AAMC Reporter: August 2005

William L. Roper, M.D. CEO of the University of North Carolina Health Care System Vice Chancellor for Medical Affairs, Dean of the UNC School of Medicine

Viewpoint: "Improving Health Care Quality Is a Worthy Investment"

Few issues weigh more on the minds of Americans than the cost of healthcare, and with good reason. Healthcare expenditures represent about 15 percent of our nation's gross domestic product - and the pace of spending growth will be in double digits again this year. Faced with the enormity of these costs and the fiscal pressures they create, it seems only right to ask the bottom-line question: How do we get more value from every healthcare dollar we spend?

While barrels of ink have been committed to writing about healthcare costs, only recently has the public debate begun to focus on improving the quality of care. That is a welcome change. To answer this question, more ink, more political capital, and more innovation must be applied to improving healthcare quality.

The Agency for Healthcare Research and Quality recently released state-level data on health care quality in its 2004 National Healthcare Quality Report. The report found that while quality is improving in many areas, high-quality healthcare is not yet a universal reality and opportunities for preventive care are often missed, particularly in the management of chronic diseases. The gap between the best possible care and the current standard of care remains large while at the same time, internal and external pressures to reduce healthcare costs are as strong as ever.

I know from experience that the more healthcare consumers learn about how quality is measured and what constitutes high-quality care, the more emphasis health care institutions place on quality as a measure of meeting their mission. Initiatives like the Centers for Medicare and Medicaid Services' Hospital Compare Web site help consumers better understand the quality of care delivered in hospitals. These efforts toward industry-wide transparency are having an impact on how we think about quality in relation to other measures of performance such as the long-standing focus on reducing costs.

Healthcare providers sometimes view controlling costs and elevating quality as conflicting initiatives. As the CEO of a large academic medical center, I spend much of my time working to make sure rising costs do not impede our ability to meet our mission. The informed healthcare consumer is the patient who will invariably demand quality over cost. Healthcare providers must find a model in which reducing cost and improving quality are not mutually exclusive. One promising innovation involves efforts by Medicare and private insurers to pay providers more money if they reach certain quality standards - the "pay for performance" concept. This effort recognizes that placing a premium on quality can help reduce the long-term costs that result from current deficiencies in the standard of care.

Other industries prove every day that quality can increase even as costs go down. That's the surest path to creating customer value. And that's true in healthcare, too. A real commitment to quality in healthcare can lower costs, for example, by ensuring medical errors are reduced, by implementing best practices that make care delivery more efficient, and by improving management of chronic illnesses that account for a huge proportion of overall healthcare spending.

Healthcare consumers have traditionally viewed efforts to control costs by payers, such as Medicare and Medicaid, insurers and employers, as compromising patient care. But it doesn't have to be that way. I believe we can reduce spending and improve consumer health by applying the principles of transparency and measurement to a continuous quality improvement process.

Transparency, when managed correctly, ensures that everybody's watching - patients and families, doctors and nurses, insurers and policymakers - and that all parties have the information they need to evaluate healthcare systems responsibly and completely.

Measurement is also essential. Pursuing quality without quantifiable evidence is wasted effort. For example, we know certain things about delivering care that can improve patient outcomes. Much of this evidence is undisputed. The tough work is making these practices part of a system of care that is repeated time and again. Consensus-based standards for performance and measurement of healthcare quality, such as those developed and advanced by the National Quality Forum, help establish accepted processes for care delivery that, when embraced, improve outcomes for patients.

At its most basic level, quality of care is best measured by its impact on the lives of patients. Which brings us back to the core question: How do we get more value from every healthcare dollar we spend?

Healthcare quality can be improved each and every day by systematically applying principles of transparency, measurement, and best practices. Coupled with incentives that reward success and demand accountability, initiatives based on these principles will directly improve the overall quality of our nation's health care system and also reduce costs.

Dr. Roper is chair-elect of the National Quality Forum and a former director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing Administration (HCFA) - now the Centers for Medicare and Medicaid Services.

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