I just finished read an incredibly thought provoking article in this week’s New Yorker, called “The Cost Conundrum, “ by Atul Gawande. (Gawande, who teaches at Harvard Medical School and its School of Public Health, also authored that piece on Peter Provonst’s work , “The Checklist” that got so much attention .)
Anyway, what Gawande did was visit the small town of McAllen, Texas. McAllen has the highest Medicare cost per capita in the US--$15,000 per enrollee in 2006, or twice the national average. Was healthcare any better there? Actually, he found, the measurable outcomes were lower. Gawande wanted to find out why, exactly, that was.
The town was littered with imaging centers, home health agencies, medical supply stores—and doctors ordering PET scans, surgeries and test after test. “Medicine has become a pig trough here,” said one of the town doctors.
Gawande also went to the Mayo Clinic, one of the highest quality healthcare systems in the country, at one of the lowest costs. And the town of Grand Junction, Colorado, which achieved some Medicare’s highest quality of care scores in the nation. A lot of what he found at those two places had to do with totality of care, and who was in charge of it.
But back to McAllen, Texas. There is a lot of data in this story, but in the end, for that town anway, it boils down to one thing: an across the board overuse of medicine, and physicians who view their practice as a revenue stream. And, why some communities behave differently from others when it comes to healthcare is the $2.4 trillion question. Someone has to be accountable for the totality of care, or you get a system with no brakes, like McAllen.
This all depressed me somewhat because I am about to start writing a story on CRM (customer relationship management) in healthcare. Now, some CIOs I really respect are starting to talk about this concept—which basically is treating the patient as a customer… or is that revenue stream? Which, after reading Awande’s article, seems like maybe the worst thing in the world.
So I’m sort of in a conundrum myself.