From Common Misperceptions to
New RealitiesCharles W. Sorenson, MD
President Emeritus, Intermountain Healthcare, and Founding Director, Intermountain Healthcare
Leadership Institute
Misperception
What matters most to healthcare is who gets elected
Reality
There is no scenario where raising quality and lowering costs isn’t the winning strategy
Misperception1
Quality costs more
Cost and Quality
are inseparably linked
Reality1
Quality lowers total cost of care
Elective Inductions < 39 Weeks
Timing of Elective Inductions
0%
5%
10%
15%
20%
25%
30%
35%
0.00%
0.25%
0.50%
0.75%
1.00%
1.25%
37th Week 38th Week 39th Week
1.12%
0.45%
0.21%
Perc
ent
on
ven
tila
tor
Increased risk of newborns on ventilators with inductions < 39 weeks
Timing of Elective Inductions
0%
5%
10%
15%
20%
25%
30%
35%
Over $1.7 million in savings during 2009 and 2010
Elective Inductions < 39 Weeks
Timing of Elective Inductions
• Nuclear Stress Testing
• Angioplasty and Stents (PCI)
• Implantation of Permanent Pacemakers
• Implantation of Defibrillators
Clinical Outcomes: • Remained ExcellentAnnual Costs to Community: • Decreased by $15 million as compared to
expected volume-adjusted charges
Source: Clinical Program
Evidence-based cardiac interventions
Misperception2
High-tech always means better care
Reality2
Expensive devices and pharmaceuticals don’t always produce better outcomes
Gizmo Idolatry
1. Common sense appeal
2. Human love of bells and whistles
3. Exploits vs. uneventful diligence
4. Proof of competence
5. Proof against negligence
6. Channeling money
1Leff, B and Finucane, T. JAMA 299:15 (April 2008)Illustration © Scientific American
Misperception3
Every patient wants any treatment that might possibly help
Reality3
Fully informed patients make good choices that are right for them
Misperception4
Physicians shouldn’t be concerned about the cost of treatment
Reality4
Protecting our patients’ resources is part of taking care of them
Misperception5
Population health = rationing
Reality5
Population-based payment allows us to invest in keeping patients healthy
Misperception6
Transparency in healthcare is too flawed to be useful
Reality6
Transparency is inevitable and has the potential to be very useful
TURP Study
Misperception7
It’s impossible for people to change their behavior
Reality7
People can change their behavior with the right motivation
We can change health behaviors
TEENPREGNANCY
Cut 50% since 1991
SEATBELT USE
14% in 198485% in 2012
HIGH LDLCHOLESTEROL
59% in 197627% in 2010
45% of all adults in 196518% in 2014
ADULTSMOKING
Photo credit: iStock Photos Source: www.cdc.gov/nchs/data/databriefs/db117.htm
TEEN ALCOHOL,DRUG, TOBACCO
Trending down since 2002
DRUNK DRIVING DEATHS
Cut 50% since 1982
Misperception8
Healthcare (physicians) exist to fix problems
Reality8
We exist to create health and fix problems when needed
Misperception9
Doing well financially means doing more stuff
Reality9
Doing well will mean doing the right stuff
Misperception10
The future of healthcare is bleak
Reality
We have never had greater potential to create a bright future
10
“I am sorry for you, young men
(and women) of this generation. You will do great things. You will have great
victories, and standing on our shoulders,
you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”
- William Osler
“I am sorry for you, young men
(and women) of this generation. You will do great things. You will have great
victories, and standing on our shoulders,
you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”
- William Osler
“I am sorry for you, young men
(and women) of this generation. You will do great things. You will have great
victories, and standing on our shoulders,
you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”
- William Osler