The Price of Cost-Effective Care

April 16, 1995|By JAMES A. BLOCK and MICHAEL E. JOHNS

Who really deserves the credit for driving down health-care costs?

While some say health maintenance organizations are responsible, a large measure of the credit goes to academic medical centers such as Johns Hopkins.

Granted, that's not the trendy view. But those who want to disconnect such centers from financial life-supports do so at their own risk -- and yours.

Diverting patients away from these centers or slashing their government funding may achieve short-term savings, but only at the risk of halting more significant long-term benefits -- benefits that are not just financial.

The reason is obvious to those who appreciate the difference between academic medical centers and most other hospitals or clinics. With their unrelenting insistence on the quest for new knowledge, academic medical centers develop the treatments and procedures that assure patients better outcomes that are truly cost-effective.

For proof, look no further than some recent accomplishments of physician-scientists at Johns Hopkins:

* The first successful treatment for sickle cell anemia. Sam Charache and George Dover demonstrated that a drug called hydroxyurea can prevent the excruciating pain and lethal side effects of this common blood disorder.

So definite was their proof that, in January, the National Institutes of Health called an early halt to clinical trials of the drug. That's good news for patients as well as for the insurers covering their frequent trips to emergency rooms and lengthy hospital stays. For employees, the new treatment means a reduction in sick-days and lost productivity.

* A new molecular tool to prevent repeat surgeries. David Sidransky and colleagues have developed a molecular probe so sensitive that it can detect cancer cells in tissues declared cancer-free by current tests.

They tried the probe first in patients who underwent head and neck surgery to remove tumors. Results published in the New England Journal of Medicine in February provide hope that such patients will have less chance of recurrences -- and hence less need for repeat hospitalizations.

* Improved surgery for pancreatic cancer. In the past, pancreatic cancer invariably led to a swift and painful death. Surgeon-in-chief John Cameron has so modified surgical procedures for some cancers of the pancreas that an increasing number of his patients are passing the five-year survival mark.

An article published in Annals of Surgery in January compared results of such surgery at Hopkins with results elsewhere in the state: We not only have better outcomes, we achieve them at less expense.

Similar examples could be cited for recent advances in treatment -- and prevention -- of conditions ranging from colon cancer and prostate cancer to chronic fatigue syndrome and epilepsy.

Is there a pattern here? We think so. What's happening is not random. It builds on a sustained track record.

Health-care cost inflation is decreasing today primarily because of medical advances over the past two decades that were developed at academic medical centers and disseminated throughout the medical world.

Much surgery can be performed on an outpatient basis or with shorter hospital stays because of better anesthesia, better instruments, better imaging techniques and new or refined surgical procedures.

Hospitalization for heart bypass surgery, for instance, has been cut from two weeks to one; for gall bladder removal, from one week to overnight. Mastectomies, hysterectomies and cleft palate repair can be performed on an outpatient basis, while cataract and hernia patients rarely stay overnight anymore.

Employers and managed care organizations should keep these changes in mind and reject arguments for squeezing academic medical centers out of today's medical marketplace.

We're not arguing for a blank check. Even if every employer and every managed care organization heeded our warning and offered full access to Johns Hopkins, we would still need to listen to the service demands of our ''customers'' -- our patients, physicians and insurers -- to flourish in todays health-care marketplace. And we have done so.

As a result, an annual, independent, benchmark study of hospital cost-effectiveness conducted by HCIA and Mercer ranked Hopkins one of the 100 top hospitals in the country.

So far, our multiple strategies for flourishing in the managed-care world seem to be succeeding. For instance, for the first time in its history, by June 30 of this year, Hopkins Hospital should discharge 40,000 patients.

With all this good news, are we satisfied to let marketplace dynamics determine our future? Not as long as the rules of the game are skewed against us.

Because we are an academic center that integrates teaching and research into the care of patients, and because we are committed to serving the needs of our community, the rates we must charge for hospital services are higher than that of many community providers.

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