IOM Report Urges ‘Overhaul’ of U.S. Health System

The new Institute of Medicine report released yesterday says that "America's health system is a tangled, highly fragmented web that often wastes resources by providing unnecessary services and duplicating efforts," and the time is ripe for a "major overhaul." The report, titled "Crossing the Quality Chasm: A New Health System for the 21st Century," presents a five-part agenda for revamping the nation's health care system to improve patient care and efficiency. William Richardson, chair of the committee that wrote the report and president of the W.K. Kellogg Foundation, said, "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients" (National Academies of Science release, 2/7).

The committee said that fault does not rest on managed care, and instead attributed troubles to the general structure of the country's health system. "There's no reason to think that the quality problem we're discussing is attributable to managed care. This is an across-the-board problem," Health Technology Center President and committee member Molly Joel Coye said (Okie, Washington Post, 3/2). At a press conference yesterday, Richardson outlined the report's recommendations, which called for a "strong commitment" to improve the current system from providers, insurers, regulators, lawmakers and the public. The first task, Richardson said, is to ensure that care is safe, effective, "patient-centered," timely, efficient and equitable. To accomplish these goals, the IOM proposed 10 rules aimed to ensure that care "guide patient-clinician relationships." These rules stipulate that care should be "customized" based on patient "needs and values," that patients should retain control over their own care, that care should be safe and that patients should be given information pertaining to care they receive. The health system should "not waste resources or patient time," and should "anticipate patient needs rather than simply reacting to events," the report states. The study also calls for clinical decisions to be based on the "best scientific evidence" available and urged increased communication and coordination between clinicians (Richardson speech text, 3/1).

The IOM study calls for a greater focus on chronic conditions such as heart disease, diabetes and asthma -- the leading causes of illness in America. To help improve care for individuals with these conditions, the committee recommended that the Agency for Healthcare Research and Quality develop a list of 15 or more diseases. Health care professionals, hospitals and health plans should then work together to draft strategies and action plans to improve care for each of these conditions over a five-year period.

The study also said that physicians should make greater use of technological advancements in medicine. Doctors could save time, money and patient lives, the report states, by using email and electronic prescriptions. Also, physicians who successfully incorporate these advances and who provide good patient care should be reimbursed adequately through payment systems that "reward quality," the report adds.

The government also has a role to play in improving the country's health care system, the report says. HHS should monitor and track improvements in patient care, and should present its findings to Congress and the president each year. To help fund all of these proposed initiatives, the report suggests that Congress create a $1 billion "innovation fund" to be used over the next three to five years (NAS release, 3/1). While an overhaul of the current system will require "significant resources," the public and private sectors must both contribute to accomplishing this task, Richardson said. He concluded, "American health care is beset by serious problems, but they are not intractable. Perfect care may be a long way off, but much better care is within our grasp" (Richardson speech text, 3/1). To listen to yesterday's press conference, go to http://www4.nas.edu/onpi/webextra.nsf/web/chasm?OpenDocument. Please note: You must have RealPlayer to listen to this broadcast.