Health Care Headache

 Health Care Headache

Providers, payers and patients battle rising costsMike Boyer If there’s one thing health care providers, payers and patients agree on it is that the rising cost of care is giving them all a headache.

It was a sentiment echoed by all the panelists at Cincy Magazine’s eighth annual Healthcare Summit, which brought together business leaders and health industry executives at the Metropolitan Club in Covington to discuss the issues facing the region’s health care.

“It’s the No. 1 issue in health care today,” says Dr. Thomas J. Redington Jr., one of the panelists and medical director of The Christ Hospital’s Critically Integrated Network. “If we can’t arrest the cost curve we’ve got some very, very serious problems.”

But just how to bring those costs under control is not as clear.

There’s a lot of media focus on health care decisions by the federal government. But panelist Erick Schmidt, vice president and managing shareholder for McGohan Brabender in Cincinnati, says, “The solution to the problem won’t come from Washington. Individuals, and the decisions we make, drive it. Having better transparency around quality and access to care and designing programs to get people to the right place at the right time are key to solving the issue.”

Panelists agreed that a shift from the traditional fee for service to a fee for value approach to paying for care is the answer. But getting there won’t be easy.

Care providers are using both fee for service and fee for value approaches, and moderator Steve Martenet, president of Anthem Blue Cross and Blue Shield in Ohio, asked what it would take for the fee for value approach to prevail.

Dr. Gary Kirsh, president of the Urology Group, says many insurers aren’t ready for a value-based approach to fees.

“It’s difficult to implement,” he says, “because you’re dealing across so many specialties.”

Kirsh also pointed to the disparity in costs between care in hospitals and that provided by specialty providers like the Urology Group.

“I’d challenge the hospitals on this a little bit,” he says. “They’re higher cost sites of service for outpatient visits when physicians are located on a hospital campus. I’d promote the notion that need to look critically at incorporating all aspects of the community in a collaborative way.”

Garren Colvin, president and CEO of St. Elizabeth Healthcare, defended hospital pricing.

“There are a lot of services hospitals provide that physicians won’t provide in the community,” he says.

“There’s two components to cost: price and utilization. Every hospital-owned facility makes money by doing procedures and if you look at utilization rates at physician-owned facility vs. a hospital facility you’ll see two different utilization rates so the total price may be cheaper in the hospital.”

Schmidt urged more and better data on health care quality.

“Representing employers in the room I think part of the challenge we have is there is a lack of data on quality,” he says. “We need steer to quality but it’s become harder and harder for employers to figure out what that quality is.”