Note: The following article is adapted from a blog post by Intermountain President and CEO Charles Sorenson, MD, which is read by Intermountain employees.
I want to share with you a few excerpts from a thought-provoking speech I heard recently that was full of sobering statistics that have implications for our Shared Accountability work-and that contained a very compelling and heart-rending story.
"When you hear the words federal deficit, think healthcare," said Shannon Brownlee, author and guest lecturer at Intermountain's Healthy Dialogues series. "Our deficit problem is a healthcare problem. When you hear the words state budget cuts, think healthcare. States are going broke trying to pay for it. And when you hear the word unemployment, think healthcare. Rising healthcare premiums account for about 20 percent of current unemployment."
She continued: "We are at a crossroads that will not only determine the fate of American medicine for many decades to come, but will alter the economic fate of the nation. That might sound overly dramatic. But, if anything, I'm underplaying the importance of our time. In reality, our children's economic futures depend upon our willingness to act now."
Ms. Brownlee is the author of the book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, in which she exposes wasteful flaws and argues that too much medicine may be what's crippling our U.S. healthcare system. It was named the No. 1 economics book of 2007 by The New York Times, and if you have a chance to pick it up, I highly recommend it.
One of the things I thought most supported Intermountain's values in Ms. Brownlee's remarks was that, while she presented strong and even frightening evidence regarding the economic implications of waste and overuse in medicine, she kept the well-being of the patient and the relief of human suffering at the heart of her argument. As she argued passionately for redrafting the "contract" that has governed medicine and healthcare for the last century-and that has led to the erroneous belief "there is no such thing as too much care"-she told this story:
"Four years ago, a woman who is now in her mid-forties went into the emergency room because she was having chest pain and difficulty breathing. A lot of things were going on in her life. Her eldest son was going off to college. She was happy about it, but she was going to miss him. She was studying to become a nurse's aide, and it was hard: She's an immigrant, and the language made it hard work. And her husband was leaving her. She appeared in the emergency room, saying: 'I think I'm having a heart attack.' The physicians put her through the standard work-up, which revealed nothing. They sent her to her to her primary care physician, who suggested she see a cardiologist. The cardiologist did a non-invasive work-up, finding no abnormalities. But soon afterward, she had another panic attack and was sent back to the cardiologist, who then said: 'Just to be sure, let's do a catheterization.' While on the table she was aware enough to be able to see the actual images of her own coronary arteries. Her physician commented on what he was seeing: 'See, just as I suspected, you have no heart disease at all. You're fine.' But as he completed the study, the catheter perforated her coronary artery. She had to be defibrillated nine times over the course of four hours. Now she really does have a heart problem. She's chronically ill, unable to walk up stairs, and she's on seven different medications, including, not surprisingly, anti-depressants. She was harmed-and she is not an isolated case. Every day, every second of every hour, American patients are being given drugs, blood tests, imaging tests, minor procedures, and major surgeries that they do not need, or that they would not have wanted if they'd understood what the trade-offs were.
"Overtreatment or overuse, whatever you want to call it, is causing harm to patients and crippling the nation financially. It's endemic to the financing and the culture of American medicine. I don't want it to sound like I'm blaming physicians. They are trapped in a system that makes it incredibly easy to deliver unnecessary care and makes it hard to do it right.
"What if the physician had said instead, 'You almost certainly don't have heart disease, but you are sick at heart. What you need is help coping with your situation, and we're here to help you.'"
Carefully educating our patients about the potential risks and benefits of tests and procedures, helping them share in the clinical decision-making process, is a significant part of our Shared Accountability approach at Intermountain. So is working to create the kind of system that makes it easy for all caregivers to "do it right."
Ms. Brownlee paid Intermountain several compliments that I'd like to share with you-as the people who actually turn good ideas into action in our organization. She referenced the American Revolution as she noted that we have been "granted the privilege of bearing witness to another extraordinary revolution, the transformation of American healthcare. And it is starting here," she said. "Intermountain is among a few places around the country at the center of that revolution." Why? "Because," she added, "you are among those who are doing the hard work of evaluating clinical processes, and making important changes in how we align incentives and communicate with our patients."
Transforming healthcare is complex, and we won't be finished in a few years. To make changes that improve clinical outcomes and reduce overall costs, we need to align incentives for providers (all of us), payers, and patients. We need to more effectively engage individuals in behaviors that reduce the risk of chronic and acute illness, and reduce the cost and physical burdens of disease. We'll continue to talk about Shared Accountability, helping all of us understand the path ahead and why each of us needs to be a part of the solution.
But there is something very simple about all of this as well. We're dedicated to extraordinary care-providing all the care that is needed, and none of the care that adds only cost or risk. We support behaviors that help people stay healthy in the first place, so they can live happier more fulfilling lives. We've begun, and not too soon. We agree with Ms. Brownlee when she says: "We cannot let this moment slip away."