Click here for a full text transcript of the conversation.

Host Ira Flatow said in his introduction:

“Lost in the fray [of acronyms and actuarial tables] is the whole reason to have the health care debate in the first place…we’re going to try to reel it back in to talk about our values. What role do they play in shaping health care policy?”

Flatow noted that in its recent collection of essays, Connecting American Values with Health Reform, “The Hastings Center has tried to bring values back into the discussion.”

Len Nichols, health policy director at the New America Foundation, also participated in the show. Nichols, a health economist who wrote an essay on stewardship for the Hastings Center collection, said that passage of the final health care reform legislation is contingent on leadership that promotes shared values. “It is sometimes true is that those values seem to differ among political antagonists….but when you probe deeply and get in a dialogue you find out the values are actually shared,” Nichols said. “I believe most people share them and therefore we will end up with a bill that moves our country forward.”

It is a business truism that if you can’t measure it, you can’t manage it.  Our healthcare system is incredibly adept at measuring revenue, procedures performed, and patients moved out the door.  In our current system, physicians and facilities get tangible rewards for managing these measures efficiently.  However, research such as the Dartmouth Atlas illustrates that more of these things—payments, procedures, and patient throughput—aren’t yielding better health outcomes.

We need to focus on measuring quality and holding providers accountable for it.  We need to redefine efficiency as using our resources to get the best health outcomes.

As the largest payer in healthcare, the Centers for Medicare and Medicaid Services (CMS) has made substantial progress toward building accountability into the system.  Nearly all hospitals that provide services to Medicare patients report on quality measures such as steps to avoid infection, mortality rates for certain surgeries, and quality of patient experience.   However, there is still a long way to go towards accountability throughout healthcare. When CMS gave physicians an opportunity to report their use of good practices in caring for Medicare patients and offered a financial incentive for that reporting, the initial response rate was below twenty percent.  That level of accountability is not enough.

Health care reform must support the efforts underway at CMS and among private payers to measure the use of good practices, the rates of positive health outcomes such as diabetes or blood pressure under control, and the level of patient satisfaction with communication and controlling pain.  We must achieve a high level of measurement so that physicians and providers can manage their quality and be held accountable for it.  Only then can we get to the point where doing health care well is as rewarding as simply doing a lot of it.