Gawande ties quality, affordability

Most of what happens in healthcare can be measured on a bell curve, Harvard School of Public Health Associate Professor Atul Gawande, M.D., told attendees at the American Medical Group Association meeting in New Orleans, and usually, the places leading the curve on quality are in the middle or bottom half of the curve on cost.

Gawande cited the University of Minnesota Medical Center in Fairview, where the life expectancy of a cystic fibrosis patient is 47 years compared with the national average of 34. Gawande said the result of this excellent track record, which includes not having a teenage cystic fibrosis patient die from the disease in 15 years, is that their patients also require fewer hospitalizations and fewer transplants.

“When we work at making care great, this is the way that makes care affordable,” Gawande said.

But he also warned that “when we succeed, there will be people who scream,” or—at the very least—suffer financially.

He told of how Children's Hospital in Boston initiated a successful program to reduce hospitalizations from asthma that went as far as buying vacuum cleaners for poor children whose families didn't have one. The program worked, but the hospital suffered because asthma was their largest source of admissions.

Instead of ending the program, Gawande said physicians are working with a private insurance company and state Medicaid officials “to remake the way they get paid.”

“They're still working on it,” Gawande said, but the important thing is that physicians took the lead instead of waiting for instructions on how to follow.

A record 1,700 people are attending the event.

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