New IOM Report Urges ‘Overhaul’ of U.S. Health System

The new Institute of Medicine report released yesterday says that "America's health system is a tangled, highly fragmented web that often wastes resources by providing unnecessary services and duplicating efforts," and the time is ripe for a "major overhaul." The report, titled "Crossing the Quality Chasm: A New Health System for the 21st Century," presents a five-part agenda for revamping the nation's health care system to improve patient care and efficiency. William Richardson, chair of the committee that wrote the report and president of the W.K. Kellogg Foundation, said, "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients" (National Academies of Science release, 3/1). The committee said that fault does not rest on managed care, and instead attributed troubles to the general structure of the country's health system. "There's no reason to think that the quality problem we're discussing is attributable to managed care. This is an across-the-board problem," Health Technology Center President and committee member Molly Joel Coye said (Okie, Washington Post, 3/2). At a press conference yesterday, Richardson outlined the report's recommendations, which call for a "strong commitment" from providers, insurers, regulators, lawmakers and the public to improve the current system. The first task, Richardson said, is to ensure that care is safe, effective, "patient-centered," timely, efficient and equitable. To accomplish these goals, the IOM proposed 10 rules aimed to "guide patient-clinician relationships." These rules stipulate that care should be "customized" based on patient "needs and values," that patients should retain control over their own care, that care should be safe and that patients should be given information pertaining to care they receive. The health system should "not waste resources or patient time" and should "anticipate patient needs rather than simply reacting to events," the report states. The study also calls for clinical decisions to be based on the "best scientific evidence" available and urged increased communication and coordination between clinicians (Richardson speech text, 3/1).

Targeting Chronic Conditions and Electronic Advances
The IOM study calls for a greater focus on chronic conditions such as heart disease, diabetes and asthma -- the leading causes of illness in America. To help improve care for individuals with these conditions, the committee recommended that the Agency for Healthcare Research and Quality identify 15 or more common diseases. Health care professionals, hospitals and health plans should then work together to draft strategies and action plans to improve care for each of these conditions over a five-year period. The study also said that physicians should make greater use of technological advancements in medicine. Doctors could save time, money and patient lives, the report states, by using email and electronic prescriptions. Also, physicians who successfully incorporate these advances and who provide good patient care should be reimbursed adequately through payment systems that "reward quality," the report adds.

Federal Funding and Involvement
The government also has a role to play in improving the country's health care system, the report says. HHS should monitor and track improvements in patient care and should present its findings to Congress and the president each year. To help fund all of these proposed initiatives, the report suggests that Congress create a $1 billion "innovation fund" to be used over the next three to five years (NAS release, 3/1). While an overhaul of the current system will require "significant resources," the public and private sectors must both contribute to accomplishing this task, Richardson said. He concluded, "American health care is beset by serious problems, but they are not intractable. Perfect care may be a long way off, but much better care is within our grasp" (Richardson speech text, 3/1). To listen to yesterday's press conference, go to http://www4.nas.edu/onpi/webextra.nsf/web/chasm?OpenDocument. Please note: You must have RealPlayer to listen to this broadcast.

Praise From Patient Groups, Lawmakers
Reaction to the report from policymakers, medical groups and patient advocates was generally positive, the Washington Post reports. Gregg Meyer, director of AHRQ's Center for Quality Improvement and Patient Safety, said, "It outlines a really ambitious plan to restructure the way that we provide health care and to move us forward" (Washington Post, 3/2). The Massachusetts Medical Society also lent its support to the study (Lasalandra, Boston Herald, 3/2). Sen. Ted Kennedy (D-Mass.) called the report "a powerful call to action" and stated that he would try to draft bipartisan legislation addressing its suggestions. Sen. Bill Frist (R-Tenn.) added that he would keep the report's recommendations in mind during Congressional discussions on Medicare reform (Cimons/Bernstein, Los Angeles Times, 3/2). Sen. James Jeffords (R-Vt.), chair of the Senate Health and Education Committee, said that Congress should closely examine how to ensure that new medical discoveries are incorporated into practice (Washington Post, 3/2).

Obstacles to Implementation
But "obstacles abound" in implementing the report's suggestions, USA Today reports. Hindrances include the cost of installing information systems, doctors' "reluctance" to use online products, patient privacy concerns, liability issues and the "long-standing resistance of hospitals, doctors and others to releasing data about their performance." Robert Blendon of Harvard University said, "Many of these recommendations could be feasible in the long term but in the short term will not seem realistic to people in government or those who run the health system" (Davis/Appleby, USA Today, 3/2). A national nursing shortage and other funding needs have also prevented some hospitals from putting money toward new technology. Britt Berrett, president and CEO of Medical City Dallas Hospital, said, "Because of such low margins in health care, we have elected to invest those dollars into direct patient care. And with the nursing shortage, that's increased our investment in that area, not allowing us to invest in technology" (Ornstein, Dallas Morning News, 3/2). Meanwhile, employers and other purchasers of health care are unwilling to pay increased premiums to provide additional funding for technological advances. Bobby Pena, spokesperson for the California Association of Health Plans, said, "It's a good sound bite to talk about quality, but at the end of the day, they want low prices" (Los Angeles Times, 3/2). Even Dr. Lucian Leape of Harvard University, one of the report's authors said that the medical establishment "will have trouble" implementing the changes called for in the study (Neergaard, AP/New York Times, 3/2). Peter Boland, a health care consultant, added that while the report "does a good job of putting in layman's terms some of the key problems" in health care, it "does not offer real solutions" to these issues. "The report restates the problem in a way that people can understand it better, and perhaps that will lead to some kind of action. But it doesn't tell us how to get there," he said (Los Angeles Times, 3/2).