More Medicine, Less Art – Reducing Variation in Healthcare Costs

After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact same way – it is always the perfect temperature and texture, and the taste is always superb. Simply put, I know what I’m going to get and it always keeps me coming back. 

The restaurant and many other industries have been executing on this strategy for years and have capitalized on it. Successful companies have long realized that lowering variation in products not only ensures a certain level of quality, but also will create long-lasting customers that keep them in business.

It’s surprising for me to think therefore that the healthcare system has been so slow to address the concept. It is why per capita spending for healthcare ranges from $4000 in Utah to $6700 in Massachusetts – for the exact same care. A study called the Dartmouth Atlas Project found that among 306 hospital referral regions, Medicare spending per patient range from more than $16,000 in some areas, to less than $6000 in others.

These numbers are astounding to me. It is no wonder that it is said that up to 30% of our current healthcare budget is due to waste in the system. That is almost a $1 trillion problem! It’s also surprising to know how little time and effort has been devoted to this huge problem by current healthcare reform initiatives. There have been some campaigns such as Choosing Wisely, which have sought to address overuse amongst specialties, which is a great start. We need more however.  What can providers and groups do to ensure some level of practice standardization? If we know that variation in healthcare costs is a huge component of our skyrocketing expenses, what are we doing to address this?

To begin with, hospitals and physicians groups should look at variation across their own operations, just as regulators and journalists have been combing through new data over the past year to look at variation across cities, states, and the country. If one emergency room doc is using lumbar series x-rays at five times the average for the department as a whole, chances are there is some wasted healthcare spending going on.

Sticking to best practice guidelines, continually monitoring utilization rates, and educating docs and other healthcare providers isn’t easy – in fact training docs to view their profession as more science than art can go against their natural inclination to think of themselves as bringing their creative problem solving skills to bear on patient care, not to mention the indoctrination of “medicine as art” some may have received in medical school.

Yet it is precisely the “art” of medicine that we were trained with that is contributing to the current peril in our current healthcare system. What we need now more than ever is a change in the way we view our healthcare system and practice. We need more medicine – less art.