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Panel
Calls for Overhaul
of U.S Health System
WASHINGTON
(Reuters Health) - Stating that the quality of American healthcare
is substandard, an Institute of Medicine (IOM) panel on Thursday
called for a complete overhaul of healthcare delivery and reimbursement.
In a just-issued
report, the committee did not call for a national health system.
Rather, it said, fee-for-service and managed care leaders should
adopt new attitudes and technology to evolve into higher quality
systems.
The report
is available on the IOM's Web site at: www.national-academies.org/webextra/chasm.
The IOM panel
described a badly disjointed health system that ignores patient
needs and treats them as less-than-human, is given incentives
to manage acute episodes but not chronic disease, loses money
when it makes quality improvements, and wastes huge amounts of
resources--both human and technical.
``The system
is failing because it is poorly designed,'' said IOM Committee
Chairman William Richardson, who is president and CEO of the W.
K. Kellogg Foundation.
``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. For too many patients,
the healthcare system is a maze, and many do not receive the services
from which they would likely benefit,'' Richardson said.
The IOM report
said care should be safe, based on scientific knowledge, timely,
efficient and equitable. Panelists also said healthcare needs
to be much more patient-centered; it should be based on healing
relationships and be more responsive to individual patient needs
and values.
Committee
member Donald Berwick said patients should have ''unfettered''
access to their medical records, and that they should be invited
to play a greater role in their own care. Patients should be respected
as people, have their questions answered promptly, and not have
to play messenger and courier among their various physicians and
hospitals, he said.
``We don't
promise you that today, but we should,'' said Berwick, who is
president and CEO of the Institute for Healthcare Improvement
in Boston, Massachusetts.
The panelists
said much change could be accomplished if health systems invested
more, and more wisely in information technology. Hospitals and
physician practices, labs, and other providers have spent billions
on technology, but most of the time, the systems aren't compatible
from one side of a hospital to another, much less from a hospital
to a doctor's office, said panelist Molly Joel Coye.
Coye, president
of the Health Technology Center in San Francisco, California,
said the information technology industry needs to develop broader
standards to allow more compatibility between health systems,
and to let a patient's electronic medical record follow them from
one hospital to another or out of state.
Privacy can
easily be maintained, alleged Coye, who added she did not see
confidentiality issues as a stumbling block to achieving the information
technology goals.
The IOM panel
also urged Congress to set aside $1 billion over the next 3 to
5 years for a Health Care Quality Innovation Fund, that would
seek to find good quality practices and share them with health
systems.
Finally, payment
for services should be restructured to reward prevention, evidence-based
medicine, and for quality improvement. A simple example: physicians
should be paid to e-mail their patients because it could improve
care and create efficiencies, Coye said.
The IOM panel
did not blame individual physicians or nurses for poor quality,
but said they were trapped in a system that did not let them shine.
``It's time
for a new system in which they can do their work better,'' Berwick
said.
The major
physician professional organizations, including the American Medical
Association, the American Academy of Family Physicians, the American
College of Physicians-American Society of Internal Medicine, and
the American College of Surgeons, issued a joint statement supporting
the IOM panel's recommendations.
``The IOM
report validates what physicians already know: as good as our
healthcare system is, more needs to be done to improve quality,''
said E. Ratcliffe Anderson, executive vice president and CEO of
the American Medical Association.
Reference
Source 89
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