Health care in our country costs too much, and in many regions, quality and access are not what they should be. Nationally, year-over-year growth in health care expenditures is one of the main drivers of the growing deficit and the national debt. In Vermont, quality is excellent compared to national norms, and most of our citizens have access to needed services. We can always improve on both of these dimensions, but the real issue is that health care costs have been increasing at an unsustainable rate over the past decade.
In our many conversations with the Green Mountain Care Board (GMCB)—the five-member panel charged with overseeing Vermont’s health care reform effort—they have articulated three goals, all centered on the cost issue:
- Move more care out of a fee-for-service payment methodology and into a system of reimbursement in which providers take responsibility for a defined patient population and are paid based on outcomes and improved quality.
- Improve coordination and collaboration among health care providers in our region.
- Reduce the rate of growth in health care spending—i.e. “bend the cost curve.”
These goals are laudable and attainable, in my opinion, but it will not be easy.
“Bending the cost curve” will require difficult choices and lots of hard work. We have already witnessed the rubber meeting the road in this regard. The administrative leaders and board at Rutland Regional Medical Center needed to review all of their existing programs and make tough choices to create a budget for FY 2013 that works. The decision? Discontinue inpatient rehabilitation services. The service provided was of very high quality and a real patient/family satisfier, but was relatively small and very labor-intensive. In addition, inpatient rehabilitation services are available at Mount Ascutney Hospital and the UVM Medical Center, relatively short distances from Rutland.
This is a real-world example of what it will take to “bend the cost curve” in Vermont. The debate about this decision was controversial and intense, and many still do not agree with the outcome. Similar discussions and decisions, all difficult, will follow as providing services close to home will be only one factor to be considered along with quality and the cost to provide services. Determining where to provide services, increasing collaboration and coordination among providers, and improvements in quality all hold promise for cost savings.
Improving quality and becoming highly reliable is an excellent cost-reduction strategy. Consider, for instance, our efforts to eliminate central-line associated blood stream infections. Four years ago, we experienced about nine infections per month in all of our critical care units combined. Between May 2011 and May 2012, we had none due to the efforts of many in our organization. Assuming about $50,000 in excess cost for each infection, this is over a $5 million reduction in annual expense.
I am confident we can truly reform health care in our region and bend the cost curve, but it will take the efforts of all of us and much hard work.
John Brumsted, MD, CEO, The University of Vermont Medical Center and The University of Vermont Health Network