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June 21, 2023
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David Burda
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Economics Outcomes Policy
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Healthcare Needs To Get Its Priorities Straight

You need to get your priorities straight. I’ll admit to receiving that admonition at various points in my life from various people in my life. My guess is, I’ll hear it a few more times before I leave this mortal coil.

I’m sure that the U.S. healthcare system has been on the receiving end of that same admonition far more than I have. Probably an infinite number of times a day as the system’s customers — us — struggle with limited access, poor care and unaffordable costs.

One way to measure the system’s priorities — or a person’s priorities, for that matter — is looking at what it spends money on. Two studies offer a new peek at what healthcare spends its money on, and they tell me that healthcare needs to get its priorities straight.

In the first study, published June 6 in the Journal of the American Medical Association, 10 researchers from Johns Hopkins University wanted to know how much it cost hospitals to collect and report quality measures to various federal, state and private-sector healthcare agencies or accrediting bodies.

To find out, they did something simple. They added up all the measures at one hospital — Johns Hopkins Hospital in Baltimore — and the person-hours it took personnel at the hospital to collect and report them. They came up with 162 different quality measures collected and reported to seven agencies and organizations in 2018. The agencies and organizations were:

  • American Nurses Credentialing Center
  • Centers for Medicare and Medicaid Services
  • Maryland Health Care Commission
  • Maryland Health Services Cost Review Commission
  • The Joint Commission
  • The Leapfrog Group
  • U.S. News and World Report

The total person-hours were 108,478 at an estimated labor cost of more than $5 million. The hospital also spent another $600,000 and change on vendor fees to help collect and report the quality measures.

“Policymakers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality,” the researchers said.

I get the adage that you have to measure something to improve it, but this is pretty ridiculous. All these agencies and organizations need to get their priorities straight. Hospitals should spend more on making care better and safer for patients and spend less on telling everyone how they’re doing it.

One way to keep patients healthy, or as healthy as they can be, is prevention. How much the U.S. spends on primary care was the subject of the second study, published June 12 in JAMA Internal Medicine.

Using data from something called the Medical Expenditure Panel Survey, two researchers from the U.S. Agency for Healthcare Research and Quality calculated the medical expenses of a representative sample of about 29,000 people with an average age of about 39 years old.

The people in the study pool spent an average of $6,252 on medical care in 2019. But only $439 of that, or 7%, was spent on primary care, which, as you know, focuses on prevention and management to keep patients healthy or as healthy as possible.

The percentage varied by age group:

  • 11.4% for those 18 or younger
  • 8.3% for those 19 through 44
  • 6.8% for those 45 through 64
  • 5.1% for those 65 or older

Not only are we spending a pittance on primary care, but we’re also spending less on primary care as people get older — presumably when they’re more likely to get sick, hurt or suffer from a chronic medical condition. That’s pretty ridiculous, too.

If you want to know what’s wrong with the healthcare system in the U.S., just look at how it spends its money. Talk about needing to get our priorities straight.

Thanks for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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