Take childlike approach to health care cost control

In order to control health care costs in this state we need to spend more time acting like children. The cow pasture near my childhood home was never captured by Commie hordes that wanted it so desperately because the boys in my “hood” fought together in its defense on a regular basis. Pooling our limited resources of military know-how and toy guns (my favorite was the Johnny 7 – “Seven guns in one!”), and using tactics of torment and stealth first tested on our siblings, we beat back legions of imaginary Russkie soldiers intent on our manure-mined turf.

Had we approached our war as American society has approached the issue of health care cost control that pasture would now be Russian territory. Unlike the Pasture Defense Force, the participants in the health care cost control debate – business, the health care industry, the health insurance industry, government and patients – have fought each other rather than the common enemy. They have passed over most opportunities to collaborate, devoting energy instead to numerous areas of disagreement, and failed miserably to control those costs.

This year will see a great deal of activity in Maine aimed at reining in health care costs, activity motivated in part by a slowing economy and rapidly increasing health insurance premiums. The Maine Legislature will be on this issue like Spandex on a super model. The managed care health insurance companies are more desperate than ever to keep down health insurance premiums.

The battle lines will be drawn, the fight joined, the dung flung and the opportunities to cooperate squandered again unless we try something different. That “something different” should be an effort at health care cost control characterized by the same spirit of collaboration most of us learned in the playgrounds and pastures of our childhood.

First and foremost, that collaboration must be given life and power beyond the spirit of the moment, in the form of a Maine Institute of Health care Quality and Cost Control. The institute should be a joint initiative of government, health care, business, health insurance, and patient interests, dedicated to health care quality and cost control. It should work with all of them but for all of us, finding, disseminating, and implementing reasonable health care cost containment initiatives. It would be a dedicated power tool for health care cost control. It needs the likes of George Mitchell to get it started.

The institute should serve as Maine’s nonpartisan health care cost control expert. It must be connected to the social institutions necessary to make it effective, so that its work is ultimately supported by new laws, medical practices, health insurance policies, etc. The institute should take cost-effective practices identified in good medical studies and work to make them the usual practice in Maine. Its initiatives should be adopted by the health care industry, with appropriate support from the health insurance industry, lawmakers, and Maine’s government.

A simple, limited example: Studies have shown that patients who twist an ankle and have certain findings on examination of the ankle do not need an ankle X-ray to rule out fracture. These exam findings are known as the Ottawa Ankle Rules, and their widespread use could cut our health care costs by preventing unnecessary ankle X-rays in the emergency department. Avoiding unnecessary X-rays and other procedures can translate into lower health insurance premiums for all of us.

Working with doctors and others represented around its tables, the institute could take the initiative to implement the Ottawa Ankle Rules in every Maine hospital. The Legislature, supported by the institute’s findings, could pass laws that would protect doctors who followed the rules when a patient sued because an ankle fracture was missed as a result, and would allow insurance companies to refuse to pay for ankle X-rays that were unnecessary under the rules.

The institute would have to be funded by taxpayers, insurance companies, doctors and hospitals, and perhaps a philanthropist or two. A grant and some state dollars could get it started; if there are such dollars to save Atlantic salmon there ought to be some to save health care. The dollars will be well spent; if the institute does not pay for itself tenfold in health cost savings every year I will eat this column.

The opportunities to collaborate in health care to reduce costs are endless. It is the collaborative process that has proven elusive. An institute funded and supported by the health care cost stakeholders could make collaborative health care cost reduction efforts a way of life in Maine’s health care cost debates. Most other efforts at cost control will be fragmented, partisan, short term, and doomed to failure.

The alternative is war over other efforts, war in which no participant has the strength to win, everyone loses, and the participants come out smelling like a bad day at the pasture.

Erik Steele, D.O. is the administrator for emergency services at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the Bangor Daily News coverage area.