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Paying for CTs and MRIs, but not (yet) for the ‘most effective service’

January 26, 2015

 By Margie Coloian

The medical paradigm is about diagnosing disease, according to Mitchell Katz, MD. “When doctors are trained to focus on finding the diagnosis,” Katz says, “the response will always be testing. That’s just the way doctors are trained.”  But does a medical system that is laser-focused on endless tests, and a multitude of subsequent treatments, deliver the highest value care?  Katz thinks not.

As director of Los Angeles County’s Department of Health Services, Katz oversees a finite county healthcare budget, which makes judicious spending of healthcare dollars a top priority. “We have a moral imperative to provide the best care, high value care,” he says, which he defines as primary and preventive services, smoking cessation, detoxification, and other services that help keep people healthy and shield them from medical interventions, many that are unnecessary.

Thanks to the expansion of the Medicaid program in California and other states, millions of Americans have gained access to healthcare. But one segment of our population has yet to fully benefit. Tens of thousands of homeless are falling through the cracks, says Katz, who is one of a small handful of select keynote speakers at the Lown Institute third annual conference, Road to RightCare: Engage, Organize, Transform, to be held this March 8-11 in San Diego.

Prescription drugs, costly diagnostics like CTs and MRIs, even better access to clinicians, have done little to improve the health of the homeless, many of whom have severe chronic and mental health conditions that are exacerbated by street life. On any night in LA County, scores of LA’s homeless end up at emergency departments for one health crisis or another. Once there, they’ll get all the tests and treatments any one would need or want. No expense is spared. But unless they are housed, they will continue the cycle of emergency department use and long hospitalizations.

Katz believes not only is housing a medical necessity, but also the “most effective service” he can provide to the homeless population. That’s why he led the fight to create a Housing for Health Division within the County Health Services Department, making sure housing takes a lead in a long list of needs. So far, hundreds have been placed in housing, but more—many more—wait in line.

“Why is it that we can afford CTs and MRIs, but we cannot afford housing?” asks Katz.

Now Katz is advocating that the federal government allow use of county Medicaid funds for the provision of housing for thousands of chronically ill homeless. Later this year, he’ll learn if the federal government approves such an innovative and unusual request. In the interim, Katz remains steadfast as a champion for housing the homeless. In fact, his passion has drawn attention from the PBSNewsHour, which dedicated a segment to this overlooked medical need.

“Compared with healthcare,” says Katz, “social determinants like housing are greater indicators of patient health. Fresh produce, clean air and water, walkable sidewalks and safe bike paths, these are what make up good health. As doctors, we can’t write a prescription for a bike path, but we should advocate for them,” he said. “One doc can’t do this alone.”

Katz is eager to speak at the conference and also to hear from other speakers and attendees about thoughtful ways to transform medicine. “People feel stymied. That’s why we need the Lown Institute. They will take a broader view of health,” Katz said, “and help to drive the necessary healthcare system changes.”

All are welcome to attend the Lown conference, but seating is limited. Registration closes on February 10.