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Monday, August 21st 2006

What's Your Case Volume?

This has become one of my primary conerns. I have a broad view of this issue. I want a more tertiary system in this country, where we lower the number of specialists and the centers that do complex procedures in favor of primary care physicians who can focus on being attentive to patients and also stressing preventitive care.

Why is that important? Well, for any number of reasons, but one of them is that the system as it is now has MANY PEOPLE, DOING A FEW COMPLEX PROCEDURES. This is a poor, poor system for quality. A surgeon or an interventionalist is like any specialty, the more you do something, the better you are. Now every hospital has to have a hear transplant program, etc. and so everyone sees fewer of those cases.

That is what is going on across the country, and more specifically as Managed Care Matters talks about, in Philly. Too much healthcare.

Two recent articles highlight the massive inefficiencies in the US health care system. In Philadelphia, five hospitals now have heart transplant programs, even though there are only enough patients for two. The result? Hospitals will not perform enough to gain the experience needed to improve safety and efficiency while lowering variable costs.

Of course, there are some protective mechanisms already, in terms of accredidation, especially at teaching hospitals with training programs. But, it is inadequate.

A single payor system could easily “fix” this problem by dictating physician numbers, but I’m not willing to settle for that and believe market forces can do the same.

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