Paint by Numbers.

Samuel J. Cohen, MD

Resident in Pediatrics at MGHfC

PGY-2

01/21/2020

Through the popular media, I had generally learned that hospital charges bore, at best, a passing resemblance to costs. I imagined Monets rather than Rembrandts (or some other more accurate painter; I’m not sure why I started down an art history metaphor, but I’m going to stick with it). This course helped me see that nearly 20% of US GDP is spent according to a Jackson Pollock.

Autumn Rhythm (Number 30) Jackson Pollock, 1950

I’m intrigued by bundled payments as the more “valuable” way to price healthcare for acute conditions and part of me feels like whether you call chronic or primary care payments bundles or risk-adjusted capitation may just be semantics. The dearth of clear outcome measures is striking, and while I worry at times that value is business-school speak for “wellness” – a term that mean whatever its user wants it to mean – I do agree that we need to do better at understanding what patients really want and find ways to hold ourselves accountable for that. However, the fact that we truly have no idea how much is costs to deliver an episode of care, be it a clinic visit or a major surgery felt revelatory. The cold Taylorism of TDABC makes me scared of becoming a cog in a giant health care machine, but the clarity it provides around efficiency, physician compensation with respect to both specialty and allied professionals, as well as resource and space allocation is powerful. However we end up deciding to pay for healthcare as a nation – be it single payer, private insurance, or something in between – we’d do well to plan our spending by what we decide things should cost. I think the first step should be understanding what they currently do.