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Sunday, October 11, 2009

Saving money with limos

Ezekiel Emanuel, senior health care advisor to the White House, wants you to have your patients picked up in a limo. Ok, not exactly, but he did list chauffeured luxury rides as one of the techniques that practices have successfully employed to get patients to show up for their appointments. If the office visit prevents a serious complication or hospitalization, then the limo's actually a cost-saver, Dr. Emanuel explained to MGMA attendees.

He has a lot of plans for saving money in health care, most revolving around the creation of comprehensive medical homes for patients with chronic diseases. (You know the drill--team care, coordinators, patient education, better transitions.) So how do we get there from here? Dr. Emanuel favors a bundled payment system. His model would be a modified fee for service system, in which the cost of a patient's care would be compared to a guideline-based, risk-adjusted estimate of what's appropriate. When a patient's care comes in under that number, physicians get to split the savings.

According to Dr. Emanuel, this system could help give doctors the feedback they want and need and provide incentives to offer quality, not excessive, care. Speaking of excessive, Dr. Emanuel also had an interesting perspective on the much-discussed impending doctor shortage. He does see a need for more primary care, but he doesn't think we are short of doctors overall. If we did fewer inappropriate PCIs and knee replacements, the existing docs would have time to get all the actually needed care done, he said.

Note: Dr. Emanuel was careful to state that he was speaking on his own behalf, not the administration's.

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posted by Stacey Butterfield at 11:33 PM  

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