What if every single day a fully loaded 747 crashed somewhere in the world, killing all 500 passengers on board? There would be outrage, and we suspect that all of the planes would be grounded until the problem was solved once and for all. But every day, right here in America, medical errors are responsible for at least that many deaths.
A 2010 study from Health and Human Services estimates that 180,000 Medicare beneficiaries die each year in the US from hospital related accidents and errors. And any recommended fix in the short-term will have to take into account that the U.S. healthcare system is being stressed to its breaking point under the impact of changes related to the implementation of the Affordable Care Act ("Obamacare") and other developments on the healthcare front. While there is urgency to fix the problems of medical errors and their calamitous effect, the big question facing healthcare leaders is HOW? Where do we start?
And, to complicate an already dire situation, here's the perfect storm that healthcare leaders must contend with in the next few years:
• 30 to 32 million additional Americans who are currently uninsured will become eligible for healthcare next year.
• The number of Medicare beneficiaries is growing by 3 percent annually as baby boomers reach 65 while the number of workers who pay into the system is shrinking.
• More Americans are developing chronic disease (hypertension, heart disease, diabetes, asthma) in childhood while more doctors and nurses are leaving the system as they, like the general population, approach retirement.
• Fewer doctors are going into primary care -- family medicine, pediatrics and internal medicine -- and those over 50 are seeing fewer patients.
• And the doctors we have are unevenly distributed with key shortages in low-income and rural areas.
• Reimbursements to hospitals and physicians are dropping and will squeeze many healthcare providers as the formulae for reimbursement shift from quantity of procedures and hours spent to quality of patient outcomes.
The bottom line: costs are still going up, safety and quality are still critical issues and there are dwindling resources to call upon for the proposed fix.
Healthcare leaders are well aware of these issues and the need to deliver care more efficiently. However, if healthcare is to be sustainable in the U.S., it must be delivered differently as well, and that will require a seismic shift.
For example, we will need to shift the focus from spending for chronic disease, which accounts for nearly 8 out of 10 healthcare dollars spent, to promoting prevention and health maintenance. Translation: let's not spend all of our scarce resources trying to heal people after they're sick. We not only need to care for people who are sick, we need to try to prevent sickness in the first place, a much more effective use of our limited financial and human resources.
And to do this so successfully in an environment where fewer doctors are choosing to enter primary care -- where the major action around prevention and health maintenance take place -- means that care will now need to be delivered by a healthcare team consisting of doctors, nurse practitioners, physicians assistants, nurses, nutritionists and dietitians and pharmacists. In this scenario, each team member would address specific patient needs related to their professional expertise. It also means all team members working to the top of their licensure, with nurses, nurse practitioners and physician assistants addressing the 85 percent of routine complaints that make up the normal day in a doctor's office, enabling the physician to focus on undiagnosed and/or more complicated problems.
Some good news: Doctors and health information technologists are starting to use healthcare informatics to create profiles of patient use of healthcare and develop innovative ways to better meet patient needs and reduce costs. One of the leaders in this effort has been Dr. Jeffrey Brenner of Camden, New Jersey. Using a block by block map of Camden with patient visits plotted on the map, Brenner identified a two-block "hot spot," where people in two buildings -- a nursing home and a low-income housing facility -- accounted for more than 4,000 hospital visits and two hundred million dollars in healthcare bills over a five-year period. Using a similar approach to Emergency Room admissions data, Brenner and his colleagues in the Camden Coalition of Healthcare Providers identified ER frequent flyers (or "super utilizers" as they are known in the medical journals) who accounted for an outsize share of emergency room visits to Camden hospitals. By using innovative approaches like embedded nurses and healthcare coaches in the "hot spots" and using case management to ensure that the ER frequent flyers needs for housing, substance and/or psychiatric treatment, primary care and medication with appropriate drug counseling, they have been able to make remarkable improvements in the lives of the patients and they have simultaneously reduced the cost of their care.
Wider implementation of such solutions and other new technologies is not going to be easy. It will cost money, it will require patients and healthcare professionals to think differently and to learn new behaviors and it will mean that third-party payers will have to re-evaluate how they will support such innovation to nurture and heal.
And, it will take time to turn the healthcare ship around, to scrap old paradigms and create new efficiencies. But there's no time like the present. Today's 747 is thundering down the runway, and we'll have to move quickly if it is to arrive at its final destination with everyone safe and sound.