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Cutting Fat

Dr. Marc Ringel

A look at treating bloodstream infections reveals an underlying discrepancy between price and value in the health care system.  And KUNC commentator Dr. Marc Ringel says there's a real opportunity to be found.

Here’s some bad news…and some good news.  The bad news is that in the last couple of decades the rate of sepsis (medical talk for bloodstream infection) has increased stratospherically.  750,000 Americans were struck by sepsis in 2000 (the last year for which I could find this statistic).  If you are hospitalized for a bloodstream infection, your odds of dying are one-in-five.  Sepsis causes at least 150,000 deaths per year.

In 2000 it cost an estimated $17 billion to treat this type of infection, rivaling the cost of caring for patients with coronary artery disease.  You can bet that, with the last decade’s accelerating health care inflation rate, the bill for sepsis is way higher today.

So, what could be good news?  First of all, thanks to advances in clinical science, between 2000 and 2010 the death rate for severe bloodstream infections, which are particularly deadly because they can lead to failure of every major organ system, fell from 39% to 27%.  Almost as good news is that treating this dread condition probably doesn’t have to cost as much as we’ve been spending.

In an article published this February in Archives of Internal Medicine, the authors report on a study they did between 2004 and 2006 on 167,000 septic inpatients at 309 hospitals.

At these facilities mortality rates of septic patients ranged from 9% to 32%.  Even correcting for illness severity, the researchers could find no correlation between the per-patient cost of managing sepsis, which ranged from $12,000 to $37,000, and the likelihood of surviving to hospital discharge. That’s more than a threefold difference in cost without any improvement in outcome!

With some fancy calculations, the study authors conclude that if the 105 hospitals that averaged higher than expected cost-per-patient for sepsis treatment could have just arrived at the group’s mean charges, which were $5000 lower, they would have saved $322 million, with no decrement in patient outcome.  Project this number to 2011 and to every sepsis patient in every hospital in the U.S. and it could come to some pretty serious money.

There are hundreds, if not thousands of studies which document the fact that throwing additional resources at maladies--more tests, medications, monitoring, consultants, and procedures--often does not advance patients toward the goal of making them better.

The pervasive discrepancy between price and value in American health care is appalling.  On the other hand I am thrilled we can finally get our hands on the sorts of data we need to fix our chronically underperforming medical system.  Researchers, like the authors of this study, are furiously developing and deploying new techniques that measure and compare the effectiveness and cost of different approaches to managing illness.

The Chinese language employs the same written character for “danger” and “opportunity.”  As we face the danger of medical insurance receding out of reach for much of the middle class and of the health care non-system sinking our whole economy, we also encounter the opportunity to create medical services that really do what they are supposed to, at a cost we can afford.

With the help of these new powerful information tools, we can cut a huge amount of fat out of American health care and be healthier for it.  And we don’t even need to pay an expensive surgeon to do the job.

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