The New Health Dialogue

Without health reform to bring down spending and improve care, health care costs are going to continue to climb out of control. Things are already starting to get ugly.

For example, UnitedHealth is currently locked in a dispute with Continuum Health Partners, an association of New York City hospitals (including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center), reports The New York Times. Contract negotiations between Continuum and UnitedHealth are growing more acerbic by the day, especially over a provision that would require hospitals to notify insurers within 24 hours of the time the patient gets admitted. If they fail to do so, UnitedHealth will cut their reimbursement for that patient in half.

UnitedHealth argues they’re trying to improve health care quality -- they want their case managers immediately involved in overseeing patient care. Dr. Sam Ho, UnitedHealth’s chief medical officer, told the Times that limiting patient stays in hospitals will increase quality, because extended hospitals stays are associated with higher infection risks, and hospital readmissions are costly. (Though it should be noted that increased risk of hospital acquired infections from treatments such as central line IVs or urinary catheters can be as much about leaving the same catheter in too long as it is about the patient being in the hospital for an extended period.) This is not about money, Dr. Ho said,

If you had a car that needed to be repaired and then it had to go back in the garage within a week, then a month, then again in two months, then perhaps the original quality of the work that was done was substandard…Absolutely, honestly, sincerely, this is a genuine attempt to try to improve outcomes for patients.

But hospitals are not convinced. Ruth Levin, Continuum’s chief contract negotiator, told the Times that doctors and hospitals were the ones with the expertise to improve quality and patient safety, not insurers. 

Jeffrey Rubin, an economics professor at Rutgers University, told the Times this push for cost control indicates escalation in insurers’ continual attempts to reduce costs, and represents “an example of the insurance company getting between you and your doctor.”

In the last few weeks, UnitedHealth sent letters to thousands of patients warning them they could be cut off from the hospitals and doctors they depend on for care, reports the Times, but Continuum responded by getting a court ordered injunction, to temporarily prevent the insurer from cutting off care.

During the raucous August recess, health reform had all kinds of false charges thrown at it, from rationing to death panels to government takeovers. Many opponents of reform were worried that health reform would come between “you and your doctor” -- but what do you do in a case like this, where out of control costs and insurer cut-backs come between you and your doctor?

Strict price controls in the face or rising costs are not going to make anyone happy -- not patients, not hospitals, not doctors, and probably not even insurers, whose bottom line will be continually strained as costs continue to climb. We need health reform that takes a comprehensive, balanced approach toward fixing our health care system, addressing the interconnected issues of coverage expansion, cost reduction, and quality improvement at the same time.