashing the incomes of doctors and others in the health industry.
NPR's Julie Rovner reports.
JULIE ROVNER: The health care cost debate pretty much comes down to this: You can't cut costs without hurting someone. Here is how former Republican senator Fred Thompson put it recently on "Meet the Press."
Senator FRED THOMPSON (Republican, Tennessee): The only way to really save costs is to have rationing, or it can be done by a crown(ph) down by the government and take it out of the hides of doctors and hospitals.
ROVNER: But some people think there is a third choice. Find a way to make the entire country deliver care as cost effectively as some parts of the country already do. The ideal health system already exists, says Len Nichols of the New America Foundation.
Mr. LEN NICHOLS (Director, Health Policy Program, New America Foundation): It exists in Grand Junction, Colorado, it exists in Billings, Montana, it exists in Denver Health, it exists in lots of places where people have figured out how to align the incentives of providers and patients so that they deliver higher quality care, more reliably, safer and at lower costs.
ROVNER: One thing those systems do that most others don't says Nichols, is coordinate care between doctors and hospitals. For example when a patient is released from the hospital, often he or she will go home with new medications and often a confused patient will go back to the old medications or take the news ones wrong. But in a coordinated system a nurse will make a phone call after a patient gets home to follow up. Nichols says something as simple as that can keep the patient on track and prevent a costly readmission to the hospital.
Mr. NICHOLS: We probably have about 20 percent of our Medicare patients are readmitted to the hospital every time. It ought to be about three percent. In those communities I named at the beginning, it is about three percent and they're doing it right because they are making sure the communication to patient is clear.
ROVNER: But it's not just that the lower spending areas of the country are doing a better job, say health experts, there's growing evidence, though still controversial, that places where medical spending is higher are doing a worse job, says doctor and researcher Elliott Fisher.
Dr. ELLIOTT FISHER (Doctor and Researcher, Dartmouth Medical School): There is a very consistent picture that the higher spending regions of the United States are not delivering care as effectively, or as efficiently, or as of high quality, as the lower spending regions.
ROVNER: Fisher runs the Dartmouth Atlas Project, which has been documenting how health care is delivered differently in different parts of the country for more than 20 years. He says one big hallmark of the high spending areas is that patients there have many more doctors, particularly more specialists.
Dr. FISHER: Patients in those higher spending communities are twice as likely to have 10 or more different physicians involved in their care. And it's really hard for physicians to maintain effective communication when there are so many more of them involved in a patient's care.
ROVNER: Which leads to problems and more expensive care that might have been avoided. What Fisher would like to see and what many in Congress are looking at, are new ways of paying doctors and hospitals. These revamped payment systems would give out bonuses for keeping patient healthy, instead of paying for every service provided which encourages doctors to see more and more patients for shorter and shorter visits.
Dr. FISHER: There are dozens of physician organizations and communities around the country that are very interested in coming together to try to form organized systems in which they could be rewarded for slowing the growth of spending rather than simply the current fee-for-service practices that we are currently rewarding at the time.
ROVNER: There's a problem, however, with getting the high spending parts of the country to act more like the low spending ones.
Mr. JOE ANTOS (Policy Analyst, American Enterprise Institute): We don't know how to do it. What we are really talking about is changing the way medicine is practiced, and that is not a price issue.
ROVNER: Joe Antos is a policy analyst with American Enterprise Institute. He says Congress should change the payment system for doctors and hospitals, but it shouldn't bet the farm on the savings that those changes might produce.
Mr. ANTOS: It would be great if it were true. But realistically, we've been talking about many of these ideas for a couple of decades now.
ROVNER: Which essentially leaves Congress in the position of every parent who has ever paid their kid an allowance for taking out the garbage. Dollar incentives can help, but they can't always perform miracles.
Julie Rovner, NPR News, Washington.
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