The wrong recipe: building higher cost with lesser care

Rethinking Pediatric Healthcare: A Call for Value-Based Transformation

In the ongoing debate over the future of healthcare, skeptics of value-based care hold fast to the belief that the economics of individual visits should reign supreme, with payment driving healthcare decisions over continuity or relationships. Consumerism, convenience, productivity, and random care are vaunted as solutions to "fix" our healthcare system. This perspective starkly overlooks the essence of pediatric care—the enduring bond between pediatricians, children, and their families, which forms the bedrock of trust and effective treatment. Critics of a relationship-driven model may not recognize that when financial incentives outweigh the continuity of care, not only does the quality of healthcare suffer but also the foundational fabric of patient-doctor relationships. Such a trend is troubling: as the focus narrows to maximizing immediate payments, both care and costs degrade, creating a lose-lose scenario for parents, children, and the healthcare system. The tangible repercussions of this philosophy manifest in pediatric emergency departments nationwide, showcasing the exorbitant costs of abandoning longitudinal care for fleeting financial gains. It's time to confront the fallacy that superior care is synonymous with higher payment and to champion a healthcare model that truly values the health and well-being of our children.

The High Cost of Lost Simplicity in Pediatric Care

The United States' pediatric healthcare landscape is defined by a baffling contradiction: care costs are skyrocketing, but the intrinsic value and quality of care for our youngest patients often stagnate. This disconnection is vividly apparent through real-world scenarios in pediatric emergency departments (EDs), increasingly the go-to for conditions once routinely managed in a pediatrician's office.

The Shifting Frontline of Pediatric Care

A week in the pediatric ED reveals the stark realities of healthcare economics. A child with a minor laceration—a condition once easily handled during regular office hours—now finds themselves in the ED. Overwhelmed practices, particularly those serving Medicaid patients, are unable to provide timely appointments, inadvertently redirecting non-emergent cases to the ED. Consequently, a potential $50 office visit escalates to a $500+ ED bill.

Echoes of Inefficiency

The inefficiency continues with a child suffering a urinary tract infection treated initially at a non-pediatric ED, only to be referred elsewhere for specialized care, resulting in duplicated ER visits and bills. Or consider the child with belly pain and fever, inadequately examined initially and subsequently diagnosed with strep throat in the ED—a condition that a simple throat check, once a staple of office visits, could have identified earlier.

Missed Opportunities for Care

The narrative repeats with a child with asthma, who could have been treated with a quick breathing treatment and medication refill in a primary care setting. Instead, they end up in the ED, where the cost of care is magnified. A similar story unfolds for a suicidal child, where a direct admission to a psychiatric unit is bypassed in favor of an ED visit, compounding costs and emotional strain without enhancing the quality of care.

The Lost Art of Pediatric Care

These incidents underline a disturbing trend: the art of pediatric care, once characterized by continuity and simplicity, is being eroded by a system incentivizing complexity and throughput over quality. As a result, children are not receiving better care; they're being funneled through more expensive routes without any added benefit.

A Call for Reassessment

This unsustainable care pattern demands a reassessment of how we value pediatric healthcare. The economics of care shouldn't compel children into the most costly care settings for routine issues. Instead, we must endeavor to restore the integrity of pediatric care, measuring value by the health and well-being of the child, not by the billing code. Currently, practices and pediatricians are regrettably not incentivized to consider the total cost of care. They are compensated for the services they provide, ignoring the escalating costs of care they defer in the name of efficiency and payment.

Envisioning a Better Path Forward

The path forward requires a return to a system where children receive the appropriate care, at the right time, in the correct setting, and by a well-trained and trusted clinician. The healthcare system must be restructured to support pediatricians and practices in delivering comprehensive care, rather than promoting unnecessary and costly ED visits, referrals to specialists, more prescriptions, and less chronic disease management.

Conclusion

The stark vignettes from pediatric emergency departments underscore a healthcare system grappling with misaligned incentives, where the cost often overshadows the care. These narratives serve as a clarion call for a paradigm shift—one that anchors itself in the value derived from tangible health outcomes and a meticulous consideration of the total cost of care. The current velocity-driven, fee-for-service model, which we might as well call 'fee for hurried care,' is failing our children. It prioritizes speed and volume over effectiveness and quality, resulting in a cycle of suboptimal treatment that costs more not just in dollars but in the well-being of our youngest patients.

It is incumbent upon us to forge a new path, one where value-based care supersedes the volume-based frenzy. This approach isn't solely about reducing costs—it's about investing wisely in healthcare that delivers better outcomes. By focusing on the quality of care and its long-term benefits rather than the immediacy of payment, we can begin to heal a system that has become too costly and too fragmented. Paying closer attention to the total cost of care means considering the entire healthcare journey of a patient, not just isolated incidents. When pediatricians are empowered to focus on preventive care, manage chronic conditions effectively, and provide comprehensive care coordination, we will see a reduction in unnecessary ER visits, hospitalizations, and redundant testing—all of which contribute to exorbitant healthcare spending without improving patient health.

To catalyze this transformation, payment models must evolve to reward the quality and outcomes of care, not just the quantity. Investments should be directed towards building robust primary care systems that are accessible and equipped to handle the comprehensive needs of children. This includes supporting mental health services, integrating care coordination, and embracing technological advancements that improve care delivery.

In conclusion, the future of pediatric healthcare hinges on our collective will to prioritize and incentivize value. This means championing a system that delivers comprehensive, high-quality care for children at a reasonable cost. By doing so, we can ensure a healthier next generation and a healthcare system that is sustainable for years to come. The journey to this ideal might be challenging, but the health of our children is an investment that cannot be deferred. Now is the time to shift gears from the perilous speed of fee-for-service to the deliberate and thoughtful path of value-based care, where every decision, every treatment, and every dollar spent moves us closer to the true goal of healthcare: better health for all.