Illuminating hospital costs, the promise of PCORI, and medical-legal partnerships

September 10, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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The opacity of hospital costs continues to plague patients who end up receiving surprise bills, which often lead to personal bankruptcy. It turns out, hospitals don’t always know what things cost either. The University of Utah Health Care is launching an initiative that could help put cost transparency in reach–at least to some degree. To identify the amount the medical center spends on every service and supply, the hospital has employed a new computer program that can display 200 million rows of costs, tracking drugs, medical devices, and clinician and staff time. In fact, as reported in The New York Times, the hospital now can calculate cost per minute in the ED, ICU and for particular surgeries. With this data, the hospital has been able to examine the drivers of cost and implement practices for more efficient care. One improvement curbs the number of orders for lab tests, which are often overused. Each order now must be justified before a lab can be drawn. Exorbitant healthcare costs, nationally and internationally, are forcing patients to seek relief in creative ways. The Sacramento Bee reports that patients are resorting to GoFundMe crowdfunding campaigns to pay their bills related to treatment, some not covered by insurance or related to taking time off from work. In 2011, there were 8,000 such campaigns around the world; today there are more than 740,000. In Sacramento alone, there are currently 1,600 campaigns asking for help.


The Patient-Centered Outcomes Research Institute (PCORI) was created under the Affordable Care Act to conduct comparative effectiveness trials and is slated to spend $3.5 billion to help illuminate the best and most patient-centered treatments. Some have voiced concerns over whether PCORI can live up to expectations, however. A review by the Center for Public Integrity found that PCORI spent only 28 percent of its contracting budget on “projects that assess how best to prevent, diagnose or treat diseases,” and provided nearly $10 million on engagement, meeting and conference awards to professional societies, as well as $500,000 to the insurance industry’s lobbying group. Additionally, a Government Accountability Office audit notes that the institute’s research priorities are “too broad and lack specificity”— concerns not unfounded when funded projects are described in such abstruse language as “creating a zone of openness to increase patient-centered care” or “how to capture stakeholder inputs.” In spite of these criticisms, many experts agree that PCORI provides a much-needed focus on patient-centeredness and evidence-based medicine. As the first assessment of the institute by an external evaluator will happen in 2020, after its funding has been spent, only time will tell.


While many clinicians are well aware of the important role that social and environmental factors play in health, they often may be at a loss as to how to help patients access the services they need. In response to this disconnect, hospital systems around the county have begun to establish partnerships with lawyers who can provide patients with counsel and support, PBS Newshour reports. Bruce Gordon, MD, explains, “We physicians have relatively little understanding of the legal process… We say things like, ‘You ought to be out of that house. You ought to be in someplace clean.’ And then I sort of wash my hands of it and don’t realize the downstream implications.” This type of medical-legal partnership program is of particular importance in light of a “sharp rise in destitute families.” Over the course of a year, more than three million children in the U.S. will experience at least three months in extreme poverty, according to Kathryn Edin, PhD, and Luke Schaefer, PhD, authors of the new book $2.00 a Day: Living on Almost Nothing in America. Edin and Schaefer describe the tremendous lengths to which these folks go just to put food on the table, and the horrible experiences they suffer simply trying to survive – highlighting the close link between poverty and health, and the dire need for more closely integrated medical and social services.



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