Sunday, April 28, 2013

Nurses not Doctors

Great feature by Ezra Klein on the program launched by Health Quality Partners in Doylestown, Pennsylvania. This is a Medicare-funded program that has reduced costs and extended people's lives by doing something very simple: they have a nurse visit all their patients at home once a week.

Most of the money Medicare spends goes to people with chronic conditions like diabetes or heart disease. In fact, 78% of Medicare's money goes to people with at least five chronic conditions. No surprise there; most of the money we spend on health care goes to really sick people. Health Quality Partners enrolls patients with at least one chronic condition and one hospitalization in the past year and sends nurses to monitor their health and talk to them about how to manage their conditions better. By doing this one simple thing, HQP has reduced hospitalizations by 33% and cut overall costs by 22%:
There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or or a machine with these results it would be front-page news in the Wall Street Journal.
You might think that Medicare would be looking to expand this program across the country. But no; it was a pilot program, and they are planning to shut it down.

This points up the madness of the American health care system, where we spend billions on surgery and drugs whether they work or not, but can't be bothered to spend money on simple interventions that really make people healthier. The system is all about making doctors and hospital companies rich, not helping people. Surgeons have a powerful lobby, so the government pays them huge fees to cut people up even when it is a bad idea. Nurses don't have much of a lobby; they are too busy actually helping people.

Not that Medicare doesn't like what HQP is doing. But they are shifting their limited budget for pilot studies toward more grandiose schemes that pay private companies, not for providing services, but for keeping their patients healthy. They hope these companies will use schemes like HQP's. And this is another problem with our health care system, the way reformers focus on Big New Ideas instead of pushing things that we already know help.

It makes me gnash my teeth. But the politics have gotten so convoluted and so entangled with mutual suspicion that meaningful reform is all but impossible. 

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