PORTLAND – It’s a jarring notion, but if the state continues to see rising health care costs while its wages remain flat, “Maine will be America’s Third World, an economic mud flat full of the old and poor with an economy based in health care and government services, and tourism, and little else.”

So said Erik Steele, D.O. and chief medical officer of Eastern Maine Healthcare Systems in Bangor, who kicked off a conference examining the state’s unbridled health care costs at the University of Southern Maine Wednesday.

“Who among you believes that if health care costs continue to rise the way they are currently we will still have a Bath Iron Works, a Cianbro, a Hannaford and Anthem in Maine in 10 years, or even five?” he asked. “Who believes we will still have a thriving small business community? Who believes our kids will come back here to live?”

If Maine’s health care costs continue to climb at their present rate, they will top $5 billion in additional spending by 2013, said Doug Libby, executive director of the Maine Health Management Coalition, one of the conference’s sponsors.

He encouraged the audience to lead the state in real reform, noting that representatives from the four biggest health care systems were in the room, which control more than half of Maine’s hospitals.

Steele said there are a number of things providers, insurers and patients can do right off. The first is stop performing high-cost procedures that have negligible benefit. Two years ago, EMMC began to strictly adhere to an evidence-based guideline for blood transfusions, reducing the procedure by 40 percent. The savings is more than $500,000 to the hospital, insurers and patients, he said.

“In most hospitals, avoiding unnecessary transfusions reduces the length of stay, the risk of serious infection, the risk of death in the hospital and the risk of death in the next five years,” he said. “Other than that, getting transfused blood is a great thing.”

He ticked off other examples: antibiotics for the flu, X-rays for simple ankle sprains, hysterectomies for uterine problems that could be handled with cheaper treatments.

“We know that a minimally invasive approach to several common surgical procedures substantially reduces the risk of complications, hospital length of stay, lost time from work, and overall costs,” said Steele. “Why would we pay in Maine for those procedures to be done any other way?”

Steele said the insurers need to develop a payment system that rewards evidence-based practices. Pursue the elimination of marginal services. Stop fighting doctors who want higher-cost care when the evidence supports it, but put up a battle when they seek treatments with little value. Stop paying for marginal procedures that don’t work.

“Not paying for this kind of care will immediately change the game,” said Steele, noting providers will think twice about ordering negligible procedures. It also supports better medicine.

“It is empowering me as a physician to be able to say to a patient ‘The reason I am not going to prescribe an antibiotic for you for the flu is because it is the wrong thing to do and your insurance is not going to pay for it’,” said Steele. “That helps take me off the hook … and gives the patient an incentive to think about whether they still want that care because they will be faced with the bill.”

To succeed, this effort needs to be adopted and practiced by all the providers in the state, Steele said. Malpractice laws have to be changed so that doctors who follow evidence-based protocols are protected, rather than exposed, to increased legal risks.

“While malpractice costs are perhaps 1 to 2 percent of total costs, the fear of having evidence-based protocols used against them when they are not followed causes many providers to resist widespread use of these protocols,” he said.

And finally, patients need to have a financial stake in their care. Co-payments for marginal care should be high while co-pays for preventative care shouldn’t exist.

Steele suggested the Maine Health Management Coalition and Maine Quality Forum lead on these initiatives by defining evidence-based procedures and driving their implementation.

“They have the payers, big employers, provider groups, health systems and smaller hospitals and are the only real active stakeholder group driving active efforts to reduce costs,” said Steele. “Getting these major players together and having them embrace this role is the first step in this initiative.”


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