Tackling Healthcare Quality and Costs

On a recent visit from my son Nick, the discussion turned to healthcare costs. Nick and my daughter-in-law Christine recently blessed our family with a chunky baby boy, elevating my status in the family lineage to grandpa. Nick’s question about cost, related to health reform and the impact on young families like his, was a great one I was happy to dig into. 

You see, in addition to being a proud grandpa, I also run a medical imaging focused healthcare consulting firm. I would like to think I know enough about health reform to be able to share some fundamentals with a twenty-something new to the workplace and trying to figure out life and a career as a mechanical engineer.   

As Nick and I begin to talk, I’m feeling confident and in my element. Our firm recently completed research that forecast the impact of health reform on imaging and the projected national utilization growth of more than 13 percent.. 

Nick wants to know more details. He starts asking about why the pricing for healthcare services varies so widely and why outpatient exams generally cost less. I begin by explaining how the pricing equation is constantly undergoing change and that the regulators and lawmakers are studying how to normalize these cost disparities through the use of electronic medical records initiatives like  the meaningful use and PQRS programs. 

The belief is, I explained, the transparency these systems can provide will improve healthcare quality overall, and this improvement combined with transparency will lower costs across the board. 

I was sure my explanations made sense, but as any parent can relate, your kids always seem to have more questions. Nick came back to where we started: “So Dad, it sounds like the government is trying to not only bring pricing in line across service locations but lower it overall. How will that affect local physicians that see tons of patients every day?”  

“Well son, it depends,” I confidently begin. “For physicians that have a diverse mix of payers, the impact will be somewhat less and take longer to come into play. But for other docs that serve a large Medicare or Medicaid population, it’s going to happen very soon.”

Quick, think of an example and relate to his world, I tell myself. “Take your pediatrician, for example. The average primary care doc sees a Medicare population of between 30 percent and 40 percent, and that would result in…” 

“Really?” my wife Amy interrupts. “How many Medicare patients do you think go to see a pediatrician?”  

Oops!  What was I thinking? Now she’s laughing at me and proceeds to share with Nick and Christine how dumb that explanation was and finishes things off correctly for me. Embarrassed at myself, I try to brush it off with a “Happy to entertain; you’re welcome!”

No doubt healthcare is complicated - obviously more complicated than I can explain, even after a 27-year healthcare career.  I’m sure I will continue to hear about that moment for a long time.  So much for thinking on the fly and relating to your audience.  

While I can count on being reminded of that moment, we can also count on the complications in healthcare and imaging continuing as providers learn new ways to demonstrate and improve quality while regulators look for ways to control cost.