A doctor's view of tort reform and accountable care organizations in healthcare

Charles J. Lockwood, MD, MHCM, dean of the College of Medicine and vice president for health sciences at Ohio State University, talks about comparative effectiveness research, cost control, and accountable care organizations with Medical Economics Editor-in-Chief Lois A. Bowers, MA.

A: Things like comparative effectiveness research are good in the sense that they'll support and encourage evidence-based medicine and best practices, but they really are a stop gap between what we have today and real-market solutions where healthcare systems are competing for better and better outcomes, higher and higher patient satisfaction, and lower and lower costs.

A: Tort reform and ensuring that there's a minimum of lost data in the system.

In the most conservative conceivable assessments sponsored by trial lawyers, tort reform reduced costs by about 4%. In the most liberal, optimistic views by physicians, some estimates have been that defensive medicine increases our costs by 30%. So probably 10% is the correct number, but 10% of $3.1 trillion is a lot of dollars. So we've got to have national tort reform, and it's got to be meaningful.

The second key would be to ensure that we have reduced waste in the system to an absolute minimum. That's going to require not only that we have greater than 80% utilization of electronic health records [EHRs] but that those EHRs communicate through health information exchanges, so that if someone gets care in one health system and they switch to get care in another one, emergently or not, their records, their lab reports, and so forth are all available to them. And so we've reduced the repetition of tests and so forth.

Those are very simple expedients that could be implemented pretty quickly.

The problem we have, of course, is that some of the best solutions to healthcare problems are Republican solutions, and some are Democratic solutions, but they should be bipartisan solutions. There are elements of both parties' health plans that would greatly improve this country, and it's a shame that a real, meaningful dialogue and meaningful compromise to allow us to have both have not occurred.

Q: What role do you see accountable care organizations playing in the healthcare system?

A: Not much. As currently construed, basically, you get to keep a little bit of the money you lose by achieving efficiencies. That's not a really good incentive for doctors.

A better incentive would come from vertical global fees or from capitation, where you get your money and now it's your job to figure out how to maximize patient outcomes and patient satisfaction and minimize cost. But to incentivize people by saying, "We're going to give you less money, and you get to keep some of the savings"-that's not a very attractive alternative.

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