Atul Gawande offers another view on creating health care cost controls in this week’s New Yorker.
A medical extension service.
It would be modeled on the agriculture extension services that transformed farming starting early in the last century. Medical extension agents would work with doctors, clinics, and hospitals on saving money, based on best practices and successful pilot projects.
(The late actor Alvy Moore played agriculture extension agent Hank Kimball on TV’s Green Acres in the 1960s.)
While Dr. Gawande notes there are a ton of pilot projects in the current Senate health care bill, he may not know that the core of an extension service is already written into law.
Many of the $19.2 billion in HITECH funding dollars passed as part of the stimulus are going to the collection of data on best practices and their dissemination.
It’s not called an Extension Service, but David Blumenthal, National Coordinator for Health IT, has already begun building the core of such a service in his latest re-organization.
You will find it under his director of operations, who will manage contracts signed for stimulus dollars. He or she will wield the weapon of “meaningful use,” and determine whether systems bought with those dollars are actually providing worthwhile data.
Savings emerge when data is turned into action. WalMart didn’t become a retailing giant just by buying IT equipment. It became one by aligning the data collected by its IT infrastructure to its business goals, squeezing suppliers, limiting time in inventory, delivering goods to shelves just in time.
Many private sector groups, like Kaiser Permanente, are already collecting the data they need to start transforming operations, and some even deliver enough services to start seeing results. Research groups like the Commonwealth Fund also collect best practices, and there’s a small underground industry of consultants targeting the savings.
Agents could be organized as a profession, they could associate by state, they could get certified, or they could be hired directly by the Department of Health and Human Services, either on an ad hoc basis or in some organized manner.
Point is the hard work is already funded. The data is going to be collected. Best practices are going to be defined. Building a profession around this should be straightforward, with practitioners earning their salary out of savings.
The elements of true health reform are in place, even if it doesn’t seem like they are.
