It comes as no surprise that Virginia’s new Secretary of Health and Human Resources, Dr. Daniel Carey, supports Governor Ralph Northam’s push to expand the Medicaid entitlement. But he’s also got some ideas on how to squeeze costs out of Medicaid — and Virginia’s health care system generally.
One strategy is to decrease the use of procedures and tests that provide little value. Writes Amy Trent with the News and Advance:
He points to routine echocardiogram and routine stress testing before noncardiac surgeries as well as routine vitamin D testing, all of which can offer little value, he said. It’s more cost effective to treat most people with a vitamin D supplement rather than routinely testing vitamin D levels except in very specific circumstances, according to Carey. Physicians need to stop giving tests that are unlikely to change the care patients receive, he said.
“We need to eliminate that because it’s not cost-effective care,” Carey said.
Carey advocates implementation of the Choosing Wisely principles, launched by the American Board of Internal Medicine, which consults 100 medical specialty groups to maintain a library of overused tests and treatments.
While the state cannot mandate these measures, Carey said in a statement, “What we can do is work with the state plans, [The Department of Medical Assistance Services], and the Virginia Center for Health Innovation to not cover low-value care.”
Meanwhile, Carey wants to expand a Virginia Commonwealth University initiative that speeds recovery from surgery.
In the online publication OncLive, Dr. Traci Hedrick, co-director of the Enhanced Recovery Program at the University of Virginia Health System, writes that since her system’s implementation of enhanced recovery protocols in patients undergoing major colorectal surgery in 2013, the hospital has seen an average reduction of two days for hospital stays, an 80 percent decrease in opioid use and a 50 percent reduction in complications. In addition, “there was a $6,567 per patient reduction in total hospital costs,” Hedrick wrote.
Enhanced recovery after surgery makes sure patients are as healthy as possible prior to surgery, thereby reducing the effects of surgery on the body.
Both initiatives sound promising. The trick is implementing them in an industry notoriously resistant to change. It’s one thing to identify ways to spend health care dollars more efficiently, and it’s quite another to persuade hospitals and physicians to adopt measures which, if successful, will cut into revenues and profits.
One thing we know: Hospitals and doctors won’t implement the changes out of competitive pressure. There is no competitive pressure. Virginia health care is increasingly dominated by a handful of monopolistic health systems and giant physician practices. Moreover, there is no price transparency, so it’s not as if a hospital could gain market share by touting its lower-cost services. Virginia does have some control over the way it designs its Medicaid programs, so perhaps there is some hope in that sub-market. Otherwise, Carey will have to rely mainly on moral suasion. However, I can’t remember the last time moral suasion ever convinced anyone to act against their self interest.