Lies, Damned Lies, and Healthcare Statistics

U.S.A. ranks 26th in Life Expectancy, Behind Slovenia!

It’s hard to ignore this dramatic newspaper front page headline.
The Life Expectancy graph is prominently displayed below the headline to
emphasize this statistic and to question the quality of U.S. healthcare.
Because you know, if there’s a graph, it must be science. IMG_5458

Even Slovenia is ahead of the USA. Further proof that the United States lags far behind
so many other nations in our quality of healthcare.”
Nothing against Slovenia, a beautiful country in Central Europe, but that statistic was meant as derogatory to our healthcare system.

While the stat may be correct, the conclusion is a lie. A damned lie.

I’m just not in the mood these days to put up with folks
attacking my country or my profession.

It’s hunting season and our nation’s healthcare is the target. Take a shot.
No limits. Like shooting fish in a barrel, you can’t miss. Whack-a-Doc.
But as the song goes, “you don’t know what you’ve got till it’s gone.”

Statistics are often used to make a point. In a world of sound bits, headlines, and shortened news stories, the superficial takes on more meaning than it should.
USA healthcare is too expensive, yes. But poor quality? Don’t be ridiculous.

The message that our nation’s healthcare is dreadful, ranked 26th in the world based upon a life expectancy chart is misleading, and frankly, it’s offensive.

It’s like telling a person that their parents were not so great
because they passed away too young.
“I beg your pardon?”

Let’s take a look at those stats.
First, life expectancy is way, way up overall. Everywhere.
In the USA, you can expect to live about 8 years longer now than you could in the 1970’s.
Your average life expectancy is 40 years longer than you could have hoped for if you were born at the beginning of the 20th century! 40 years longer!
In fact, throughout the history of Mankind, the average life expectancy has been only around 40 years old… most people died before 40… until this last century.

Thanks, America!

IMG_5461Advances during the last hundred years have been largely driven by the efforts of the United States, through improvements in hygiene, waste disposal, water management, immunizations, pharmacological and surgical advances. Free market motivation, American innovation, and altruistic dedication.

Our entire world has benefitted from the advances made in the USA.
How quickly some people forget.

An American medical education remains the most respected in the world, with many countries reaching out to our healthcare leadership and experience to guide their own efforts. There are foreign physicians training in every major medical center in our country. They are the lucky ones to be able to train here and they will tell you so. We lead the world in success rates in almost every mode of treatment and procedure. For example, the USA has the highest breast cancer survival rates in the world. And more than three-quarters of American women are screened for cervical cancer, more than in any other country.
May God continue to bless our greatest national treasure, American women.

Here’s another point: Life expectancy is largely driven by genetics.
Any biologist can tell you that the great diversity of race that makes America strong also affects our nation’s life expectancy rates. When all other variables are filtered out, people tend to live about as long as genetic tendencies guide. So comparing these numbers in the USA with, let’s say, Japan, Sweden, or Switzerland, the gene pool plays a significant role.

There are other factors in the life expectancy calculations.
For example: Violence and Auto Accidents.
U.S. Centers for Disease Control and Prevention reported in 2013:
More Americans die each year from suicide, around 40,000/year,
than die from motor vehicle accidents, around 35,000/year.

Our leading causes of death, heart disease and cancer, are more dramatically influenced
by a person’s lifestyle choices than healthcare intervention. Diet, exercise, smoking, and hope can affect these diseases far greater than acts of medicine.

We have access to more options of healthcare diversity than any country in the world. Our freedom to choose our own personal path to better healthcare is astounding.
Alternative, Chiropractic, Homeopathy, Spiritual, Naturalistic, Evidence-Based, Academic.
Take your pick. Blend them all if you choose. America’s healthcare remains the best in the World. It’s just up to you to use it wisely. Accountability, that’s the best option.

My final point.
IMG_5162When did the length of life become the measure of healthcare quality?

Healthcare is better measured by our vibrance, passion, and joy.
Our bodies are meant to be used, our minds tested, our muscles strengthened.
Run, walk, eat well, breath, study, pray, laugh, age.
Fill your years, however many years you may have, with love and curiosity.
There is no greater place than America to do so.
Ignore the naysayers and statisticians, let them be buried in Slovenia.

We have the greatest healthcare system in the world.

Guy L Culpepper, MD

 

Accountable Care Organizations – The Weavers

The Emperor’s New Clothes – The Weavers

picEmperors-New-Clothes1

Imagine the weavers staring at the naked, royal abdomen of the emperor. They knew full well the absurdity of the situation, but once the path of deception was taken, the weavers could only compliment their leader’s fine taste in clothing.

Last week I wrote about the clothing. Now, let’s take a closer look at the weavers.

An Accountable Care Organization, as a model of healthcare delivery, embraces the core values of primary care. The stated goals of measuring performance, improving efficiency, and coordinating care are undeniably worthwhile.

Rewarding primary care physicians to reduce the cost of healthcare

remains the right idea.

The ACO has the potential to do so much good. But the weavers got involved.

Hospitals, Insurance Companies, and Healthcare Entrepreneurs could see that the reimbursement system was changing. Billions and billions of dollars would be shifting from their control. 

Time to start weaving.

If primary care physicians were to be able to control costs, then the weavers knew that they needed to be able to control primary care physicians. 

The initial model of the ACO, proposed by the Medicare Shared Savings program in January 2012, empowered primary care to form networks with other providers to organize and coordinate delivery. That was the simple beauty of the ACO. Motivate PCPs. PCPs could use data to steer patients to more cost effective resources. By saving money, the PCPs could receive greater pay themselves. That would be a win for all.

Save primary care by helping primary care save money.

The problem for the weavers was simple. If PCPs saved money by keeping patients out of hospitals, referring to less expensive consultants, or using cost effective treatments… the money that they saved might be the weaver’s money.

That would never do. After all, weavers need lots of money… you know, to weave.

ACOs threatened to change the revenue of some very powerful and influential weavers. 

Those silly PCPs, they can’t save money on their own. The weavers must help these simple PCPs. Healthcare can only be delivered by complex, multi-layered vertically integrated networks. And these networks are very expensive because… well, they are expensive.

So messages were quickly spread:

Join an ACO or perish.

Don’t miss out. Never mind the details. Pay no attention to the beta testing. You need this. You want this. You got to be in this. We’ll worry about what an ACO is later. Sign up. Structure? Distributions?Ownership? This is the latest, greatest, new thing.

And just as with the Emperor’s new clothes, “only the ignorant” can’t see the beauty.

Physician’s anxiety to join an ACO was reinforced by….you guessed it…the very companies forming the ACO.  Hospitals, Insurance Companies, Specialists Organizations, and Entrepreneurs. Vertically integrated companies that much protect their market share, increase utilization, and support massive infrastructure. The very companies that contributed to our nation’s healthcare economic crisis. They don’t want to be part of the problem, they want to help….they just need lots of money to do it. 

And who are their key targets?  PCPs.

Remember that the only medical specialty required to form an ACO is primary care. So naturally all ACOs claim to be “primary care driven”. But ask who controls the revenue, who determines the overhead, and who steers the direction of utilization? Weavers are quick to point out the beauty of the clothing. But if you can’t see it, you must be ignorant.

In order to be recognized by the Department of Health and Human Services as an ACO the network must include sufficient numbers of PCPs to provide care for a minimum of 5000 patients. All of the other members of the ACO are infrastructure, overhead, and weavers.

So, if PCPs are the core component of an ACO, why don’t PCPs form their own ACO?

I’m so glad that you asked. I’ve written enough about the weavers.

Because, after all, only the Emperor himself could stop this charade.

Next week we’ll talk about the Emperor…  and oh, by the way…  you are the Emperor.

Guy L Culpepper, MD