Common sense tells us that there is a direct relationship between the cost of something and the quality of it.
A $2,000 junker simply isn't as reliable as a $15,000 car. And despite some experience to the contrary, we often assume the same is true in medicine. We often figure better care is simply more expensive.
But common sense can sometimes fail us when it comes to money, or to health. It's better care to avoid a readmission, and it saves money across the system. It's better care for the patient to go to fewer (but more impactful) visits, and it saves money across the system.
And recently, we came across one particularly striking example of a better treatment that is also the less expensive course of care.
The New York Times did a thoughtful review of literature showing that "the overwhelming majority [of knee replacement patients] recover equally well and may experience fewer complications if they go home directly from the hospital and get outpatient rehabilitation instead of spending days or weeks in a costly rehab facility."
The issue is that the category of care that is BOTH cheaper AND better is a category of care that requires sophisticated care coordination.
When double knee replacement patients go home instead of going to a rehab facility, they only do better IF they have prepared their home and made the accommodations in their lives to have the physical space and the support they need -- and if their medical providers have the tools to collaborate with each other and with the patient in the case of any issues, complications, or backsliding.
We tend to believe that the "simple" way to make sure providers are in touch is to have the patient stay in the rehab facility. That way there are eyes on the patient, and we think providers are talking to each other. But the proof is beginning to pile up that the "get them in the building" approach doesn't improve outcomes, doesn't actually improve healthcare collaboration, and certainly doesn't keep costs contained. It's a vestige of our old healthcare system -- and we providers deserve better and our patients deserve better.
There are more and more rewards for providing care that gets the best results and is also cost-efficient. But we need to have the healthcare collaboration and care coordination tools in place to make it possible.
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