Panel: Health Care Needs Major Surgery

The nation’s health care system is flawed--often giving patients outdated or insufficient care--and is badly in need of overhaul, the Institute of Medicine said in a report issued Thursday.

Urging doctors to shift from focusing on acute illnesses to monitoring chronic conditions, the report said, “Between the health care we have and the care we could have lies not just a gap, but a chasm.”

The institute is part of the National Academy of Sciences, which advises the federal government on health and science issues. Its recommendations are not binding but often sway policy. An institute report on medical mistakes last year provoked considerable notice.

The issues raised in the health care report are not entirely new. Managed care companies have talked for years about the need to create an organized approach for treating people with chronic conditions, and several have implemented such programs. And the suggestion that doctors should be rewarded more for quality than for their ability to save money has long been under discussion.

But as long as employers, the federal government and other purchasers of health care continue to insist that premiums stay low, the situation is unlikely to improve, said Bobby Pena, spokesman for the California Assn. of Health Plans.

“It’s a good sound bite to talk about quality, but at the end of the day, they want low prices,” Pena said. “We’re getting two messages. Which one do you listen to?”

Another problem, Pena said, is that some of the programs touted in the report have come under criticism from opponents of managed care. For example, the use of evidence-based medicine, in which doctors use only those treatments that have been scientifically proven to be effective, has been derided as “cookbook medicine” that prevents doctors from trying new approaches.

The report does a good job of putting in layman’s terms some of the key problems and debates in health care, said Peter Boland, a health care consultant based in Berkeley. But, he said, it does not offer real solutions to these difficult and costly 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,” Boland said. “But it doesn’t tell us how to get there.”

The study blamed a system that does not make the best use of its resources, especially information technology. “Patient information typically is dispersed in a collection of paper records, which often are poorly organized, illegible and not easy to retrieve,” said the report, which also urged physicians to start communicating with their patients through e-mail.

Among other things, the panel recommended a fundamental change in the way payments are made--regardless of the type of payment system involved--that would require certain services be performed, as defined by the specific condition.

This would replace the current system in which “the payment comes in if you see a doctor,” regardless of what the doctor does, said Dr. Molly Joel Coye, president of the Health Technology Center in San Francisco and a panel member.

Instead, payments would be tied to a set of services that have been well-established by science.

For example, “only 20% of diabetics get eye exams and foot checks, which are considered absolutely necessary in diabetic care,” Coye said. “The [current] payment system doesn’t say: ‘You have to do all these things for your patient if you want to get paid.’ And it should.”

The group also called upon Congress to create a $1-billion innovation fund for use during the next three to five years to subsidize promising projects and communicate the need for change.

Sen. Edward M. Kennedy (D-Mass.) said that the report was “a powerful call to action” and that he would try to craft bipartisan legislation that would address its concerns.

And Sen. Bill Frist (R-Tenn.), a transplant surgeon who has been active in health care legislation, said he would try to incorporate the institute’s suggestions when lawmakers seek to reform Medicare.

*

Cimons reported from Washington and Bernstein from Los Angeles.