Newest item on the checklist: greater integration

Dr. Atul Gawande through his books and articles in the New Yorker magazine successfully popularized ideas like adopting checklists to reduce medical error and targeting the sickest and costliest patients as a way of holding down healthcare costs.

But during his keynote address Monday to hospital finance officials meeting in Las Vegas at the Healthcare Financial Management Association's Annual National Institute, he ventured into new territory. He challenged finance officers to help lead their organizations toward greater integration and assume financial risk for patient outcomes.

Using a slide showing April 2013 headlines from the New York Times and Washington Post about hospitals profiting from surgical errors (alas, he didn't use Modern Healthcare's report on the same JAMA study, which he co-authored), Gawande said fee-for-service medicine actually grew the margin on one complicated surgery from $17,000 to $56,000 after things went wrong. "The incentives are perverse," he said.

It's time for hospitals and insurers to strike a different deal and move away from fee-for-service medicine. He applauded systems that are taking a greater outpatient role by purchasing physician practices; expanding their nursing home and home health operations; and eventually taking on risk by buying or developing health plans.

He claimed at least 90 health organizations with more than $1 billion in revenue are now moving toward becoming fully integrated. "That's the journey we're all talking about," he said.

Follow Merrill Goozner on Twitter: @MHgoozner

More Live@HFMA Coverage