Eye on better patient outcomes

By Deborah J. Botti
For the Times Herald-Record
Posted Jan. 13, 2015

What if you had a choice between selling two products that produced identical results with the only real difference being the price and your profit; which would you attempt to sell – the most expensive or least expensive?

Of course, the business students saw dollar signs.

And while few will dispute that medicine is a business, this solely profit-driven manner of thinking has no place in today’s healthcare transformation, says Teitelbaum.

“The goal of value-based or accountable care is to have compensation tied to outcomes – not the number of procedures or tests ordered. … The key to healthcare transformation is the primacy of patient welfare,” he says of the altruism that is infused in the objectives. “I’m not saying that everyone is going to become Mother Teresa, although that would be wonderful. But when making medical decisions, all that matters is the patient. Economics are secondary.”

Healthier patients are less of a drain on an already groaning system, ultimately freeing some of those strained resources for others.

And to make the math work, while providing the best care with an eye toward improved outcomes, the least wasteful course needs to be chosen.

“If you believe in medical tenants, this concept isn’t optional, it’s imperative …for society and the system,” he says, pointing to a recent Accountable Care Summit. “It’s not about taking anything valuable away, but it’s to avoid wasteful procedures.”

Teitelbaum traces professionalism in healthcare all the way back to principles Hippocrates and Maimonides touted, and calls for patient-centric care that looks at the whole person – physical, behavioral, cultural and ethnic – acknowledging that there may be differing views between physicians and patients.

“Patients need empowerment and engagement,” he says. “But the flip side is patient autonomy. We can come forth with our best arguments, but then it’s their choice.”

Healthcare transformation, then, requires transparency.

“We must treat our patients with honesty and integrity, and spend time with them,” he says. “That’s the only way they can make an intelligent decision.”

So while an amniocentesis might be recommended for a 38-year-old pregnant woman, if the results will not change her decision about the pregnancy, then why do the test?

Similarly, if a patient wants a CAT scan, but the results won’t change the treatment plan, then why do the CAT scan?

“There was a study published this year about orthopedic procedures by Virginia Mason University,” he says. “Their study found that a third of total knee replacements were inappropriate. That’s staggering.”

And expensive.

Teitelbaum also points to Wisconsin, where patients can review data on a reputable website how the hospitals and doctors in their area are doing. That transparency was demanded by the professionals there, and it’s an agenda that Teitelbaum says is being pushed for in New York.

“If we’re doing our job as physicians, we need to embrace transformation and patient-centric care with honesty and integrity – and there must also be transparency,” he says.

Teitelbaum says he believes the Crystal Run sites are evolving to meet these challenges. Crystal Run Healthcare has also partnered with Mount Sinai Health System and established the Mount Sinai-Crystal Run Alliance for Healthcare Transformation in which to share resources to further “better care, better health and lower cost.”

Teitelbaum has said that one-stop healthcare gives Crystal Run an advantage in continuity of care – and the ability to control costs.

Additionally, Crystal Run has applied to the state to be able to offer its own health insurance plans, which Teitelbaum has called the “ultimate in accountability.”

“We’re on pins and needles here,” he says. “We don’t have final approval from the state yet – but we’re literally expecting it any day. Our premiums, which are extremely competitive, have been approved. We’re hopeful we can offer this in 2015.”