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U.S. health care system fails to deliver

Donald Berwick answers questions during an interview. | AP Photo

Health care reform brings better health, better care and lower costs, the author writes. | AP Photo Close

By DONALD BERWICK | 7/31/11 10:02 PM EDT

A few weeks ago, a colleague in the Department of Health and Human Services shared a story about his mother’s care. Briefly, here’s what he told me.

His mother had a knee replacement in January 2010. Shortly after discharge, she began noticing bleeding from the surgical site. She went to the doctor, but no specific actions were taken to address the bleeding. By the end of January, she had gotten a severe infection, requiring her to return to the hospital to have surgery to remove the new knee. After surgery, she was transferred to a skilled nursing facility, where she was nearly dropped during the transfer. Two weeks into her stay,

In the end, she had to go back to the hospital, where it was found the near drop had dislodged a temporary rod in her knee, cracking bones and requiring more surgery. By the end of June, the doctor had determined the infection had abated enough to put in the new knee. But the surgery was complicated by a severe, hospital-acquired staph infection, requiring her to return to the hospital four times a week for intravenous antibiotics. Now, 18 months after her first surgery, she’s back on her feet. But her operated knee is one inch shorter than the other, meaning more orthopedic care for her well into the future.

Think about how much needless suffering she had to endure. And think about how much more she — and all of us — paid for the treatment of those complications: infections, falls and operative mishaps, almost every one of which was preventable given current knowledge of high-quality health care. Think about the quality of the health care system that she needed — and that every one of us wants to have.

I wish the story were unique but it isn’t. Unfortunately, there are too many examples that show how our system can fail to meet patients’ needs. These problems are not a reflection on the many doctors, nurses and other professionals who work tirelessly to deliver the highest quality care they can. Instead, they reflect a delivery system that’s not always designed with the patient in mind.

Improving care and lowering costs are at the heart of the Affordable Care Act. As a pediatrician, as a patient and now as administrator of the Centers for Medicare & Medicaid Services, I have seen our health care system both at its best and at its worst. We know that system that we want — and with the ACA, we can have it:

  • Doctors, hospitals and all health care providers working together with the needs of the patient at the very center of their attention.
  • Cooperation among clinicians to guarantee people the best possible care every step of the way.
  • Relentless focus on improving patient safety and outcomes of care to reduce — even eliminate — complications and errors that hurt patients and drive health care costs up.
  • Alignment among all payers — private insurers and public programs like Medicare, Medicaid and the Children’s Health Insurance Program — to encourage and support better care for the patient.

A patient-centered health care system is not just a dream, it’s a pressing need. We can see proof of the possibility in examples across the country: physician groups that are effectively coordinating care; hospitals that have eliminated many forms of patient injuries and complications; realignment of financial incentives in Medicare and Medicaid to reward better, more coordinated care — paying for the quality and results of care, not just the quantity of care.

Thanks to the ACA, we now have new and promising tools to help take these successful examples to full, national scale. The Obama administration has launched the Partnership for Patients, a landmark investment of up to $1 billion to help America’s doctors and hospitals prevent infections and patient injuries. We are developing models for Accountable Care Organizations — groups of physicians, hospitals and other health care professionals who coordinate the care of patients who rely on them and share in the financial savings that come from better care if they meet tough quality standards. The new Center for Medicare and Medicaid Innovation will spread best practices across different settings of care, making excellence the norm.

We are also reforming our payment systems to encourage hospitals to improve patient safety, reduce preventable hospital readmissions and ensure that we are paying for value over volume. The ACA allows us more than ever before to set up payment systems that reward health care professionals who put the needs of the patient first. And increasing CMS efforts to promote transparency are giving people better tools to make choices about their care and more knowledge about the results of their care.

In the health care system we want — the system that we are moving toward at last — my colleague’s mother’s care would have been far different and much better. If her physicians and hospitals were in an ACO, they would have had more capacity for coordinating her care and stronger incentives for doing so. If payment for her care rewarded hospitals and doctors for reducing complications and readmissions, the rate of those mishaps would have been lower. If her primary-care clinicians were strengthened by forming a medical home or health home, she would have had better guides and advocates through the complexities of modern medical technology. All of those improvements and more are en route as we translate the ACA into reality.

We’re moving on the right path toward the three core goals that guide all CMS strategy and were put within our reach by the ACA: better health, better care and lower costs. That’s a future that deserves all the determination that we can bring to it.

Donald Berwick is administrator of the Centers for Medicare & Medicaid Services in the Department of Health and Human Services.

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