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RUFF: Our organization, Mountain Medical, has worked hard to come up with transparent costs. We do high-tech stuff—advanced imaging, MRI, CT, interventional things—and we came up with a program that patients could actually get real-time quotes from our facility for a cost estimate based on their insurance, their deductible or if they are just paying cash, which I think our patients have appreciated tremendously.
There are now web-based tools that you can use to look up what the appropriate cost for an imaging test might be, or any physician service, at healthcarebluebook.com. Third-party payers are putting that out on the internet. But we are at the infancy of application of IT in healthcare compared to other industries. We don’t share information well at all.
I sit at Intermountain Healthcare, and three years ago imaging tests that were done at an outside facility, where the patient was transported in for a trauma case, we couldn’t import those into our system. Today, finally, in the last six months we can import those into our system so we can actually get that information. We don’t have to repeat the testing and add cost to the system by doing that.
The health information exchange—not the insurance exchange but our health information exchange—is a step in the right direction. If you are a physician and seeing a patient in the office, you can get access to what the patient has had previously if the other physicians they’ve seen are participating in that. We are way behind most of the developed world in sharing healthcare information, which has added dramatically to our costs. Competition is good but it’s negative when we can’t share information.
HAMILTON: If I could change one thing in healthcare it would be the use of technology to prevent medical errors and increase patient safety. I’m a big believer in technology, probably to the point of irritation, but I’m an anesthesiologist and I’ve seen our specialty improve tremendously in my lifetime, orders of magnitude safer than it used to be, largely due to technological innovations.
But we still have medication errors because of bad handwriting. People put a decimal point in the wrong place and you give 10 times the dose or one-tenth of the dose. For a lot of these things, there are easy fixes. And like Dr. Ruff said, we are behind other industries sometimes in implementing this, partly because it’s so complex.
WHETMAN: If I could make one change to improve healthcare it would be the conversation between the physician and the patient. All the things that we are talking about—the technology, the changing incentives—will help us improve. But at the end of the day, patients are going to their providers for direction and navigation in a very complex system. And physicians are really trying to do what’s best for the patient and are not necessarily thinking about how it’s going to get paid for or the next step.
BINGHAM: The one single word that comes to mind as we’ve talked is just “simplify.” Most patients don’t even know what to ask their doctor. So as we roll out this technology, as we add this transparency, what are we doing to actually make it understandable? We need to put it at a third- and fourth-grade reading level to actually make it work. If all I know how to do is turn it on but don’t know how to actually do anything with it, what’s going to happen?
So we have to keep that simplify part in mind. As we do that, we’ll see great strides made.
MCOMBER: The administrative side of the healthcare is something that has to be addressed. Along with that is how highly regulated healthcare is—if you don’t check a box, you don’t get paid. The one big piece we need to look at is simplifying, but that includes the administrative and regulatory side of things.
Right now we are looking at about an average of three billers per physician in order to do it correctly. That’s a huge amount of administrative and regulatory costs.
SANPEI: Oftentimes the best improvements are made in the areas where you’re already performing the best. The reason is because those are the places where you have much of the infrastructure to continue to improve and accelerate the improvement. You have the right leadership in place. You have the right culture in place. You have the right innovation in place.
In Utah we have many of those pieces in place. We are the lowest cost per capita for a reason, and I think we still have the greatest opportunity out of any of the states to come up with solutions that work and will be sustainable and can be extrapolated to other places. Utah has got an optimistic future and if anybody can do it, we can here.