Becker's Hospital Review

68 CARE DELIVERY for 18 percent of GDP. Most people know that's a problem, but no one goes to med school to change GDP. We need to reframe the cost conversation within the doctor-patient relationship, forgive the things they are not responsible for and focus on the things they are. If you take a picture of a generic American medical bill and show it to physicians, you will find several things wrong. Within 10 seconds, this will be the longest a doctor has ever looked at it. Prices are inflated and arbitrarily determined and doctors will throw their hands up at it. You need to tell them you understand it's not their fault and forgive them for that, but then highlight the times they are adding cost without helping the patient get better. ose instances are directly in their wheelhouse and they need to own that. Q: What would your best advice be to hospital leaders who want to help physicians be more cost-conscious? NS: e same thing — Keep the focus on the patient, as opposed to healthcare costs in general. e cost to the patient is different than the cost to the hospital, and the thing clinicians care most about is the cost to the patients they are caring for. Leaders need to show physicians thinking about costs is not skimping on necessary care, and maintain focus on the part of the problem that physicians own. Physicians may say patients are demanding that they need this, or voice concerns about medical malpractice, and leaders need to acknowledge that. Yeah, sometimes patients will say that and yeah, medical malpractice is tough, but it's not the whole ballgame. Q: What is your take on how healthcare has played out in the election so far? NS: First let me say that Costs of Care is very intentionally nonpartisan. Of course politics affect everything in healthcare, but we try really hard to make sure we present our solutions in a nonpartisan, neutral and objective way. e way it has played out is Obamacare has become a lightening rod for the Republican side. It's more neutral on Democratic side; there's a little bit of a spat between Bernie and Hillary about whether you start all over or do single payer, but they are essentially on the same page. ere are real legitimate pros and cons no matter which side you take. I would say if you are against the ACA, tough nuggies. It was held up in highest court in the land twice. If you are for it, you have to stand by it, and understand we didn't make healthcare any more affordable for Americans. For many of them we've made it easier to purchase insurance — but that's just your ticket to the show. Most Americans have high-deductible health plans and the average deductibles are several thousand dollars. No matter who you are, that's real money. Tests and treatments that don't make you feel better are eating into people's wallets. More people are insured, but insured with the worst insurance and still struggling to afford care. I would argue in 2016 healthcare is the least affordable it has been in the last half century. ere have been lots of benefits. My own younger brother wouldn't have a mechanism of getting insurance — he's in his 20s and doesn't work for a big employer. I see the benefits in my own patients because being a woman is not a preexisting condition anymore. ese are big forms of social progress, but it's an incomplete solution and we still have more to do. e key for the Becker's audience in thinking about healthcare reform is to be careful not to conflate two things: payment reform and delivery reform. e way money flows happens in the halls of Congress and delivery reform happens in the halls of hospitals. What we have to do is figure out what to do differently in our hospitals and clinics. If you have created the carrot and stick, your job isn't done. n "Usually people talk about healthcare costs in abstract terms, like they account for 18 percent of GDP. Most people know that's a problem, but no one goes to med school to change GDP." — Neel Shah, MD

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