CHICAGO—Since 1980, the medical value gap has widened between the United States and other countries. The U.S. has increased both public and private sector spending, and yet obesity rates are still the highest of any developed country, said Michael S. Benninger, MD, chair of otolaryngology at the Cleveland Clinic in Ohio. “Specialists dominate healthcare delivery in the United States,” he added.
Explore this issue:July 2016
The Affordable Care Act (ACA) was intended to remedy this situation, and it represents an unprecedented health plan consolidation. Its implementation, however, is associated with the escalating cost of healthcare, along with a Centers for Medicare and Medicaid Services (CMS) drive for provider accountability. Both the payer and provider have adopted new technologies, and the past years have seen the rise of both public and private healthcare exchanges and patient cost sharing.
During the Triological Society Annual Meeting, a panel of experts convened to discuss the implications of this evolving landscape for physicians, patients, and optimized care. The panel acknowledged that the new risk-based payment models represent an industry shift that leaves physicians not only to respond to unsustainable costs, but also to absorb the shifting of risks to providers. It is against this backdrop that physicians must look closely at the practice of medicine and define value.
“Value is, basically, quality over cost,” said panel moderator Dr. Benninger, opening the door to the diverse perspectives of the panel members.
“We live in interesting times. … Value is going to be the new buzzword,” said Christine G. Gourin, MD, professor of otolaryngology-head and neck surgery at The Johns Hopkins University School of Medicine in Baltimore. By 2018, 90% of fee-for-service will be reimbursed based on value, she added.
David E. Eibling, MD, professor in the department of otolaryngology at the University of Pittsburgh in Pennsylvania, introduced the role of transparency in value: “The foundation of healthcare, of course, is transparency.” Transparency can be defined as the free, uninhibited flow of information that is open to the scrutiny of others. Dr. Eibling argued that as physicians understand and improve transparency, they will likewise improve overall value. Transparency has the potential not just to fix many of the problems with patient safety, but also to help with healthcare cost and quality. Its many advantages include the fact that it is relatively inexpensive. Transparency also works across all levels of the healthcare system: It improves quality and safety by enhancing the trust among stakeholders in general, and between clinicians and patients in particular. Transparency encourages physicians to put the patients’ interests first to ensure quality care. As such, it is generally welcomed by patients, families, and policy makers.